Critical Anatomical Landmarks in Transanal Total Mesorectal Excision (taTME)

Abstract

The introduction of transanal endoscopic techniques to the surgical management of rectal neoplasia has led to an improvement in surgical technique but also the development of different potential complications. The cornerstone to all surgical dissection is a clear understanding of and identification of anatomical landmarks, as well as the correct and incorrect anatomical planes. The anatomy of the extraperitoneal rectum is familiar to most practicing colorectal surgeons; however this familiarity is predominantly from an abdominal approach, entering the pelvis from above. The anatomy when viewed from below (transanally) is the same; however the view is quite different and thus necessitates a relearning of the anatomy as it is seen from this direction. This chapter will focus on the applied surgical anatomy required for surgeon mastery of transanal total mesorectal excision (taTME). It will not detail all anatomic structures of the anorectum, pelvis, and pelvic floor as this is assumed knowledge.