Transanal Laparoscopic TME with Robot-Assisted Abdominal Laparoscopy



Transanal total mesorectal excision (taTME) exists as an excellent new technique for sphincter-preserving surgery in the distal rectum. Convergence of this with a minimally invasive approach from above, albeit laparoscopically or robotically, allows for an extension of sphincter preservation and represents the ultimate application of a minimally invasive approach. In this chapter, we will describe a taTME approach using laparoscopy from below. The abdominal portion of the procedure including release of splenic flexure, high ligation of the inferior mesenteric artery and inferior mesenteric vein (IMV), mobilization of the colon, and completion of the TME dissection from above will be described using a robotic technique. Anatomic and technical approaches will be highlighted demonstrating the evolving field of rectal cancer surgery.


Rectal cancer Transanal abdominal transanal proctosigmoidectomy TATA taTME Robotic surgery Sphincter-preserving surgery 


  1. 1.
    Marks G, Mohiuddin M, Goldstein SD. Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int J Radiat Oncol Biol Phys. 1988;15:1065–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Marks G, Bannon J, Marks J. Transanal-abdominal transanal radical proctosigmoidectomy with coloanal anastomosis for distal rectal cancer. In: Baker R, Fisher J, Nyhus L, editors. Mastery of surgery. 3rd ed. Boston, MA: Little, Brown and Company Inc.; 1996. p. 1524–34.Google Scholar
  3. 3.
    Marks JH, Frenkel JL, D’Andrea AP, Greenleaf CE. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am. 2011;20(3):501–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Nicholson G, Knol J, Houben B, et al. Optimal dissection for transanal total mesorectal excision using modified CO2 insufflation and smoke extraction. Colorectal Dis. 2015;17(11):265–7.CrossRefGoogle Scholar
  5. 5.
    Marks JH, Lopez-Acevedo N, Krishnan B, Johnson MN, Montenegro GA, Marks G. True NOTES TME resection with splenic flexure release, high ligation of IMA, and side-to-end hand-sewn coloanal anastomosis. Surg Endosc. 2016;30(10):4626–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Marks JH, Myers EA, Zeger EL, Denittis AS, Gummadi M, Marks GJ. Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer. Surg Endosc. 2017;
  7. 7.
    Marks JH, Salem JF, Valsdottir EB, Yarandi SS, Marks GJ. Quality of life and functional outcome after transanal abdominal transanal proctectomy for low rectal cancer. Dis Colon Rectum. 2017;60(3):258–65.Google Scholar

Copyright information

© Springer Japan 2018

Authors and Affiliations

  1. 1.Division of Colorectal SurgeryLankenau Medical CenterWynnewoodUSA
  2. 2.Department of Colorectal Surgery, Lankenau Medical CenterMain Line HealthcareWynnewoodUSA

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