Laparoscopic TaTME for Low Rectal Cancer (Video)

Transanal total mesorectal excision (TaTME) is a promising new surgical approach for patients with low rectal cancer tumors. It makes the hardest part of TME, in the narrow pelvis, easier to dissect.

In this four-minute video, watch Conor Delaney, MD, PhD; Stephen S. Brandstetter, MD; and Sherief Shawki, MD, of Cleveland Clinic’s Digestive Disease and Surgery Institute perform sequential laparoscopic TaTME on a 49-year-old man with a 3 cm rectal mass. Learn recommendations for preventing injuries during the procedure, particularly to the prostate and seminal vesicles in males and the vagina in females.

From top down to bottom up

Historically, surgeons have taken a ‘top down’ strategy to removing rectal cancer — entering the abdomen first and then dissecting and working their way downward toward the pelvis. This technique, however, carries some inherent challenges, including ones so great that surgeons sometimes must stop before the surgery is complete.

TaTME of rectal cancer is an approach where surgeons start from the bottom — through the anus — and dissect up through the pelvis. According to colorectal surgeon Dana Sands, MD, who has among the highest single surgeon volumes of TaTME in the world, surgeons can better visualize and remove lower rectum tumors with this natural-orifice technique while maintaining the benefits of a standard laparoscopic procedure.

Cleveland Clinic is a leading center for TaTME in the United States whose surgeons have proctored other surgeons from around the world in the technique. In addition to rectal cancer, Cleveland Clinic is treating people with chronic pelvic infections, colostomies that need to be closed and others with a history of failed pelvic reconstruction with this surgical approach.

In addition to the greater ease associated with a ‘bottom up’ or transanal approach, smaller incisions and shorter length of stay for patients are potential advantages compared to traditional abdominal approaches to pelvic surgery.