Transanal TAMIS total mesorectal excision (TME)—a work in progress

Excerpt

Since Heald’s [1] landmark publication in The Lancet in 1982, total mesorectal excision (TME) has become the only globally acceptable surgical method for curative rectal extirpation for rectal adenocarcinoma. The advent of TME and the worldwide adoption of this technique has accounted for perhaps the largest and most important advance in our quest to improve cancer care within the specialty of colorectal surgery. During the last 50 years, there have been two other advances; firstly, Norman Nigro [2] discovered that chemoradiotherapy could replace rather than be used prior to abdominoperineal resection for anal carcinoma. More recently, Angelita Habr-Gama [3] demonstrated that this Nigro-type protocol may be applicable in selected patients with rectal carcinoma. However, given the prevalence of rectal carcinoma as compared to anal carcinoma, the advance championed by Bill Heald has clearly had the single largest impact in the oncologic aspect of our specialty. While it has been repeatedly shown that local recurrence rates have plummeted from unacceptably high double-digit to low single-digit rates even without neoadjuvant therapy [4], it has also been shown that the laparoscopic and minimally invasive management of rectal carcinoma seems at least equivalent to and perhaps in many aspects, better than TME by standard laparotomy [5, 6]. While the subjective improvement such as superior visualization and therefore magnification are harder to quantify, the objective ones such as improved lymph node yield, shorter hospital stay, reduced pain, and expedited resolution of ileus have all been repeatedly proven. …