The learning curve in TaTME—considerations to guide safe implementation

Deborah S. Keller, Roel Hompes


For a colorectal surgeon, the immediate goal in rectal cancer surgery is to extract a perfect total mesorectal excision (TME) specimen with clear oncologic margins. Since the introduction of the TME concept by Heald in 1982, data from both historic and modern randomized controlled trials (RCT) comparing surgical approaches for rectal cancer have demonstrated that this can be challenging (1-5). The subjective perception of a technically challenging and often unsatisfactory pelvic dissection, paired with the ongoing controversy regarding the optimal surgical approach, fuel the need for further innovation.