Download PDF
Clin Colon Rectal Surg 2022; 35(02): 099-105
DOI: 10.1055/s-0041-1742109
Review Article

Transanal Endoscopic Surgery: Who Should Be Doing This Procedure?

François Rouleau Fournier
1   Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Carl James Brown
1   Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Transanal endoscopic surgery (TES) was introduced in the 1980s, but more widely adopted in the late 2000s with innovations in instrumentation and training. Moreover, the global adoption of minimally invasive approaches to abdominal procedures has led to translatable skills for TES among colorectal and general surgeons. While there are similarities to laparoscopic surgery, TES has unique challenges related to the narrow confines of intraluminal surgery, angled instrumentation, and relatively uncommon indications limiting the opportunity to practice. The following review discusses the current evidence on TES learning curves, including potential limitations related to the broad adoption of TES by general surgeons. This article aims to provide general recommendations for the safe expansion of TES.

Keywords

transanal endoscopic surgery - TES - TEM - TAMIS


Publication History

Article published online:
28 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nelson H, Sargent DJ, Wieand HS. et al; Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350 (20) 2050-2059
    CrossrefPubMedSearch in Google Scholar
  • 2 Jayne DG, Guillou PJ, Thorpe H. et al; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25 (21) 3061-3068
    CrossrefPubMedSearch in Google Scholar
  • 3 Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G. Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 2002; 287 (03) 321-328
    CrossrefPubMedSearch in Google Scholar
  • 4 Hazebroek EJ. Color Study Group. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 2002; 16 (06) 949-953
    CrossrefPubMedSearch in Google Scholar
  • 5 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (05) 1205-1210
    CrossrefPubMedSearch in Google Scholar
  • 6 Wasmuth HH, Faerden AE, Myklebust TÅ. et al; Norwegian TaTME Collaborative Group, on behalf of the Norwegian Colorectal Cancer Group. Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 2020; 107 (01) 121-130
    CrossrefPubMedSearch in Google Scholar
  • 7 Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J 2007; 83 (986) 777-779
    CrossrefPubMedSearch in Google Scholar
  • 8 Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT. Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care 2000; 16 (04) 1095-1108
    CrossrefPubMedSearch in Google Scholar
  • 9 Koebrugge B, Bosscha K, Ernst MF. Transanal endoscopic microsurgery for local excision of rectal lesions: is there a learning curve?. Dig Surg 2009; 26 (05) 372-377
    CrossrefPubMedSearch in Google Scholar
  • 10 Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT. Statistical assessment of the learning curves of health technologies. Health Technol Assess 2001; 5 (12) 1-79
    CrossrefPubMedSearch in Google Scholar
  • 11 Barendse RM, Dijkgraaf MG, Rolf UR. et al. Colorectal surgeons' learning curve of transanal endoscopic microsurgery. Surg Endosc 2013; 27 (10) 3591-3602
    CrossrefPubMedSearch in Google Scholar
  • 12 Maya A, Vorenberg A, Oviedo M, da Silva G, Wexner SD, Sands D. Learning curve for transanal endoscopic microsurgery: a single-center experience. Surg Endosc 2014; 28 (05) 1407-1412
    CrossrefPubMedSearch in Google Scholar
  • 13 Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H. A system for a transanal endoscopic rectum operation [in German]. Chirurg 1984; 55 (10) 677-680
    PubMedSearch in Google Scholar
  • 14 Helewa RM, Rajaee AN, Raiche I. et al. The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance. Colorectal Dis 2016; 18 (11) 1057-1062
    CrossrefPubMedSearch in Google Scholar
  • 15 Hur H, Bae SU, Han YD. et al. Transanal endoscopic operation for rectal tumor: short-term outcomes and learning curve analysis. Surg Laparosc Endosc Percutan Tech 2016; 26 (03) 236-243
    CrossrefPubMedSearch in Google Scholar
  • 16 Chen N, Peng Y-F, Yao Y-F, Gu J. Trans-anal minimally invasive surgery for rectal neoplasia: experience from single tertiary institution in China. World J Gastrointest Oncol 2018; 10 (06) 137-144
    CrossrefPubMedSearch in Google Scholar
  • 17 Lee L, Kelly J, Nassif GJ. et al. Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 2018; 32 (03) 1368-1376
    CrossrefPubMedSearch in Google Scholar
  • 18 Clermonts SHEM, van Loon YT, Stijns J, Pottel H, Wasowicz DK, Zimmerman DDE. The effect of proctoring on the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Tech Coloproctol 2018; 22 (12) 965-975
    CrossrefPubMedSearch in Google Scholar
  • 19 Martin JA, Regehr G, Reznick R. et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84 (02) 273-278
    PubMedSearch in Google Scholar
  • 20 Vassiliou MC, Feldman LS, Andrew CG. et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 2005; 190 (01) 107-113
    CrossrefPubMedSearch in Google Scholar
  • 21 Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001; 44 (02) 217-222
    CrossrefPubMedSearch in Google Scholar
  • 22 Chen W, Sailhamer E, Berger DL, Rattner DW. Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery. Surg Endosc 2007; 21 (02) 238-243
    CrossrefPubMedSearch in Google Scholar
  • 23 Slack T, Wong S, Muhlmann M. Transanal minimally invasive surgery: an initial experience. ANZ J Surg 2014; 84 (03) 177-180
    CrossrefPubMedSearch in Google Scholar
  • 24 Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998; 280 (20) 1747-1751
    CrossrefPubMedSearch in Google Scholar
  • 25 Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJO, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer 2006; 106 (11) 2476-2481
    CrossrefPubMedSearch in Google Scholar
  • 26 Killeen SD, O'Sullivan MJ, Coffey JC, Kirwan WO, Redmond HP. Provider volume and outcomes for oncological procedures. Br J Surg 2005; 92 (04) 389-402
    CrossrefPubMedSearch in Google Scholar
  • 27 Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 2011; 364 (22) 2128-2137
    CrossrefPubMedSearch in Google Scholar
  • 28 Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 2012; (03) CD005391
    PubMedSearch in Google Scholar
  • 29 Huo YR, Phan K, Morris DL, Liauw W. Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery. J Gastrointest Oncol 2017; 8 (03) 534-546
    CrossrefPubMedSearch in Google Scholar
  • 30 Dietz DW. Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRiCh). Multidisciplinary management of rectal cancer: the OSTRICH. J Gastrointest Surg 2013; 17 (10) 1863-1868
    CrossrefPubMedSearch in Google Scholar
  • 31 Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. Royal Marsden Hospital, Colorectal Cancer Network. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?. Br J Cancer 2006; 94 (03) 351-357
    CrossrefPubMedSearch in Google Scholar
  • 32 Tambe B, Wang CV, Noren E, Duldulao MP, Barzi A, Lee SW. Tertiary care multidisciplinary teams associated with improved survival in rectal cancer patients: a comparative study. Am Surg 2018; 84 (10) 1645-1649
    CrossrefPubMedSearch in Google Scholar
  • 33 Berho M, Narang R, Van Koughnett JAM, Wexner SD. Modern multidisciplinary perioperative management of rectal cancer. JAMA Surg 2015; 150 (03) 260-266
    CrossrefPubMedSearch in Google Scholar
  • 34 Pan-Canadian standards for rectal cancer surgery - CPAC. Canadian Partnership Against Cancer. Accessed July 8, 2020 at: https://www.partnershipagainstcancer.ca/topics/rectal-cancer-surgical-standards/
    PubMed