title: Technologies, technical steps, and early postoperative results of transanal TME.
abstract: BACKGROUND
  First described in 1982, TME overcomes most of the concerns regarding adequate local control after anterior rectal resection. TME requires close sharp dissection along the so-called Heald's plane down to the levators, with distal dissection often cumbersome. In recent years, Transanal TME was introduced with the aim to improve distal rectal dissection and quality of mesorectal excision.
  
  
  METHODS
  A prospective, non-randomized study, started in 2013, is currently ongoing in two Italian Centers. Study objectives were assessing the safety of TaTME and TME quality. TaTME technique and technologies as performed in these centers and cumulative results at ≤30 postoperative days of the first 102 patients are reported.
  
  
  RESULTS
  Early postoperative morbidity and mortality rates were 33.3% (34 pts, 16 Clavien-Dindo I + II and 18 Clavien-Dindo III + IV + V), and 1.96% (two deaths), respectively. The quality of mesorectal excision according to Quirke was: complete in 97.1% and nearly complete in 2.9% of the cases.
  
  
  CONCLUSIONS
  The results confirm the effectiveness of TaTME, especially regarding the quality of the mesorectal dissection. Open questions regarding standardization, anatomical landmarks, indications, morbidity (with special regard to local infection and sepsis), learning curve and oncological outcomes require further answers from larger studies and RCTs before definitive validation of this procedure.  .
authors.affiliation: a Department of Surgery , Rummo Hospital , Benevento , Italy ;
authors.forename: Cristiano G S
authors.initials: CG
authors.lastname: Hüscher
authors.affiliation: b Department of Surgery San Giovanni Hospital , Rome , Italy.
authors.forename: Simone Maria
authors.initials: SM
authors.lastname: Tierno
authors.affiliation: b Department of Surgery San Giovanni Hospital , Rome , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Romeo
authors.affiliation: b Department of Surgery San Giovanni Hospital , Rome , Italy.
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Lirici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome
keywords: Rectal cancer; access platforms for TaTME; dissection technology; total mesorectal excision; transanal minimally invasive surgery; transanal total mesorectal excision