title: Transanal total mesorectal excision: technical aspects of approaching the mesorectal plane from below.
abstract: Standardization of transanal total mesorectal excision requires the delineation of the principal procedural components before implementation in practice. This technique is a bottom-up approach to a proctectomy with the goal of a complete mesorectal excision for optimal outcomes of oncologic treatment. A detailed stepwise description of the approach with technical pearls is provided to optimize one's understanding of this technique and contribute to reducing the inherent risk of beginning a new procedure. Surgeons should be trained according to standardized pathways including online preparation, observational or hands-on courses as well as the potential for proctorship of early cases experiences. Furthermore, technological pearls with access to the "video-in-photo" (VIP) function, allow surgeons to link some of the images in this article to operative demonstrations of certain aspects of this technique.
authors.affiliation: a Department of Abdominal Surgery , Jessa Hospital , Hasselt , Belgium ;
authors.forename: Joep
authors.initials: J
authors.lastname: Knol
authors.affiliation: b Division of General Surgery , University Health Network , Toronto , Ontario , Canada.
authors.forename: Sami A
authors.initials: SA
authors.lastname: Chadi
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009873:Operating Rooms / Q000458:organization & administration; D010348:Patient Care Team; D012004:Rectal Neoplasms / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*
keywords: TaTME; mesorectum; rectal cancer