title: Developing and assessing a cadaveric training model for transanal total mesorectal excision: initial experience in the UK and USA.
abstract: OBJECTIVE
  Transanal total mesorectal excision (taTME) has become one of the most promising technical advancements in the surgical treatment of rectal cancer, with rising numbers of surgeons seeking training. We describe our experience with human cadaveric courses for taTME delivered in two countries.
  
  
  METHODS
  Four fresh human cadaveric workshops conducted in Oxford, UK, in 2015 and two in Chicago, USA, in 2013-2014, trained a total of 52 surgeons. Parameters of operative performance for each delegate were recorded. Previous surgical experience and uptake of taTME in the surgeons' clinical setting were surveyed.
  
  
  RESULTS
  Forty-seven taTME cases were performed on cadaveric models. Participating surgeons had previous experience in laparoscopic TME surgery and transanal approaches but limited taTME exposure. The purse-string remained occluded throughout in 93% of UK and 60% of US cases. Operative timings for key procedural steps were similar between the two countries with a mean time from start of circumferential dissection to peritoneal entry of 79.5 min (range 25-155). 96% of surgeons dissected transanally to a level S2 or above. The TME specimen quality was complete or near complete in 81%, with improvements noted between the first and second procedure performed. 81% of surgeons surveyed are currently performing taTME in their local hospitals.
  
  
  CONCLUSIONS
  Fresh-frozen cadavers provide excellent teaching models for complex pelvic surgery. A structured training curriculum including reading material, dry-lab purse-string practice and postcourse mentorship will provide surgeons with a more complete training package and ongoing support, to ultimately ensure the safe introduction of taTME in the clinical setting.
authors.affiliation: Oxford University Hospital NHS Foundation Trust, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Penna
authors.affiliation: The Oregon Clinic, Providence Cancer Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: M
authors.initials: M
authors.lastname: Whiteford
authors.affiliation: Oxford University Hospital NHS Foundation Trust, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
authors.affiliation: Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Sylla
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D002102:Cadaver; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010388:Pelvis / Q000601:surgery; D010537:Peritoneum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013663:Teaching; D000067368:Transanal Endoscopic Surgery / Q000193:education* / Q000379:methods; D006113:United Kingdom; D014481:United States
keywords: Transanal TME; cadaver; mentorship; training; workshops