Abstract
The transanal natural orifice translumenal endoscopic surgery (NOTES) approach for rectal cancer is one of the few NOTES applications that has successfully transitioned from experimental model to clinical practice. Transanal NOTES total mesorectal excision (taTME) facilitates the completion of minimally invasive, sphincter-preserving, total mesorectal excision (TME) in patients with distal rectal tumors who would otherwise require abdominoperineal resection (APR) or conversion from laparoscopic to open TME. This chapter reviews the evolution of transanal NOTES applied to colorectal surgery, as well as the most recent published outcomes of taTME to date, for both benign and malignant indications. A detailed description of laparoscopic-assisted taTME for a low rectal tumor is provided, with description of instrumentation, team, and operative setup and related technical pearls. The chapter emphasizes appropriate patient and tumor selection, a stepwise approach during transanal dissection, troubleshooting, and the recommended training pathway for taTME, all of which are critical to achieve an adequate oncologic resection and favorable perioperative outcomes in patients with rectal cancer.
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