Urethral injury in body donor TaTME training

Abstract

Urethral injury is one of the major risks in transanal total mesorectal excision (TaTME). To provide surgeons with experience in and management of potential critical surgical scenarios, urethral and prostate injuries were intentionally created during a body donor workshop under standardized training conditions. We conducted a 2-day structured TaTME body donor training workshop. The theoretical module included lectures on topographic anatomy, clinical evidence, and surgical technique and pitfalls. Practical modules started with an interactive demonstration of crucial landmarks for the transanal approach using predissected formalin-fixed specimens. Next, surgical teams underwent proctored surgical training that implemented the key steps of TaTME on simulators and four male body donors. Strategies to avoid urethral damage involved intentional dissection and injury of the urethra and prostate, with subsequent demonstration of these lesions. After emphasizing the critical anatomical landmarks, the proctored surgical teams performed TaTME successfully without any urethral lesions. To demonstrate worst-case scenarios, two major pitfalls associated with TaTME, i.e., urethral injury and mobilization of the prostate, were simulated. These deliberate injuries proved to be critical learning experiences for all participants. Appraisal of crucial anatomical landmarks and deliberate implementation of urethral/prostatic injury scenarios in preclinical TaTME training workshops is an effective way to teach surgeons how to avoid those injuries in patients. Structured and supervised training should be offered to all surgeons prior to implementing TaTME procedures in order to acquire skills necessary to address the delicate structures at risk during transanal approach.