TRANS ANAL TME (TaTME) await more data and till then continue Robotic assisted Surgery
Ta TME approach was supposed to be the next miracle surgery for rectal cancers. But we always felt that it has very very selective indications and needs proper training. We did 12 cases for post RT and post Surgery recurrences and structure post surgery. And then we went for hands on training on cadaver in Norderstedt, Hamburg, Germany with experts like Dr. Manish Chand and others in November,2018, exactly the same month 4 years ago with minus 0 temperature.. He is a dynamic Surgeon from the UK. And had useful interaction.
Levator Ani is the layer which basically determines our level of transection. Our goal is to do the dissection till this layer and we choose our approach to achieve it with tumor free margins. Whichever technique the Surgeon is trained can be done – Open, Laparoscopy or Robotic or TaTME. The patient’s pelvis is also another determining factor along with BMI.
We always felt that Robotic approach can reach the levator Ani level or Intersphincteric area easily no matter what BMI or pelvis. Intersphincteric dissection is a good technical exercise, but has a lot of post op problems and has more recurrences. With 3 arms and 45 mm Sureform Robotic Staplers we can achieve good TME and tumor margin free resection. Even with Ta TME the sphincters and Levator decide the level of transection along with distal tumor edge.
What can be achieved with Ta TME can be achieved with Robotic assistance,ICG, Sureform staplers.
And above all the Norwegian trial has shown detrimental results with Ta TMEA. But yes we wait for the new data and until then we need to continue the Robotic approach for rectal cancers.