ThereisclearconsensusthattaTMEshouldbeperformedby experienced,skilled,andwell-trainedsurgeonswhocanoutgrowthe learningcurveinthemostefficientway.Arecentconsensusofanexpert groupofsurgeonsfromaninternationaltaTMEconferencestatesthat trainingisnecessarybeforesurgeonsundertakethisprocedure. Furthermore,itstronglyrecommendsthatsurgeonsundertakeataTME trainingcoursethatincludesdidacticlectures,mentoredcadaveric dissection,livesurgery,anduneditedvideobeforeclinicalapplication. Ideally,thisapproachshouldbeundertakenbyhigh-volumerectalcancer surgeonswithexpertisenotonlyinlaparoscopicorroboticTMEbutalso intransanalendoscopicmicrosurgery(TEM;RichardWolf,Knittlingen, Germany),TEO,orTAMIS,andfamiliarwithISRtechniquesforverylow rectaltumors.InstitutionscontemplatinginitiatingthetaTMEprogram shoulddemonstratemultidisciplinaryexpertiseinthemanagementof rectalcancerwithtumorboardreviewofallrectalcancers.Evenfor surgeonswithallprerequisiteskillsfortaTME,in-depthprocedural trainingismandatorybeforeclinicalpractice.Inaddition,proctorshipfor thefirstfewclinicalcasesisstronglyrecommended,giventhelackof familiaritywithanatomicallycorrectperinealdissectionplanesfroma perinealendoscopicapproach.Theserecommendationsstemfromthe factthattaTMEprocedurescalluponmasteryofseveralessential technicalcompetencies,namely,laparoscopicsuturingthroughasingle­incisionplatform,transanalendoscopicdissection,and,most importantly,familiaritywiththeperinealanatomyandin-depth understandingoftherelationshipbetweentherectum,analsphincters, prostate,andurethra.