This book captures the cornerstone developments in a new body of knowledge. Like fabric, it encompasses content woven together by leading TAMIS and taTME authorities from across the globe, thereby assuring a collective representation. It is through this circle of pioneers, who reside in the four corners– Asia, Europe, Australia, and the Americas– that this book is able to deliver enriching perspectives.

Soon, we will embark upon a new journey, with 2030 visible on the horizon. What new challenges and discoveries lie ahead? With nite and precious time on Earth, fulllment comes from knowing our collective contributions will remain indenitely– and may provide the foundation for what transpires next. I consider myself truly fortunate to be part of a group shaping the future of surgery. To be able to ride atop this epic wave of innovation has been the stuff of dreams.

Orlando, FL, USA SamAtallah

Part I Transanal Minimally Invasive Surgery (TAMIS)

1 Historical Perspectives and Rationale for Development . . . . . . . 3

Sergio W. Larach and Beatriz Martín-Pérez

2 TAMIS: Indications and Contraindications . . . . . . . . . . . . . . . . . 11

Uma R. Phatak and Justin A. Maykel

3 An Algorithm for Local Excision for

Early-Stage Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

George J. Chang and T. Paul Nickerson

4 Complete Clinical Response in Rectal Cancer

After Neoadjuvant Therapy: Organ Preservation

Strategies and the Role of Surgery . . . . . . . . . . . . . . . . . . . . . . . . 31

Laura Melina Fernandez, Guilherme Pagin São Julião, Bruna Borba Vailati, Angelita Habr-Gama, and Rodrigo O. Perez

5 Salvage Surgery After TAMIS Excision of

Early-Stage Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Sook C. Hoang and Charles M. Friel

6 Organ Preservation and Palliative

Options for Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Nienke den Dekker, Stefan Erik Van Oostendorp, and Jurriaan Benjamin Tuynman

7 Operative Equipment and Insufflator Options . . . . . . . . . . . . . . 57

William Frederick Anthony Miles, Muhammad Shaque Sajid, and Eleni Andriopoulou

8 Operating Theater Setup and

Perioperative Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Teresa H. deBeche-Adams, Raymond Yap, and George Nassif

9 Surgical Technique for Local Excision of

Rectal Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Matthew R. Albert and Paul Kaminsky

10 Pyramidal Excision for Early Rectal Cancer and

Special Closure Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Giovanni Lezoche, Mario Guerrieri, and Emanuele Lezoche

xvi

11 Closure Versus Non-closure After Local Excision . . . . . . . . . . . . 113

Dieter Hahnloser

12 Operative and Perioperative Outcomes . . . . . . . . . . . . . . . . . . . . 117

Elena A. T. Vikis, Anne-Marie Dufresne, and George Melich

13 Functional Outcomes After Local Excision

for Rectal Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Elizabeth R. Raskin

14 Oncologic Outcomes for Local Excision of

Rectal Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Lawrence Lee, Nathalie Wong-Chong, and John Monson

15 Applications Beyond Local Excision . . . . . . . . . . . . . . . . . . . . . . . 143

Deborah S. Keller

16 The Evolution of Robotic TAMIS . . . . . . . . . . . . . . . . . . . . . . . . . 153

Sam Atallah, Nicolas C. Buchs, and Seon-Hahn Kim

17 Transanal Robotic Surgery and Future Directions . . . . . . . . . . . 165

Kevin M. Izquierdo, Thushy Siva, Jean Salem, Brigitte Anderson, and John Marks

18 TAMIS: Current Controversies and Challenges . . . . . . . . . . . . . 175

Heather Carmichael and Patricia Sylla

Contents

Part II Transanal Total Mesorectal Excision (taTME)

19 Indications for Malignant Neoplasia of the Rectum . . . . . . . . . . 187

Reagan L. Robertson and Carl J. Brown

20 Indications for Benign Disease of the Rectum . . . . . . . . . . . . . . . 197

Willem A. Bemelman

21 Operating Theater Setup and Two- Team Coordination . . . . . . . 217

Aimee E. Gough, Phillip R. Fleshner, and Karen N. Zaghiyan

22 Single-Team taTME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Antonio Caycedo-Marulanda, Shady Ashamalla, and Grace Wai Ma

23 Transanal Access Platform Options and

Instrument Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Giovanni Dapri

24 Intraoperative Decision-Making:

Converting to taTME, When and for Whom? . . . . . . . . . . . . . . . 255

Isacco Montroni and Antonino Spinelli

25 Key Aspects of the Abdominal Dissection . . . . . . . . . . . . . . . . . . . 263

Masaaki Ito

26 Zen and the Art of the Purse-String . . . . . . . . . . . . . . . . . . . . . . . 271

Andrew R. L. Stevenson

Contents

xvii

27 An Overview of Operative Steps and

Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

F. Borja de Lacy, María Clara Arroyave, and Antonio M. Lacy

28 Strategies for Ultralow-Lying Rectal Cancer . . . . . . . . . . . . . . . . 285

Sam Atallah and Eric Rullier

29 Critical Anatomical Landmarks in

Transanal Total Mesorectal Excision (taTME) . . . . . . . . . . . . . . 299

Stephen W. Bell

30 Urethral Injury: The New Challenge for taTME . . . . . . . . . . . . . 311

Heather Carmichael and Patricia Sylla

31 How to Avoid Urethral Injury in Males . . . . . . . . . . . . . . . . . . . . 321

Sam Atallah and Itzel Vela

32 A Roadmap to the Pelvic Autonomic Nerves

During Transanal Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Werner Kneist

33 Operative Vectors, Anatomic Distortion,

and the Inherent Effects of Insufflation . . . . . . . . . . . . . . . . . . . . 343

Sam Atallah, Albert M. Wolthuis, and André D’Hoore

34 Total Hindgut Mesenteric Mobilization for taTME . . . . . . . . . . 357

J. Calvin Coffey and Rishabh Sehgal

35 The Role for Perfusion Angiography . . . . . . . . . . . . . . . . . . . . . . . 373

António S. Soares and Manish Chand

36 Perioperative Preparation and Postoperative

Care Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

Anuradha R. Bhama, Alison R. Althans, and Scott R. Steele

37 Intraoperative Morbidity of taTME . . . . . . . . . . . . . . . . . . . . . . . 391

T. W. A. Koedam, Jurriaan Benjamin Tuynman, Sam Atallah, and C. Sietses

38 Functional Outcomes to Transanal Minimally

Invasive Surgery (TAMIS) and Transanal

Total Mesorectal Excision (taTME) . . . . . . . . . . . . . . . . . . . . . . . 399

Elisabeth C. McLemore and Patricia Sylla

39 Oncologic Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405

Sharaf Karim Perdawood

40 TaTME for Radical Exenteration . . . . . . . . . . . . . . . . . . . . . . . . . 411

Sami A. Chadi and Dana Sands

41 TaTME for Abdominoperineal Excision . . . . . . . . . . . . . . . . . . . . 419

Suguru Hasegawa, Tomoaki Okada, Daibo Kojima, Akira Komono, Ryohei Sakamoto, Naoya Aisu, Yoichiro Yoshida, and Yoshiharu Sakai

xviii

42 Hartmann’s Reversal by a Combined

Transanal-Transabdominal Approach . . . . . . . . . . . . . . . . . . . . . 429

Jean-Sébastien Trépanier, F. Borja de Lacy, and Antonio M. Lacy

43 Pure NOTES Transanal TME . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

Joel Leroy, Frédéric Bretagnol, Nguyen Ngoc Dan, Hoa Nguyen Hoang, Truc Vu Trung, and Chuc Phan Ngoc

44 Totally Robotic taTME: Experiences and

Challenges to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

Marcos Gómez Ruiz

45 Next-Generation Robots for taTME . . . . . . . . . . . . . . . . . . . . . . . 465

Jessie Osborne Paull, Abdullah I. Alalwan, and Vincent Obias

46 Video-Based Training Apps and Deferred

Live Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475

Joep Knol

47 Navigation for Transanal Total Mesorectal Excision . . . . . . . . . . 485

Luis Gustavo Capochin Romagnolo, Arthur Randolph Wijsmuller, and Armando Geraldo Franchini Melani

48 Current Controversies and Challenges in

Transanal Total Mesorectal Excision (taTME) . . . . . . . . . . . . . . 493

Shlomo Yellinek and Steven D. Wexner

Contents

49 Transanal Total Mesorectal Excision:

The Next 10 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499

Ronan A. Cahill

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509

Contributors

Naoya Aisu, MD, PhD Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan

AbdullahI.Alalwan, MD The University of Toledo, Department of General Surgery, Toledo, OH, USA

MatthewR.Albert, MD Center for Colon and Rectal Surgery, Department of Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA

Alison R. Althans, BA Case Western Reserve University School of Medicine, Cleveland, OH, USA

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

Brigitte Anderson Colon and Rectal Surgery, Lankenau Medical Center, Marks Colorectal Surgical Associates, Wynnewood, PA, USA

Eleni Andriopoulou, MD DEA Department of Digestive Disease, The Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

María Clara Arroyave, MD Department of Surgical Oncology, Clinica Somer, Rionegro, Colombia

ShadyAshamalla, MSc, MD, FRCSC Sunnybrook Health Sciences Centre, Department of General Surgery, Toronto, ON, Canada

Odette Cancer Centre, Toronto, ON, Canada

Sam Atallah, MD, FACS, FASCRS AdventHealth Orlando, Oviedo Medical Center, and University of Central Florida College of Medicine, Orlando, FL, USA

StephenW.Bell, MBBS, FRACS Cabrini Monash University Department of Surgery, Malvern, VIC, Australia

Alfred Hospital, Melbourne, Australia

WillemA.Bemelman, PhD Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands

AnuradhaR.Bhama, MD Rush University, Chicago, IL, USA

xix

Frédéric Bretagnol, MD, PhD Digestive Surgery—University Louis Mourier Hospital (APHP), Paris, France

CarlJ.Brown, MD, MSc, FACS, FRCSC St. Paul’s Hospital, Department of Colorectal Surgery, Vancouver, BC, Canada

NicolasC.Buchs, MD-PD University Hospitals of Geneva, Department of Surgery, Geneva, Switzerland

Ronan A. Cahill Department of Surgery, Mater Misericordiae University Hospital (MMUH), Dublin, Ireland

Section of Surgery and Surgical Specialities, School of Medicine, University College Dublin, Dublin, Ireland

HeatherCarmichael, MD Department of Surgery, University of Colorado, Aurora, CO, USA

Antonio Caycedo-Marulanda, MD, MSc Health Sciences North, Department of Surgery, Sudbury, ON, Canada

Colorectal Surgery North, Sudbury, ON, Canada

SamiA.Chadi, MD, MSc, FRCSC, FACS University Health Network and Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada

ManishChand Division of Surgery and Interventional Sciences, University College London Hospitals, NHS Trusts, GENIE Centre, University College London, London, UK

Contributors

GeorgeJ.Chang, MD, MS The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX, USA

J. Calvin Coffey, MB, BSc (Hons), Phd, FRCS University Hospital Limerick and University of Limerick, Department of Surgery and Graduate Entry Medical School, Limerick, Ireland

Nguyen Ngoc Dan, MD Hanoi High Tech & Digestive Center, St Paul Hospital, Hanoi, Vietnam

Giovanni Dapri, MD, PhD, FACS Saint-Pierre University Hospital, European School of Laparoscopic Surgery, Department of Gastrointestinal Surgery, Brussels, Belgium

Teresa H. deBeche-Adams, MD Florida Hospital, Center for Colon and Rectal Surgery, Orlando, FL, USA

F. Borja de Lacy, MD Gastrointestinal Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain

Nienke den Dekker, BSc Department of Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands

André D’Hoore, MD, PhD University Hospitals, Abdominal Surgery, Leuven, Belgium

Contributors

xxi

Anne-Marie Dufresne, MD, FRCSC Royal Columbian Hospital, Department of Colorectal Surgery, New Westminster, BC, Canada

Laura Melina Fernandez, MD Angelita & Joaquim Gama Institute, Sao Paulo, Brazil

PhillipR.Fleshner, MD, FASCRS Cedars-Sinai Medical Center, Division of Colon & Rectal Surgery, Los Angeles, CA, USA

CharlesM.Friel, MD, FACS, FASCRS Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA

AimeeE.Gough, MD Cedars-Sinai Medical Center, Division of Colon & Rectal Surgery, Los Angeles, CA, USA

MarioGuerrieri, MD Università Politecnica delle Marche, Ancona, Italy

AngelitaHabr-Gama, MD, PhD Angelita & Joaquim Gama Institute, Sao

Paulo, Brazil

Colorectal Surgery Division, University of São Paulo School of Medicine, Sao Paulo, Brazil

Dieter Hahnloser, MD University Hospital Lausanne, Department of Visceral Surgery, Lausanne, Switzerland

Suguru Hasegawa, MD, PhD, FACS Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan

HoaNguyenHoang, MD, PhD Thai Binh Medical University, Thai Binh, Vietnam

Hanoi High Tech & Digestive Center, St Paul Hospital, Digestive Colorectal Department of Minimally Invasive Surgery, Hanoi, Vietnam

SookC.Hoang, MD Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA

Masaaki Ito, MD National Cancer Center Hospital East, Department of Colorectal Surgery, Kashiwa, Japan

KevinM.Izquierdo, MD Lankenau Medical Center, Division of Colorectal Surgery, Wynnewood, PA, USA

PaulKaminsky, MD, PhD Center for Colon and Rectal Surgery, Department of Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA

Deborah S. Keller, MS, MD Division of Colon and Rectal Surgery, Department of Surgery, New York–Presbyterian, Columbia University Medical Center, New York, NY, USA

Seon-Hahn Kim, MD, PhD Korea University Anam Hospital, Colorectal Division, Department of Surgery, Seoul, South Korea

Werner Kneist, MD University Medicine of the Johannes GutenbergUniversity Mainz, Department of General, Visceral and Transplant Surgery, Mainz, Germany

xxii

JoepKnol, MD Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium

T. W. A. Koedam, MD Amsterdam UMC, Department of Surgery, Amsterdam, Noord-Holland, The Netherlands

Daibo Kojima, MD, PhD Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan

AkiraKomono, MD Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan

AntonioM.Lacy, MD, PhD Gastrointestinal Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain

SergioW.Larach, MD, FASCRS Endosurgical Center of Florida, Orlando, FL, USA

LawrenceLee, MD, PhD Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

Center for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada

JoelLeroy, MD, FRCS (Honorary, London) Hanoi High Tech & Digestive Center, St Paul Hospital, Digestive Colorectal Department of Minimally Invasive Surgery, Hanoi, Vietnam

Contributors

Emanuele Lezoche, MD, FACS, HF, ASCRS Università di Roma “SAPIENZA”, Rome, Italy

GiovanniLezoche, MD Università Politecnica delle Marche, Ancona, Italy

Grace Wai Ma, MD Health Sciences North, Department of Surgery,

Sudbury, ON, Canada

Colorectal Surgery North, Sudbury, ON, Canada

John Marks, MD Colon and Rectal Surgery, Lankenau Medical Center, Marks Colorectal Surgical Associates, Wynnewood, PA, USA

Beatriz Martín-Pérez, MD Hospital Clinic, Barcelona (Spain), Gastrointestinal Surgery, Barcelona, Spain

JustinA.Maykel, MD Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA

Elisabeth C. McLemore, MD Colon and Rectal Surgery, Los Angeles Medical Center, Kaiser Permanente, Department of Surgery, Los Angeles, CA, USA

Armando Geraldo Franchini Melani IRCAD Latin America, Barretos, Brazil

Americas Medical City, Rio de Janeiro, Brazil

Contributors

xxiii

George Melich, MD Royal Columbian Hospital, Department of Surgery, New Westminster, BC, Canada

WilliamFrederickAnthonyMiles Department of Digestive Disease, The Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

JohnMonson, MD Florida Hospital Medical System, Orlando, FL, USA

Center for Colon and Rectal Surgery, AdventHealth Orlando, Orlando, FL, USA

Surgical Health Outcomes Consortium (SHOC), Orlando, FL, USA

University of Central Florida, College of Medicine, Orlando, FL, USA

Isacco Montroni, MD, PhD, FASCRS Colorectal Surgery, AUSLRomagna, Ospedale per gli Infermi- Faenza, Faenza, Italy

GeorgeNassif, DO Florida Hospital, Center for Colon and Rectal Surgery, Orlando, FL, USA

ChucPhanNgoc Hanoi Medical University, Hanoi, Vietnam

Hanoi High Tech & Digestive Center, St Paul Hospital, Digestive Colorectal Department of Minimally Invasive Surgery, Hanoi, Vietnam

T. Paul Nickerson, MD The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX, USA

Vincent Obias, MD, MS George Washington University Hospital, Department of Surgery, Washington, DC, USA

TomoakiOkada, MD Department of Surgery, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan

JessieOsbornePaull, MD Walter Reed National Military Medical Center, Department of General Surgery, Bethesda, MD, USA

SharafKarimPerdawood, MD Slagelse Hospital, Department of Surgery, Slagelse, Denmark

Rodrigo O. Perez, MD, PhD Angelita & Joaquim Gama Institute, Sao Paulo, Brazil

Colorectal Surgery Division, University of São Paulo School of Medicine, Sao Paulo, Brazil

Ludwig Institute for Cancer Research São Paulo Branch, Sao Paulo, Brazil

UmaR. Phatak, MD, MS Section of Colon and Rectal Surgery, Surgery Department, Boston University Medical Center, Boston, MA, USA

ElizabethR.Raskin, MD, FACS, FASCRS Loma Linda University, Loma Linda, CA, USA

VA Hospital Loma Linda, Department of Surgery, Loma Linda, CA, USA

ReaganL.Robertson, MD, MSc, FRCSC St. Paul’s Hospital, Department of Colorectal Surgery, Vancouver, BC, Canada

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