Discover the R E V O L U T I O N in C O L O R E C T A L S U R G E R Y
What is taTME and why is it so important?
By Sam Atallah, MD — intended for patients, nurses, and other healthcare personnel
taTME is an abreviation for transanal total mesorectal excision. It is usually pronounced “T-A”-“TME”. It was developed as a method to better access the lower pelvis, something that is challenging to surgeons to do normally. A good analogy that’s easy to understand, is imagine if you wanted to work on a car engine. Well, you would open the hood, and exopse the engine. While you could reach many areas, there are parts of the motor that you just can’t reach with your hands, unless you put the car on a lift and access the engine from underneath the vehicle. In this sense, taTME is like using a lift to access those ‘deep parts’ of a car motor.
You may say, well, “why are surgeons just now thinking of this?!” In truth, the concept had been around for a long time — since the early ‘80s. The problem was that surgeons didn’t really have a good tool or technique to work in this manner. All that changed in 2009, when Transanal MInimally Invasive Surgery (TAMIS) was born. TAMIS was a new kind of tool or ‘platform’ which allowed colorectal surgeons a way to operate ‘from beneath the tumor’. While this technique is still quite new, early data seems to indicate that ability to completely remove tumors and the ability to do the operation without a permanent colostomy is better than traditional methods, although we are still collecting these results.
So this new approach, taTME, now lets colorectal surgeons access (especially) the real low parts of the rectum that are ‘deep in the pelvic cavity’ affording surgeons a smarter and probably better way to remove rectal tumors. Now, this doesn’t mean we’ve gotten rid of laparoscopy, and that patients who have taTME don’t have incisions. Most times, taTME is done with either laparoscopic or robotic assistance as surgeons still have to do some work inside the abdomen in order to remove tumors properly and reconnect the bowel. Many times the rectal tumor can be removed transanally, and so this can reduce the amound of scars and pain from surgery afterwards, but it’s not the main reason taTME is done.
Dr. Atallah’s 2019 Textbook on TAMIS and taTME
taTME — FAQs
Is taTME minimally invasive?
-Yes, there are still abdominal scars (it’s done in combination with laparoscopy and robotic surgery)
Can taTME be done all transanally without any scars?
-Yes, but this is extremely rare
Does taTME require you to have a temporary bag (ileostomy)?
-Most times, especially in the setting of prior radiation therapy, a temporary bag is required
What is the main reason taTME is important?
-It provides surgeons with better access to tumors of the rectum, and this may mean a better surgical approach to removing the tumor completely
What’s the difference between TAMIS and taTME?
-TAMIS is a platform. It allows surgeons a way to access the rectum and pelvis, sort of like ‘mini-laparoscopy’. TAMIS was developed for and is mainly used to excise or ‘carve out’ rectal tumors. Not all rectal tumors can be carved out like this however, because they would just grow back. A more complete method is to remove an entire portion of the rectum and its surrounding lymph nodes — TAMIS is used as a way to do that, and this operation is called taTME. TAMIS is generally done without any abdominal incisions. taTME is almost always done with abdominal incisions.
Can I go home the same day?
-For TAMIS, most often patients are discharged the day of surgery to home or admitted for observation and are discharged the following morning. taTME requires an admission to the hospital and is not an outpatient operation. Typically, the hospital stay ranges from 3-5 days.
Are there risks with taTME?
-The risks are the same as with any other minimally invasive operation for rectal cancer, with one exception. There is a risk of damage to the urethra in men undergoing the procedure, something that typically is not a risk with other approaches. This is one reason that it is very important for colorectal surgeons to receive special training on this complex operation.
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Ask Dr. Atallah (Principle Investigator at Florida Hospital) about enrollment into the MultiCenter Phase II Study on taTME as registered on ClinicalTrials.gov
WATCH as Dr. Atallah Discusses TAMIS and taTME
Read Dr. Atallah’s Editorial on taTME
Learn More About the revolution in surgery (Video)