Introduction of new techniques and technologies in surgery: Where is transanal total mesorectal excision today?

Abstract

The introduction of new surgical techniques and technologies has traditionally been unregulated. In many settings surgeons frequently adopt novel procedures without following a structured program of implementation or supervision. The appearance of innovative technology played a pivotal role in the advancement of new surgical techniques during the industrial revolution. Innovation has been an essential component of surgical development, which led to contemporary surgical techniques such as minimally invasive surgery. Different initiatives have been developed to guide the safe introduction of new surgical techniques and other procedures. Those include comprehensive concepts such as the Idea, Development, Exploration, Assessment, Long-term study framework, which could be particularly relevant when reflecting on the novel transanal total mesorectal excision (taTME), introduced a decade ago. This relatively novel and complex procedure promised to overcome some of the major limitations of traditional surgical approaches for rectal cancer. According to the Idea, Development, Exploration, Assessment, Long-term study framework, taTME is in the phase of exploration, where there is an existing and increasing number of reports being published as the experience grows. The current management of rectal cancer is in a state of radical evolution, with multiple options that were not previously available. TaTME is only one technique amongst many which could be part of a rectal cancer surgeon’s armamentarium; however, it requires further rigorous study and evaluation.

Keywords: Rectal cancer; New technology; Safety; Innovation; Transanal surgery

Core tip: The introduction of new surgical techniques and technologies has traditionally been unregulated. In many settings surgeons frequently adopt novel procedures without following a structured program of implementation or supervision. According to the Idea, Development, Exploration, Assessment, Long-term study framework, transanal total mesorectal excision (taTME) is in the phase of exploration, where there is an existing and increasing number of reports being published as the experience grows. In addition, there are prospective collaborative studies including registries, audits and databases. This experience leads into the phase of assessment, at this point randomized controlled trials such as the Multicenter Phase II Study of Transanal TME (UStaTME trial), the Transanal vs Laparoscopic TME (COLORIII trial), French Research Group of Rectal Cancer Surgery and others are actively recruiting patients