Indications for Benign Disease of the Rectum

The transanal approach pioneered for rectal cancer brought to light all of the learning curve issues that could be imagined. As the era of taTME launched, a deja vu reminiscent of the implementation of laparoscopic cholecystectomy and laparoscopic colorectal surgery and their known early challenges existed. However, the learning curve issues have been clearly appreciated thanks to the taTME registry. Apart from a new set of short-term complications (such as injury to the male urethra) that have been realized, the long-term oncologic safety of the transanal approach still has to be established. The quality of resection with taTME, such as the risk of margin positivity with this technique, is still being established. Furthermore, taTME is unique in that the rectum is intentionally divided or “perforated,” and we are still uncertain about the risk of such specimen perforations as the potential exposure of the dissection area with tumor cells might negatively influence long-term outcomes.