Cadaver lab TaTME

Mathieu D’Hondt
Mohammed Abu Hilal

Competency Based Modular Training in TaTME technique

In our opinion optimal Competency Based Modular Training in TaTME technique includes:

1. Online preparation
2. Dry lab training
3. Cadaver training
4. Proctorship

Cadaver training is a crucial step in becoming well trained in the technique of TaTME. These sessions are expensive and are most efficient when trainees are well prepared.

Dissection in a cadaver is comparable to dissection in a real patient, following the same steps. An expert in TaTME should guide the trainee through these steps and should evaluate the procedure using a standardized evaluation form. Also the trainee should fill out a self-assessment score for all parts of the procedure. We consider the GAS forms (Global Assessment Score) for trainee and trainer, as proposed in the Educational Consensus Workshop in Bristol (10-2015), as the best available and therefore we include them at the bottom of this page to be used.

Transanal phase of TaTME in a cadaver dissection

Set up and start

- E1. Appropriate patient positioning
- E2. Correct Set-up of transanal platform
- E3. Purse-string creation
- E4. Marking and full thickness rectotomy
- E5. Mucosectomy / Intersphincteric dissection
        Complete TME dissection
- E6. Safe dissection of the posterior plane
- E7. Safe dissection of the anterior plane
- E8. Safe dissection of the lateral plane
- E9. TME dissection performed in a step-wise fashion in order to remove the specimen like a cylinder
- E10. Connection between the abdominal and perineal teams
         Anastomosis (A. Handsewn - B. Stapled)
- E11. Safe eversion - delivery of proximal rectum without rupture
- E12. Handsewn coloanal - colorectal anastomosis
- E13. Stapled anastomosis : creation of purse-string
- E14. Stapled anastomosis : placement of stapling device through purse-string and firing of stapler

In this part of the SPOC we discuss most of the steps and also include colorized video-parts from cadaver sessions.

 colorized video-parts from cadaver sessions
Holdafbeeding video

Tips to perform a pursestring suture
. Small bites, go in where you came out, * lift up the suture to the center of the rectal lumen and * overlap last and first stitch.

Holdafbeeding video

Tips to tie the pursestring suture.
In most cases the Gelpoint cap is removed to tie the pursestring suture.

Holdafbeeding video

Tips to perform a full thickness dissection.
The recognition of a * full thickness dissection is of crucial importance at the start of the procedure. If not the surgeon can get lost in the * muscular layers of the rectal wall.

Holdafbeeding video

Pitfalls when performing the posterior dissection
. Best to check the anatomy before starting the dissection to identify the * coccyx and prostate/vagina. Possibly difficult start at 6 o'clock because of * the anococcygeal ligament. Also realize that a ** donut-sign means dissecting into the wrong plane and chosen plane has to be * adjusted.

We believe that a cadaver lab session is necessary to safely introduce the technique of TaTME and helps to prepare for hands-on trainings and proctorship.