Technique for a stapled anastomosis following transanal total mesorectal excision (taTME) for rectal cancer

Transanal total mesorectal excision (taTME) is an emerging technique in rectal cancer surgery. As with all novel techniques, new challenges arise, requiring small modifications. Transanal TME presents the surgeon with a challenge when forming a stapled anastomosis because a linear stapler is not used to transect the rectum during this procedure, instead the distal rectal wall is divided at the start of the transanal dissection. This leaves the distal rectal end open, requiring the use of a purse-string suture to close it before a stapled anastomosis can be fashioned. Accurate positioning of the stapler from the transanal side may be difficult without a stapled closure of the distal rectal stump because the shaft of the stapler must pass through the centre of the purse-string. To overcome this, some surgeons have used a long-shaft haemorrhoid stapler, but the functional impact of this stapler with its wider diameter and extra tissue bulk incorporated into the anastomosis is unknown. We present a simple technique that we have devised to facilitate a stapled anastomosis following a transanal TME using a standard circular stapler. This article is protected by copyright. All rights reserved