Transanal total mesorectal excision (TaTME) has been developed as an alternative approach to laparoscopic TME for rectal cancer. What is the PRIMARY anatomical advantage of the transanal approach over laparoscopic TME?

• A Elimination of the need for total mesorectal excision
• B Superior visualisation and dissection in the narrow male pelvis and bulky rectal tumours by approaching the dissection plane from below ✓
• C Ability to perform the procedure without a synchronous abdominal component
• D Lower risk of urethral injury compared to laparoscopic TME

Explanation

TaTME was developed to overcome the technical challenges of completing the distal mesorectal dissection in the narrow male pelvis (high BMI, narrow pelvis, bulky tumours) where laparoscopic TME struggles to achieve accurate dissection in the distal mesorectal plane. The transanal component approaches the dissection plane from below, providing superior visualisation and tactile feedback at the level of the levators and beyond. TaTME is typically performed as a synchronous two-team approach (abdominal + transanal). It does not eliminate the need for TME principles. Urethral injury is a recognised risk of TaTME due to the anterior plane dissection.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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