Penna M, Whiteford M, Hompes R, Sylla P
Oxford University Hospital NHS Foundation Trust, Oxford, UK.
The Oregon Clinic, Providence Cancer Center, Oregon Health and Science University, Portland, OR, USA.
Colorectal Dis. 2017 May;19(5):476-484. doi: 10.1111/codi.13525.
Transanal total mesorectal excision (taTME) has become one of the most promising technical advancements in the surgical treatment of rectal cancer, with rising numbers of surgeons seeking training. We describe our experience with human cadaveric courses for taTME delivered in two countries.
Four fresh human cadaveric workshops conducted in Oxford, UK, in 2015 and two in Chicago, USA, in 2013-2014, trained a total of 52 surgeons. Parameters of operative performance for each delegate were recorded. Previous surgical experience and uptake of taTME in the surgeons' clinical setting were surveyed.
Forty-seven taTME cases were performed on cadaveric models. Participating surgeons had previous experience in laparoscopic TME surgery and transanal approaches but limited taTME exposure. The purse-string remained occluded throughout in 93% of UK and 60% of US cases. Operative timings for key procedural steps were similar between the two countries with a mean time from start of circumferential dissection to peritoneal entry of 79.5 min (range 25-155). 96% of surgeons dissected transanally to a level S2 or above. The TME specimen quality was complete or near complete in 81%, with improvements noted between the first and second procedure performed. 81% of surgeons surveyed are currently performing taTME in their local hospitals.
Fresh-frozen cadavers provide excellent teaching models for complex pelvic surgery. A structured training curriculum including reading material, dry-lab purse-string practice and postcourse mentorship will provide surgeons with a more complete training package and ongoing support, to ultimately ensure the safe introduction of taTME in the clinical setting.
经肛门全直肠系膜切除术（taTME）已成为直肠癌外科治疗中最具前景的技术进展之一，寻求相关培训的外科医生数量不断增加。我们描述了在两个国家开展的taTME人体尸体课程的经验。
2015年在英国牛津举办了4次新鲜人体尸体研习班，2013 - 2014年在美国芝加哥举办了2次，共培训了52名外科医生。记录了每位学员的手术操作参数。调查了外科医生之前的手术经验以及他们在临床工作中对taTME的采用情况。
在尸体模型上共进行了47例taTME手术。参与的外科医生此前有腹腔镜TME手术和经肛门手术的经验，但taTME经验有限。在93%的英国病例和60%的美国病例中，荷包缝合全程保持闭合。两个国家关键手术步骤的手术时间相似，从开始环周解剖到进入腹膜的平均时间为79.5分钟（范围25 - 155分钟）。96%的外科医生经肛门解剖至S2或更高平面。TME标本质量完整或接近完整的占81%，在首次和第二次手术之间有所改善。接受调查的外科医生中有81%目前在其当地医院开展taTME手术。
新鲜冷冻尸体为复杂盆腔手术提供了优秀的教学模型。一个结构化的培训课程，包括阅读材料、干式荷包缝合练习和术后指导，将为外科医生提供更完整的培训方案和持续支持，以最终确保在临床环境中安全引入taTME。
