Using cadaveric simulation to introduce the concept and skills required to start performing transanal total mesorectal excision.

Aim: The aim was to document the outcomes of surgeons attending a cadaveric simulation course designed to provide an introduction to transanal total mesorectal excision (TaTME).

Method: This was a prospective observational study documenting the outcomes from classroom and wet lab activities. Follow-up questionnaires were used to monitor clinical activity after the course.

Results: Outcomes of 65 delegates from 12 different countries attending seven cadaveric simulation courses are described. Median time to insert and close the rectal purse-string was 15 min (range 7-50 min) and median time to complete the transanal mesorectal dissection was 105 min (range 60-260 min). Objective assessment of specimen quality showed that 42% of specimens were complete, 47% nearly complete and 11% were incomplete. Failure of the intraluminal rectal purse-string was the most common difficulty encountered. Within 6 months of attending the course, nearly half (26/55; 47%) of the surgeons who responded had performed between 1 and 13 TaTMEs. Only 8/26 (31%) of the surgeons had arranged mentoring for their first case.

Conclusion: This training model provides high levels of trainee satisfaction and the knowledge and technical skills to enable them to start performing TaTME. There is still work to do to provide adequate supervision and mentorship for surgeons early on their learning curve that is essential for the safe introduction of this new technique.