Transanal total mesorectal excision as a natural orifice specimen extraction technique

Due to high rate of morbidity in open rectal cancer surgeries, there is still an ongoing search for minimally invasive methods. The most accepted minimally invasive method has such benefits like faster recovery, less pain, less risks due to minimal invasion and decrease in post-operative herniation. Laparoscopic and robotic surgery is a minimally invasive method compared to the open method. However, it requires an abdominal incision during specimen removal, which limits its potential to reduce complications related to postoperative pain and wound infection rates. With the development of minimally invasive surgery, the approach to rectal cancers, especially benign and malignant masses located in the middle and lower rectum has moved to a more sophisticated stage. Today, natural office specimen extraction has become very popular. In the last decade, transanal total mesorectal excision (TaTME) has recently been increasingly applied in cancers localized in the middle and lower rectum. The application of this method requires two teams performing transabdominal and transanal operations, which allows for the specimen to be extracted without any abdominal incision. TaTME facilitates the direct distal visualization of the tumor, provides better distal or circumferential margin, prevents tumor perforation, requires fewer staples, and offers better urinary and sexual functions. In addition, this method has reduced the abdominoperineal resection rate from 25% to 2.9% according to the literature. Ultimately, this surgery leads to a better result in sphincter preservation.