TaTME is a technique for rectal cancer surgery that combines surgical stages performed from below, through the anal canal, and through the abdomen. The part of the rectum containing the tumour is removed together with the appropriate surrounding tissue. This approach may be considered particularly for some patients in whom working deep within the pelvis is difficult.
TaTME is not considered the preferred option for every rectal tumour. Its potential benefit depends on the tumour's location, the anatomy of the pelvis and the specific training of the surgical team. Working through the anus does not mean that the operation is minor or that a stoma will definitely be unnecessary.
What difficulty does the approach from below address?
The rectum lies deep in the pelvis, close to the urinary and reproductive organs, blood vessels and nerves. The fatty tissue around it is called the mesorectum. This tissue contains lymph nodes, to which cancer cells may spread. Total mesorectal excision, or TME, removes the appropriate part of the rectum together with the mesorectum along anatomical boundaries.
In the conventional laparoscopic approach, the surgeon works from above downwards using a camera and instruments inserted through small abdominal incisions. A narrow pelvis can restrict the space for instrument movement, particularly when the tumour is low down. Seeing the margin below the tumour and dividing the bowel at the appropriate level can be technically difficult.
In TaTME, this lower area is approached from the anal side. “Ta” stands for transanal, meaning through the anus. The surgeon sees the lower margin directly and dissects the tissues upwards. The aim is to provide a different view of the difficult part of the operation; the principle of complete cancer removal remains unchanged.
What is considered when selecting patients?
Low and some mid-rectal tumours, a narrow pelvis and difficulty reaching the area with instruments from the abdomen may prompt discussion of this technique. These are not automatic indications. With the same anatomy, an experienced team may consider another laparoscopic, robot-assisted or open approach more suitable.
Before the choice is made, the tumour tissue results, magnetic resonance imaging, or MRI, of the pelvis and other tests showing the extent of the disease are assessed together. The tumour's relationship to neighbouring organs, previous operations and radiotherapy may also change the plan. In some cases, more extensive surgery beyond the standard tissue boundaries is needed.
The possibility of reconnecting the bowel is assessed separately. If the tumour involves the anal sphincter, the muscle system that holds in stool, approaching from below does not resolve this. The possible need for a temporary or permanent stoma, an opening of the bowel onto the abdominal wall, is discussed beforehand.
The specific benefit expected for you should be explained when the decision is made. An anatomical reason such as “the tumour can be reached more clearly from below” is a different argument from the technique simply being new. Understanding why an alternative operation has or has not been chosen is part of an informed decision.
How are the abdominal and anal stages combined?
The operation is performed under general anaesthesia, with the patient asleep. From the abdominal side, the bowel and blood vessels are prepared. A special device placed through the anal canal allows the team to work from below with a camera and instruments. Depending on how the team is organised, the stages may take place one after the other or at the same time.
Once the areas of dissection meet, the resected section is removed and, in suitable cases, the bowel is reconnected. This join is called an anastomosis. A temporary ileostomy, a stoma made from the small bowel, may be needed to protect a low anastomosis while it heals.
The general principles of the laparoscopic stage are explained on the Laparoscopic Surgery for Rectal Cancer page. The two approaches can be seen together in the video TaTME (transanal total mesorectal excision) for mid-rectal cancer; this is surgical footage intended for adults.
Although the names TaTME and TAMIS are similar, the extent of the operations differs. TAMIS usually involves local removal of a limited lesion in the bowel wall. TaTME is an approach to major cancer surgery that includes removal of the rectum and surrounding mesorectum.
What is known about the outcomes?
Comparative studies involving specially trained teams have shown similar cancer control outcomes for TaTME and laparoscopic TME. In the TaLaR trial, TaTME was not inferior to the laparoscopic approach for three-year disease-free survival according to the predefined comparison criterion. This does not show that TaTME is better for everyone.
In the short-term results of the COLOR III trial published in 2026, postoperative complications and complete resection rates were similar, while conversion to open surgery was less common in the TaTME group. The trial's ongoing follow-up is separately important for understanding long-term cancer control and bowel function.
Approaches to the use of this technique differ between countries. NICE guidance in England limits consideration of TaTME to the research setting. This cannot be presented as a local rule for Azerbaijan, but it shows why safety concerns and the monitoring of outcomes need to be discussed openly.
Specialist team experience and follow-up after surgery
Viewed from below, the appearance and orientation of tissues differ from the view through the abdomen. Entering the wrong tissue plane can injure the urethra, the tube that carries urine out of the bladder, as well as nearby organs and nerves. Standard laparoscopic experience alone is therefore not considered sufficient preparation for TaTME.
Structured training, supervision by an experienced surgeon during the initial operations and ongoing recording of outcomes are important when introducing this approach. The team must be prepared not only to perform the technique but also to recognise and treat any injury promptly. Previous concerns about local cancer recurrence make this monitoring particularly important.
During recovery, the team monitors for leakage from the bowel join, infection, bleeding and problems passing urine. If you develop fever, increasing abdominal or pelvic pain, persistent vomiting, inability to pass urine or severe weakness at home, contact the surgical team urgently. The laboratory report on the removed tissue and subsequent examinations guide both further treatment and long-term follow-up.