NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland
 
Status In progress
Process IP
ID number 1184
Description The aim of TaTME is to improve the clinical outcome of rectal resection, and to reduce length of hospital stay and morbidity after surgery. It may facilitate proctectomy (removal of all or part of the rectum) that would be difficult by an open or laparoscopic approach. This could be in people with a narrow pelvis or high body mass index, or where the position of the tumour is low in the rectum. Before surgery, the patient has bowel preparation and prophylactic antibiotics. Using general anaesthesia, and with the patient in the lithotomy position, standard abdominal laparoscopic mobilisation of the left colon and upper rectum is done. After inserting an operating platform into the anus, the lower rectum including the total mesorectum is mobilised. At the start of the transanal part of the procedure, a purse-string suture is put in to close the rectal lumen. This is followed by a full thickness rectotomy. After identifying the TME plane, the dissection progresses proximally until it connects with the dissection from above. The specimen can be removed through the transanal platform or, if the tumour is large, through the abdomen using a small incision. Anastomosis to connect the colon and the anus can be done using sutures (hand-sewn technique) or staples, and a temporary ileostomy is usually created. When anastomosis is not possible, a permanent stoma is created.

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Timeline

Key events during the development of the guidance:

Date Update
22 July 2021 - 19 August 2021 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance