1.1 Current evidence on the safety and efficacy of transanal total mesorectal excision (TaTME) to remove the rectum is limited in both quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake TaTME should take the following actions:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
1.3 TaTME should only be done by surgeons who are experienced in laparoscopic and transanal rectal resection and who have had specific training in this procedure.
1.4 Clinicians should enter details about all patients undergoing TaTME (for malignancy or a benign indication) onto the TaTME registry and review local clinical outcomes.
1.5 NICE encourages further research into TaTME of the rectum. Patient selection should be explicitly documented. If the procedure is used to treat malignancy, outcomes should include completeness of excision, recurrence rates, survival, quality of life outcomes and avoidance of the need for a stoma in the long term. All complications should be reported, specifically including incontinence.