Learning Transanal Total Mesorectal Excision.

A dynamic evolution is occurring in transanal surgery. Transanal techniques began with intraluminal surgical removal of rectal masses and have progressed to transanal total mesorectal excision (taTME) for rectal cancer. TaTME was first performed in 2009 by Sylla, Rattner, Delgado, and Lacy. This article documents the training pathway followed by pioneers in the taTME technique as well as consensus reports outlining the process of learning the taTME technique. A literature search was performed for taTME training, learning, and technique. Key elements in learning the taTME technique include appropriate indications, cadaver training, and outcomes reporting such as participating in a taTME registry. Consensus reports also agree on the following facets associated with improved outcomes: (1) appropriate case selection of mid and low rectal cancers, (2) prerequisite completion of an accredited training program in laparoscopic colorectal surgery and prior experience in transanal endoscopic surgery, (3) a two-team taTME approach from above and below is ideal, and (4) higher rectal cancer volume surgical practice. The unifying international recommendation for surgeons interested in learning the taTME technique conveys the following message: taTME is an advanced and complex technique that requires dedicated training and experience in TME surgery.

Aortoiliac Endarterectomy: A Useful Tool in Modern Vascular Practice.

Aortoiliac endarterectomy was the standard treatment for aortoiliac occlusive disease before the availability of prosthetic graft material for aortobifemoral bypass, although the number of patients appropriate for this repair continues to diminish in the endovascular era. Patients with focal aortoiliac disease are often treated with bilateral "kissing" iliac stents through an endovascular approach. However, in patients with eccentric plaque morphology or smaller caliber vessels, the risk of distal embolization and vessel rupture is not insignificant. On the other hand, if the disease is localized to the distal aortic bifurcation, an open aortobifemoral bypass may be excessive and incur additional morbidity. Our case report reviews a 60-year-old woman who presented with lifestyle-limiting claudication from an isolated aortoiliac atherosclerotic plaque who we proceeded with an open aortoiliac endarterectomy.