In June 2016, The Canadian Congress on Transanal total mesorectal excision (TaTME) brought together the leading rectal surgeons from around the world and formally introduced Canada to a procedure with enormous potential. The TaTME method is already dramatically improving oncologic and functional outcomes for patients internationally. Soon, with the creation of the Canadian TaTME Proctorship Network, surgeons in Canada will have accessible resources and training to gain experience in this innovative technique.
Historically, rectal surgery has had rather morbid connotations. Traditional procedures in the field employ a ‘top-down’ method, involving entry through the abdomen. Patients have typically experienced high variability in recovery, with the ostomy pouching system being a common component of rehabilitation. The TaTME method literally turns the approach upside-down, sparing the abdominal muscle and making the surgery far less invasive overall.
Course Director Dr. Shady Ashamalla, who travelled abroad to learn the technique before bringing it to Sunnybrook Health Sciences Centre, is using the conference as a stepping-stone toward national integration. “We feel that we now have enough experience and expertise locally in Canada that we don’t think people need to be travelling internationally to learn the technique,” he said in a phone interview. Building off of the success and momentum from the conference, CPD is now operating a one-day cadaveric course repeating every three months to train surgeons in TaTME.
Inspired by similar networks established by colleagues in the Netherlands, Dr. Ashamalla and CPD have initiated the Canadian TaTME Proctorship Network. The network will identify rectal surgeons experienced in the technique from across the country and establish them as proctors. Any Canadian rectal surgeon looking for TaTME training will soon be able to connect with their local proctor through a centralized online resource.
“Once the connection is made, there is a set curriculum established with a beginning and end point to the training process, with the end point signifying the surgeon’s readiness to start performing the procedure in their own practice.”
This curriculum will emphasize a continuous link between learner and proctor, which will involve in-person shadowing, a standardized competency assessment and consistently open lines of communication throughout the training process. Upon completion, learners can be assessed to become proctors and continue to grow the network.
The implementation of such a national program has the potential to extend beyond TaTME and into other innovative surgical procedures. By creating a program that is organized, credentialed and monitored, the TaTME Proctorship network can indeed act as a template for safe, thoughtful and effective surgical training.
Dr. Shady Ashamalla is Head of the Division of General Surgery Minimally Invasive Surgical Oncology at Sunnybrook Health Sciences Centre and Assistant Professor of Surgery at the University of Toronto.