Is TaTME the same as TAMIS?

No. TAMIS is local excision. TaTME removes the mesorectum through a transanal approach.

Does TaTME avoid an abdominal incision?

Usually no. The surgeon also works through the abdomen — small incisions to divide blood vessels and free the upper rectum. Only the lowest, hardest part starts through the anal canal. It is not TAMIS.

Is TaTME better for everyone?

No. It is discussed when the lowest, hardest part is easier to approach from the anal canal. It is not a promise of better outcomes.

Why is the urethra mentioned?

A wrong anterior plane from below can approach the urethra, especially in men. That is a technique-specific risk of this approach.

Rectal Cancer

TaTME Surgery

Transanal total mesorectal excision — not TAMIS

TaTME (transanal total mesorectal excision) removes the lowest, hardest part of the mesorectum from the anal canal upward in selected mid and low rectal cancers. The oncologic aim is the same as standard TME: an intact fascia and a clear circumferential margin. It is not TAMIS. TAMIS is done only through the anus, with no abdominal incision. In TaTME the surgeon also works through the abdomen; the anal canal is used for the lowest, hardest part.

This is not the default for every rectal cancer. It is discussed when the lowest part is hard to reach from above. Early wide adoption raised concern about local recurrence, so experience and case selection matter. It is not a claim of better outcomes.

3D diagram: TaTME — laparoscope, hook and dissector from above; cautery from below; they meet in the pelvis — Laparoscope, hook and dissector from above · cautery from below · they meet in the pelvis · educational illustration

Figure summary

Selected mid and low rectal cancers
Lowest part hard to reach from above
Not the default for every case
Sphincter involvement is a separate decision

When is it discussed?

The usual conversation is a selected mid or low rectal tumor when the lowest part is hard to reach from above: a narrow male pelvis, obesity, or a very low site. Upper rectal cancers rarely need it. If the sphincter is involved, the operation may still be an abdominoperineal resection. TaTME does not change that rule.

Selected mid and low rectal cancers
Lowest part hard to reach from above
Not the default for every case
Sphincter involvement is a separate decision

How is it done?

The lowest, hardest part starts through the anal canal and moves up into the pelvis. In the same operation the surgeon also works through the abdomen: small laparoscopic or robotic incisions to divide blood vessels, free the upper rectum, and bring the left colon down. The two fields meet in the pelvis. Teams may work together or one after the other. What follows still depends on anatomy: low anterior resection, ultra-low or coloanal anastomosis, or a permanent stoma. This is not an operation done only through the anus.

This is not TAMIS

TAMIS locally excises a selected polyp or very early tumor. It does not clear the mesorectum, and an abdominal incision is not part of that plan. TaTME is total mesorectal excision done from below. Same transanal family, different operation.

Risks that are specific to this approach

Working upward from the anal canal, especially at the front in men, brings urethral injury and the risk of entering the wrong tissue layer into the consent in a way standard top-down TME does not. Carbon dioxide embolism is uncommon but described with transanal insufflation. Early national series, during wide rollout, reported higher-than-expected local recurrence. That does not ban the operation. It also does not make it the default without an experienced team and a narrow indication. Comparative evidence does not support claims of fewer complications, better function, or better cancer outcomes.

After TaTME

Recovery follows anastomosis height and whether a stoma was used. A temporary ileostomy is often discussed. Pathology reads mesorectal integrity and margins. Bowel, urinary, and sexual function sit in the same risk family as other pelvic TME operations.

Common questions

Is TaTME the same as TAMIS?
No. TAMIS is local excision. TaTME removes the mesorectum through a transanal approach.
Does TaTME avoid an abdominal incision?
Usually no. The surgeon also works through the abdomen — small incisions to divide blood vessels and free the upper rectum. Only the lowest, hardest part starts through the anal canal. It is not TAMIS.
Is TaTME better for everyone?
No. It is discussed when the lowest, hardest part is easier to approach from the anal canal. It is not a promise of better outcomes.
Why is the urethra mentioned?
A wrong anterior plane from below can approach the urethra, especially in men. That is a technique-specific risk of this approach.

Evidence

Scientific sources

Show sources · 3

Guideline framing for transanal total mesorectal excision (TaTME) in selected mid and low rectal cancers. It is not a mandatory replacement for standard TME, and it is not TAMIS.

1. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upESMO · 2017 (see the ESMO GI portal for updates) · DOI: 10.1093/annonc/mdx224Open source →
2. NCCN Clinical Practice Guidelines in Oncology: Rectal CancerNCCN · Current versionOpen source →
3. ASCRS clinical practice guidelines libraryAmerican Society of Colon & Rectal Surgeons (ASCRS) · Guideline libraryOpen source →

Last reviewed: 14 September 2026. Links go to publisher pages.

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