Transanal total mesorectal excision (TaTME): are we doing it for the right indication? An assessment of the external validity of published online video resources

Background The steep learning curve for safe introduction of transanal total mesorectal excision (TaTME) highlights the need for mentored training reserved for surgeons with expertise in minimally invasive colorectal surgery and transanal surgery. Video-based education in minimally invasive surgery is considered by surgical trainers as a useful teaching aid to maximize learning. This study aims to systematically assess the availability and quality of online TaTME videos. Methods TaTME videos were systematically searched on , Colorectal diseases video channel, , and AIS channel. Data collected included video characteristics, presence of supplementary educational content, patient details, indication for surgery, different steps of TaTME presented, and surgical outcomes. Results Forty-six videos were included with a median of 92 views per month. Nineteen videos (41.3%) reported the age of the participants and 29 patients were male (63%). Body mass index (BMI) was reported in 20 videos (43.5%) with a median of 27 and it indicated obesity (BMI >= 30) in 2 cases only. The use of neoadjuvant treatment was reported in 8 cases (17.4%). Eighteen videos (39.1%) reported the distance of the tumor from the anal verge, with a median of 6.4 cm and in 9 out of 18 cases, the tumor distance from the anal verge was 7 cm or higher. Pathological staging was reported in 17 videos (37.0%), with 1 T1, 3 T2, 10 T3, and 3 T4 tumors. Conclusions There is considerable interest in TaTME videos. Lack of consensus on reporting of these videos limits the educational value of these resources, which are missing important patient details and postoperative outcomes.