Analysis of the impact of the learning curve and other factors on the duration of TaTME procedures

BACKGROUND: Transanal total mesorectal excision (TaTME) is a technically demanding procedure with a significant learning curve. Operative time is often used as a proxy for procedural proficiency. OBJECTIVE: To evaluate the impact of the learning curve and selected patient- and procedure-related factors on the operative duration of TaTME procedures. METHODS: A retrospective analysis was conducted on 250 consecutive patients who underwent TaTME for rectal cancer between 2016 and 2025. Operative time trends were assessed in relation to case sequence, individual surgeon experience, and patient-related variables including sex, body mass index (BMI), ASA score, and technical aspects such as protective ileostomy creation. RESULTS: The mean operative time across the cohort was 200.52 min. A significant reduction in operative duration was observed over time, with stabilizing after approximately 100 cases. Male sex, higher BMI, and ASA scores ≥ 3 were independently associated with longer operative times. The use of a protective ileostomy also significantly increased operative duration. After adjusting for surgeon experience and case complexity, no difference remained between laparoscopic and open approaches. Substantial interoperator variability was observed, particularly in early cases. CONCLUSIONS: TaTME is associated with a steep learning curve, which significantly increases operative time. Patient-related factors such as sex, BMI, and comorbidities further influence surgical duration. These findings support the need for structured training pathways, outcome monitoring, and individualized preoperative planning.