RT Journal Article SR Electronic T1 Evolution of transanal total mesorectal excision according to the IDEAL framework JF BMJ Surgery, Interventions, & Health Technologies FD BMJ Publishing Group Ltd SP e000004 DO 10.1136/bmjsit-2019-000004 VO 1 IS 1 A1 Sapho Xenia Roodbeen A1 Annalisa lo Conte A1 Allison Hirst A1 Marta Penna A1 Willem A Bemelman A1 Pieter J Tanis A1 Roel Hompes YR 2019 UL http://sit.bmj.com/content/1/1/e000004.abstract AB Tremendous innovations have taken place in surgical procedures, but contrary to drug development, this process has been unregulated in the past. IDEAL promotes a structured framework for the safe implementation and assessment of a new surgical technique or intervention, by describing five stages for evaluating and reporting of innovations: Idea, Development, Exploration, Assessment and Long term. Transanal total mesorectal excision (TaTME) is a relatively new technique in rectal cancer surgery that has attracted huge interest and increasing adoption worldwide. This review article aims to provide an overview of the evolution of TaTME, according to the IDEAL framework, which guides us in the difficult yet exciting process of surgical innovation.