Transanal TME is a feasible method for oncologic resection of locally advanced mid- and distal-rectal cancer with curative intent. It has special application for patients with obesity and anatomic constraints such as a narrow male pelvis.

TA-TME is a complex technique that requires a minimum of 45-51 cases to reach an acceptable incidence of high-quality TME and lower operative duration.

For carefully selected patients, TAMIS for local excision of rectal neoplasia is a valid option with low morbidity that maintains the advantages of organ preservation.

Transanal minimally invasive surgery (TAMIS), which can provide high-quality local excision for rectal neoplasia, has emerged as an important alternative to transanal endoscopic microsurgery. The role of TAMIS beyond local excision has also been explored, and it has been shown that this platform can be used for complete rectal resection with total mesorectal excision (TME). The stepwise approach to TAMIS for TME is described and illustrated in video format.

These data suggest that TaTME for rectal cancer is feasible with an acceptable pathological outcome and morbidity profile. Further data on functional and long-term survival outcomes are required.