Totally transrectal endoscopic total mesorectal excision (TME).

Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it.