This book captures cornerstone developments in a new body of knowledge and provides an expert resource on a hot topic in rectal surgery. Transanal minimally invasive surgery (TAMIS) was designed for local excision of select rectal neoplasms, however soon it became realized that the TAMIS technique could be used for applications beyond local excision, most notably for transanal total mesorectal excision (taTME). This new operative technique has revolutionized our approach to the distal rectum by allowing for improved access, especially in obese male patients with an android pelvis, and by minimizing abdominal wall access trauma. The endpoints of improved oncologic resection, as defined by mesorectal envelope completeness, negative circumferential resection margins, and negative distal margin, are assessed. This book details controversies, pitfalls, and future directions of taTME and TAMIS.