Highlights
The safe adoption of transanal total mesorectal excision (taTME) has occurred in many countries worldwide.
Planes beyond TME can be utilised in more advanced cases to achieve negative margins during transanal dissection.
In this case, the transanal technique allowed the surgeons to ensure organ preservation and control the R1 risk point during dissection.
An R0 resection was achieved.
This technical note highlights that in experienced hands, taTME can be safely implemented to maintain restorative options in locally advanced rectal cancer requiring resection beyond the mesorectal plane.