Transanal total mesorectal excision (TaTME) is widely performed for the resection of rectal cancer around the world. However, due to lower body mass index and a lack of necessity, TaTMEs have not been accepted in East Asia as generally as in Western countries. In East Asia, conventional laparoscopic surgeries have been performed with lower rates of open conversions and robotic surgery has been considered as an acceptable option for patients with narrow pelvis. This review article discusses TaTMEs from an East Asian perspective.