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Summary: The management of rectal cancer has evolved over the years with several options available to physicians taking care of cancer patients, including refined neoadjuvant and adjuvant therapies and novel surgical techniques. Among the recently developed surgical approaches to rectal cancer, transanal total mesorectal excision (TaTME) proposes to address the anatomical limitations of the bony confines of the pelvis, bulky tumours, and fatty mesorectum through a new approach. Indeed, while taking advantage of the magnification of a laparoscope, performing a total mesorectal excision through the anus may confer a number of benefits. In particular, a different viewpoint with a facilitated excision of the lower third of the mesorectum, better visualization of the endangered structures during dissection, and potentially a safer anastomosis by avoiding the multiple stapler firings too often required in a conventional complete anterior approach. Following the first live case in 2009 and inspiring experience of the pioneers, dissemination of TaTME took place swiftly with many institutions having adopted this technique and published encouraging results. Yet, beyond the benefits of TaTME, surgeons did experience unknown intra-operative equipment and technical difficulties, with incorrect plane dissection, pelvic bleeding, unstable pneumopelvis and, more worryingly, major injuries such as urethral division which were not seen before embarking on TaTME procedures. This presentation will present the benefits and pitfalls of TaTME, report on own and international experience in TaTME, and suggest a training pathway to safely learn and implement TaTME.