Transanal Endoscopic Microsurgery (TEM) allows local excision of rectal tumors located 4 to 18cm above the anal verge. The technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical aspects of the approach, and the stringent patient selection criteria. In this lecture, N. Demartines provides us with a videoclip demonstration, and goes over the current status of TEM and addresses questions with regards to future applications.