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Minimal invasive surgery for locally advanced rectal cancer is challenging and requires advanced technological assistance to make the procedure feasible and safe. The Transanal Total Mesorectal Excision is an innovative approach for rectal cancer. It provides several advantages compared to the fully laparoscopic technique. Issues such as transection of the distal margin and difficult cases may have found a solution with this procedure. You have been able to see this procedure many times on AIS Channel. This time we want to show you transanal surgery from another point of view. This surgery will focus on the main steps for the combined transanal and transabdominal approach (Cecil approach) for rectal cancer, highlighting the most frequent mistakes and how to prevent them.