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In selected cases of ulcerative colitis (UC), restorative proctocolectomy with a J-pouch and ileo-anal anastomosis (IPAA) is the treatment of choice. Total mesorectal excision has been preferred when performing the proctectomy, although a close rectal dissection (CRD), without following the "holy plane", has also been described. The transanal approach has evolved, and it is no longer limited to local excision of rectal neoplasms, with total mesorectal excision having currently become one of its main indications. Furthermore, this approach can also be used in cases of UC requiring surgery. Hybrid transanal CRD appears to be the next step in the evolution of minimally invasive transanal surgery.
