Recently, the general surgery gastrointestinal group successfully performed Transanal Total Mesorectal Excision (TaTME) for a patient with low to moderate rectal cancer, and the patient recovered well and was discharged 10 days after surgery with no adverse effects on outpatient review. The patient, Mr. Xue, 58 years old, had rectal cancer, which was clearly diagnosed by colonoscopy and imaging examination before surgery, and there was no evidence of distant metastasis or intra-abdominal implantation. The traditional treatment is open or laparoscopic-assisted radical rectal excision (Total Mesorectal Excision, TME), but considering the patient’s small pelvis and relatively early tumor stage, Dr. Yao Hongwei, chief physician of the gastrointestinal specialty group, proposed the idea of transanal approach for TME. After discussion in the whole department of general surgery, it was determined that the patient had indications for surgery and decided to perform TaTME surgery for the patient. After thorough communication and preoperative preparation, Dr. Yao Hongwei, the chief surgeon, Dr. Chen Ning, the deputy chief surgeon, and Dr. Chen Chaowen, the chief surgeon of the Department of Anorectal Surgery, successfully performed TaTME on the patient on August 6. The operation was successfully completed by using a single-hole instrument, establishing a pneumoperitoneum through the anus, freeing the rectal mesentery “from the bottom up”, disconnecting the blood vessels and clearing the tumor lymphatic reflux area, protecting the ureter and other important organs, and dragging out the specimen through the anus to complete the ultra-low anastomosis. The resection of intestinal canal was 22cm, the distance of lower tumor margin was 2.5cm, the rectal mesentery was intact, and the number of lymph nodes was cleared 23, which fully met the standard and effect of radical treatment. Compared with the traditional transabdominal TME, TaTME surgery is less traumatic and has a lower pain score index than the traditional transabdominal TME surgery because the surgery is performed through the natural orifice of the anus, with no incision in the abdomen and perineum, and the patient can eat and move to the floor in a few days, and recovered satisfactorily in the outpatient follow-up after discharge. In recent years, various innovative surgical procedures and concepts for the surgical treatment of rectal cancer have emerged, and TaTME is one of the highlights and hot spots. Even Heald, the famous scholar who proposed the TME procedure, considers TaTME to be a perfect combination of the core concepts of transnatural orifice technique (transanal), single-port laparoscopic technique and TME principles, which is a revolutionary innovation. Compared to traditional TME surgery, TaTME operation is performed in the reverse direction, i.e., Down-to-Up, resulting in an opposite spatial sense of operation, and the operation starts with an anterior sacral breach into the abdominal cavity to establish a pneumoperitoneum, which requires a very familiar anatomy and a skilled laparoscopic base of operation here, making the whole operation more difficult. TaTME belongs to the category of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which is less traumatic to the patient, has faster recovery, and has the same curative effect as traditional TME surgery. The successful implementation of the first TATME case in our hospital marks that our general surgery has entered the advanced ranks of this field.