In recent years, laparoscopic-assisted total mesorectal resection for rectal cancer has been widely used, while new methods of laparoscopic rectal cancer surgery are still being explored relentlessly to further reduce trauma. The combination of natural orifice transluminal endoscopic surgery (NOTES), transanal endoscopic microsurgery (TEM) and single The development of transanal TME (Ta-TME), derived from incision laparoscopic surgery (SILS), has gradually become a new hot topic of interest for colorectal surgeons. In the past two years, complete transanal total rectal mesorectal excision (pure-NOTES Ta-TME or no scar Ta-TME) has been proposed, which belongs to the category of pure NOTES technique and greatly reduces the surgical trauma. It has made a new attempt for the development of minimally invasive surgical treatment of middle and low rectal cancer. The latest report from Yang Yingchi, Department of General Surgery, Beijing Friendship Hospital, concluded that the Ta-TME technique is safe and feasible, and the medium-term and near-term results are satisfactory. Ta-TME not only ensures the quality of the resected total colonic mesenteric specimen, but also outperforms traditional laparoscopic surgery in some aspects. Atallah, who was the first to report on Ta-TME, considers its introduction to be the culmination of the development of surgical treatment for rectal cancer and the culmination of the last 30 years of surgery for low to intermediate rectal cancer. Ta-TME combines the core concepts of the transnatural orifice technique (transanal), the single-port laparoscopic technique (using a sealed and inflatable SILS or TEM operating platform), and the TME principle (the ability to ensure total mesorectal resection with retrograde separation along the “sacred plane” despite the bottom-up approach), and is It is a revolutionary innovation and has a very good development prospect. Our (Beijing Friendship Hospital of Capital Medical University) experience shows that it is feasible to perform complete Ta-TME in clinical practice, and based on the perioperative results and specimen quality, the surgical safety, recent results and tumor eradication degree of complete Ta-TME are ideal. However, compared with conventional laparoscopic surgery, complete Ta-TME has its own characteristics and requirements, which are mainly reflected in the requirements for the technical basis and the grasp of indications. The operation direction of complete Ta-TME is “reverse”, bottom-up, and the spatial sense of operation is also opposite, there is no natural body cavity at the beginning of the operation, the space is small, the level is unclear, and there is very little room for maneuvering between instruments, the lumpectomy field is parallel to the operation plane, and the natural curvature of the presacral area increases the difficulty of operation. Therefore, the whole operation process is more difficult, and it is impossible to carry out this operation without the support of very skilled laparoscopic techniques, especially single-port laparoscopic techniques, so it should first be carried out by experienced senior specialists in large general hospitals and units qualified for endoscopic surgery at the fourth level of general surgery. The procedure should be attempted in large general hospitals and units qualified for general surgery level IV by experienced senior specialists. In our opinion, the indications for Ta-TME should be strictly controlled at the early stage of operation. The preoperative tumor stage should be limited to T3N1M0 or less; the lower margin of the tumor should be 6-200 px from the anal margin; the tumor diameter should be less than 50 px. Some studies suggest that the risk factors for metastasis after local resection of T1-2 stage low rectal cancer are related to gender, preoperative peripheral blood CEA increase, vascular or nerve infiltration, degree of tissue differentiation and tumor size. Complete Ta-TME can also be performed in patients with neoadjuvant downstaging, and our results suggest that these patients are also satisfied with the safety, recent outcome, and tumor eradication, as reported by Chouillard. .