The paper describes the removal of a broad-based tubulo-villous adenoma from the middle rectum using a transanal endoscopic microsurgical technique. This procedure, which was introduced by Buess, Thess and Hutterer in 1983, represents an alternative to the classic transanal technique, compared to which it is more accurate, and to the trans-sacral and transperitoneal methods compared to which it is less invasive.