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To review the outcome of local excision [minimally invasive transanal surgery (MITAS)] with the use of an original anal retractor, stapler device, and several modified surgical techniques for selected rectal tumours. Method: One hundred and seventy-four patients with 176 tumours undergoing MITAS between 1995 and 2009 were retrospectively reviewed forprospectively collected data without adjuvant radiation or chemotherapy.MITAS took a median of 26 min with an average of 20 g blood loss. There was no mortality and morbidity was low. The tumours were at 9 (4.5-20) cm from the anal verge and measured 27 (4-80) mm in diameter. There were 52 adenomas, 67 Tis, 17 low-risk pT1, and 24 high-risk pT1 carcinomas. Eighteen patients underwent further surgery including two with a high risk pT1 carcinoma who refused additional operations and had recurrent disease. The, sole patient with a positive surgical margin underwent a second MITAS for recurrence and has remained free of disease over 63 months follow up.MITAS allows access toproximal rectal tumours and ‘total excisional biopsy’ with a short operative time, minor blood loss, and low morbidity. It is suitable for carefully selected adenomas and early carcinomas.