BACKGROUND: Rectal tumors up to 25 cm from the anal verge may be resected by transanal endoscopic microsurgery (TEM). TEM is suitable for resection of benign adenomas, but can also be used for selected malignant tumours. MATERIAL AND METHODS: Based on review of the literature and our own experience with 150 procedures, we present a review of the method and indications for TEM. RESULTS: TEM is a safe and suitable method for resection of rectal adenomas that cannot be radically removed by endoscopic methods. TEM offers lower recurrence rates and less morbidity than traditional treatment. Large tumours and involvement of the microscopical resection margin disposes for recurrence. Selected malignant tumours (like small carcinoid tumours and early stage [Tis, T1] adencarcinomas) with higer moderate differentiation may be resected by TEM with the same oncological result as open surgery. INTERPRETATION: Tumours can be resected in the entire rectum with TEM. TEM is especially suitable to resect benign adenomas, and may also have a place as primary treatment of selected malignant tumours in Norway. Depending on selection criteria and combination with radiotherapy, the method may be suitable for 30 - 110 patients/year with rectal cancer in Norway.