Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that was introduced by Buess in the early 1980s. The TEM procedure employs a dedicated rectoscope with a 3D binocular optic and a set of endoscopic surgical instruments. Since the beginning its advantages have been evident: magnification of the operative field, better access to proximal lesions with lower margin positivity and fragmentation over traditional transanal excision techniques. A non-systematic literature search was performed in the PubMed database to identify all original articles on rectal cancer treated by TEM. Only series including at least ten cases of adenocarcinoma with two years' mean minimum follow-up and published in English were selected. Nowadays more than two decades of scientific data support the use of TEM in the treatment of selected patients with non-advanced rectal cancer. This paper describes the indications and the surgical technique of TEM in the treatment of rectal cancer.