Transanal endoscopic microsurgery (TEM), which was first introduced several years ago, allows the excision of rectal tumours not susceptible to a more traditional endoscopic approach or as an alternative to highly invasive or debilitating procedures. We surveyed the effective implementation of TEM in Italy, the indications adopted by each surgical department and the technical results achieved. We contacted 34 surgical departments and analysed the answers given by 17 centres (those actually using the technique = 50%). Most of these are situated in Northern Italy. A total of 1208 procedures were declared (84% of them performed in 6 centres). The most frequent declared indications were adenomas and T1 and T2 carcinomas (741 cases). The contraindications have to do with the staging, localisation and size of the neoplasms. The mean operative time reported by most of the centres ranged from 60 to 90 minutes. The most frequent complication in 13 departments was haemorrhage. The conclusions reported by some of the surgeons contacted are useful. The implementation of TEM is confined to only a few centres with a large number of treated cases. Overall analysis of the data raised many questions needing to be answered, especially with regard to the proper use of a surgical technique that is difficult but not impossible to implement.