Total mesorectal excision (TME) is standard treatment of mid- and low rectal cancer and has evolved with minimally invasive surgery. Laparoscopic TME has proven to be technically challenging, and recent randomized controlled studies fail to prove it oncologically superior to open TME. Robotic-assisted TME may overcome the technical difficulties and shows comparable oncological results, yet it is associated with significant additional costs. Transanal TME is a promising method which seems to overcome the technical and financial issues of the other techniques, without compromising the short-term oncological results.