Introduction: Transanal endoscopic microsurgery (TEM) was developed by Gerhard Buess in 1983 as an alternative to traditional transanal surgery. The method has become more and more widespread in the treatment of benign as well as T1 rectum tumours. We have used the method for several years and we present our results in this paper. Materials and methods: Retrospective examination of patient files from consecutive registered patients who underwent TEM in the period June 1999 to November 2004, in all 76 operations on 74 patients. Results: 49 patients had adenomas; both the recurrence and complication rate was 6%. Median follow-up period was 12 months (range 0-57). 15 had a T1 tumour removed; the recurrence rate was 15%. One had a serious complication. Median follow-up period was 12 months (range 3-36). Eight had a T2 tumour removed; the recurrence rate was 16%. One had a serious complication. Median follow-up period was 21 months (range 9-36). Two patients were treated for a T3 tumour as part of palliation. Conclusion: Our results are comparative to the largest foreign data. The recurrence rate is on the same level as open as well as laparoscopic surgery and far less than traditional transanal surgery. The complication risks are on the same level as laparoscopic access and far les than open surgery. However, preoperative investigation has to be developed further. Research is needed to clarify if selected patients with T2 cancer could be treated with TEM in combination with radiotherapy.