Laparoscopic total mesorectal excision (LTME) has become the standard surgical treatment of rectal cancer. There is however technical challenges when operating patients with a narrow pelvis with tumours located in distal or middle part of the rectum. We describe a case of a 71-year-old male operated for a rectal cancer by LTME assisted by transanal approach. The patient had an uneventful post-operative course. Follow-up showed no signs of recurrence.