Transanal minimally invasive surgery (TAMIS) is a surgical platform that enables local excision of rectal tumours, originally described by Atallah et al. [1]. It has mainly been used for the excision of benign lesions, but has also been used in the management of early malignant lesions. As with any local approach to rectal malignancy lack of lymph node resection is a concern [2]. TAMIS has the advantages of being easy and safe to perform [3]. Dissection in TAMIS is achieved by traction and counter-traction in a rather confined space (the pneumorectum), which can be difficult. Visualisation of tissue planes can be challenging. We adopted a well-developed endoscopic technique known as endoscopic submucosal injection (ESI) to facilitate dissection...