Surgery for rectal cancer is evolving using the newest minimal invasive single port platforms. This has led to transanal single port laparoscopy employing a reversed total mesorectal excision; the TaTME. The procedure has gained significant interest of colorectal surgeons and beyond since the new technique opens up new possibilities enabling high quality dissection in small difficult area’s. It has shown to result in better dissection of the low rectal cancers and has shown to have favorable outcome for patients. The VU University Medical Center, and The Gelderse Vallei hospital, have performed more than 100 procedures and have published scientific research concerning colorectal surgery and TATME. In addition the Spaarne Gasthuis and recently the IJsselland Hospital have also been trained in TaTME and performed substantial number of TaTME procedures. In order to educate and train consultants in transanal rectal cancer surgery the Vumc has set up a well evaluated TaTME course which has currently been running successfully since 2014. The experienced faculty of the four hospitals are involved in lectures and hands-on training. Our group is also internationally involved in TaTME courses. The learning curve of this technical demanding procedure will be evaluated prospectively in conjunction with the Imperial College in London in order to assure quality and safety. To evaluate the TATME procedure for patients with mid and low rectal cancer in terms of oncological outcome and functional outcome we have set up a randomized trial; The COLOR-III study.