Caycedo etal. [7] describe ve peritoneal vio­lations in 50 cases (10%). All peritoneal viola­tions were repaired using the TAMIS platform and AirSeal® Insufation System (ConMed, Inc., Utica, NY, USA). The authors of this article recommended not operating on anterior lesions suspected to be above the peritoneal reection if the surgeon is not facile at laparoscopic suturing, as they carry a high risk of peritoneal entry. Our current data suggests an unplanned intraperito­neal entry rate of 3.9%, where repair was primary performed by intracorporeal suturing via the TAMIS platform (6 of 9 patients), while 2 patients required conversion to laparoscopy to close the defect and 1 necessitated a laparoscopic low anterior resection, as the defect was too large to close primarily. Subcostal needle catheterization using a 14-gauge needle in the left upper abdo­men at Palmer’s point was used to evacuate the intra-abdominal CO2 and facilitate transanal repair, with successful completion of the surgery in 3 of the 6 patients who had repair transanally. Interestingly, one patient who sustained a perito­neal violation went on to have two further TAMIS procedures for recurring adenomas in the same position (despite clear circumferential margins on previous TAMIS excisions), and these two further TAMIS local excisions were not compli­cated by peritoneal entry, likely secondary to scarring from the initial procedure [5].