Infection may be a special problem during taTME since the rectal wall is intentionally divided during the course of the operation, which could negatively impact the sterility of the proce­dure (i.e., compared to abdominal approaches which typically utilize staplers to simultaneously divide and seal the lumen). In a study by Velthuis et al. [17], 23 consecutive patients underwent taTME utilizing the TAMIS approach. Prior to and after purse-string application, the lumen was irrigated with a bactericidal agent. During the dissection, three samples were obtained sterilely via a swab delivered into the pelvis from the abdominal laparoscopic ports. This revealed that 39% of the cultures were positive for colonic ora and, of these, 44% developed pelvic infec­tion requiring therapy. The authors concluded that taTME is associated with positive cultures in more than one-third of patients, and the data sug­gests that locoregional infectious complications are more common. Thus, while infection is a postoperative complication, its incidence may be increased if during taTME, adequate irrigation and a properly constructed purse string are not assured.