As of yet, there are no publications or video reports of an anterior exenteration in a female patient via the taTPE.The approach has been dis­cussed and theorized among authors. Many ante­rior exenterations in female patients mandate en bloc posterior vaginectomy. Theoretically, the main technical impediment with the taTPE approach is the difculty in maintaining pneumo­pelvis when the posterior vaginal wall has been excised, because the transanal TAMIS port cannot close the entire perineal defect. As such, the peri­neal approach, with or without sphincter preser­vation, can be potentially performed posteriorly and laterally, leaving the tumor and specimen pedicled on the anterior attachments to the poste­rior wall of the vagina. Additionally, care should be taken to ensure preservation of the autonomic nerves that coarse along the lateral vagina, if oncologically permissible. Once the perineal dis­section is communicated posteriorly and laterally to the abdominal dissection, the abdominal team can also continue the abdominal dissection to the level of the cephalad limit of the intended vagi­nectomy. The vaginectomy can then be performed transvaginally and transperineally into the vaginal vault and circumferentially around the area of the vagina involved. If the anus is preserved, the pos­terior wall of the vagina can be closed with or without added reconstruction. If the anus is not preserved, a myocutaneous ap can often be per­formed to reconstruct the posterior wall of the vagina and the perineum. If an en bloc hysterec­tomy is intended, a standard approach to hysterec­tomy can be performed with the anterior dissection continued along and through Morrison’s pouch to communicate with the vaginal vault. Care must be taken to avoid injury to the bladder and urethra anteriorly during this dissection.