AIM: Rectal neoplasm excision is a challenging issue in gastrointestinal endoscopy and surgery. This technical note describes a hybrid method for the excision of challenging rectal neoplasms. METHOD: The procedure consists of the combined use of classic endoscopy and transanal endoscopic microsurgical instrumentation for full-thickness removal of a recurrent rectal polyp in a patient who had previously undergone endoscopic excision of a Tis rectal adenocarcinoma, located behind the valve of Houston and 9 cm from the anal verge. RESULTS: The lesion was removed completely in 50 min with no operative complication. The patientʼs postoperative course was uneventful, and she was discharged after 5 days. Pathological examination of the specimen confirmed complete resection of the lesion with adequate disease-free margins. CONCLUSION: Hybrid transanal endoscopic microsurgery successfully combines the precision and flexibility of classic endoscopy with the radicality and safety of transanal endoscopic microsurgery for the treatment of demanding benign or early-stage malignant rectal tumours.