Abdominal access was gained with a 5mm port. A rectotomy was made in the posterior rectum 3 cm above the dentate line. The retrorectal space was dissected using a dilating balloon to open the retrorectal space while visualized through the laparoscope. The flexible endoscope was introduced through dissected space and into the peritoneal cavity under direct vision. The appendix was ligated and transected using endoscopic tools. The appendix was extracted through the rectotomy. The rectotomy was closed under direct vision using interrupted absorbable suture. Tranrectal endoscopic appendectomy is a feasible operation using current instrumentation.