Purpose: Transanal Minimally Invasive Surgery (TAMIS) is a viable technique for local excision of rectal lesions, offering improved access, specimen quality and recurrence rates compared to traditional methods. While most published data are from tertiary centres, this study evaluates the outcomes of TAMIS performed at a regional New Zealand hospital. Methodology: A retrospective analysis was conducted on all patients who underwent TAMIS at Tauranga Hospital between December 2014 and October 2025. Demographic, operative, histopathological, morbidity and 30-day mortality data were collected. Complications were classified using the Clavien–Dindo system. Results: Sixty five patients (mean age 69; 69% male) underwent TAMIS over the study period. The mean resection size was 41×29mm. Histological diagnoses included adenomas (n=35), adenocarcinomas (n=20), carcinoid tumour (n=1), gastrointestinal stromal tumour (n=2), benign scar tissue (n=6) and rectal prolapse (n=1). R0 resection was achieved in 97% of polyps and 85% of adenocarcinomas. The mean length of stay was 1.5days. Complications of Clavien–Dindo grade II occurred in 11.0% and grade III in 6%, with postoperative haemorrhage being most common. One mortality occurred within 30 days postoperatively (1.6%). None of the adenocarcinoma patients developed recurrence; two (6%) patients had recurrent adenomas both successfully managed with local treatment. Conclusion: TAMIS can be performed safely and effectively in a regional centre, providing acceptable morbidity and mortality rates for a wide range of rectal pathologies.