Background Transanal minimally invasive surgery (TAMIS) is an established technique for local excision of complex rectal adenomas and selected early rectal cancers, predominantly performed in high-volume tertiary colorectal centres. Access to TAMIS in regional hospitals remains limited, often necessitating referral. We report the early experience of introducing TAMIS within a regional colorectal unit through structured collaboration with tertiary colorectal centres. Methods A retrospective analysis was conducted of consecutive patients undergoing TAMIS for rectal lesions at a regional referral hospital. Patient demographics, lesion characteristics, operative details, histopathology, peri-operative outcomes, and short-term follow-up were reviewed. All cases were discussed at a multidisciplinary team (MDT) meeting with input from tertiary colorectal services. Results Three patients underwent a total of four TAMIS procedures, including one staged diagnostic and definitive excision. Lesions were large sessile adenomas located in the low to mid rectum. TAMIS was successfully completed in all cases without conversion to alternative surgical approaches. Final histopathology demonstrated tubulovillous adenoma with low-grade dysplasia in all patients, with no invasive malignancy identified. One patient experienced a Clavien–Dindo grade II postoperative complication following a prolonged procedure. No readmissions or early recurrences were observed during short-term follow-up. Conclusion Transanal minimally invasive surgery can be safely and effectively introduced in a regional colorectal unit when supported by structured multidisciplinary governance and collaboration with tertiary colorectal centres. This model enables delivery of high-quality, organ-preserving surgery closer to home while maintaining oncological safety and appropriate escalation pathways. Collaborative regional–tertiary networks may represent an effective strategy for improving equity of access to advanced colorectal care.