Transanal access platforms have been an important contribution since their creation over 30 years ago, yielding high quality, full-thickness rectal resections in more proximal locations, with excellent visibility compared to classical transanal excision and some endoscopic techniques, in both benign and malignant lesions. Laparoscopic surgery has contributed to the emergence of new platforms that integrate conventional laparoscopic instruments into transanal resections reporting good initial results. These platforms are the present and future of natural orifice transluminal endoscopic surgery (NOTES). In this review we discuss about the different available platforms, their indications and results.