A modified Kraske approach was used for removal of a villous adenoma in the mid-rectum. The patient was placed in a prone position and a midline vertical incision was made over the lower part of the sacrum and coccyx. After removing the coccyx and lower part of the sacrum, the Waldeyer fascia was incised, and the rectum was exposed. After opening the rectum, the tumor was removed, the rectum was closed in two layers. The incision was closed with a suction drain. This operation describes an infrequently used, but very useful approach, to tumors of the mid-rectum.