Total mesorectal excision (TME) has been described as the optimal method of resection for rectal cancer (Br J Surg 1995). Recent reports include five-year survival rates of 70-75% and local recurrence rates of 5-8% (compared with the US and worldwide figures of 30%) in approximately 500 patients with Dukes' B and C cancers. Total mesorectal excision accomplishes a complete re-section of regional disease by sharp dissection between the parietal and visceral planes of the pelvic fascia. This video will demonstrate the operative technique of total mesorectal excision in association with both sphincter preservation and autonomic nerve preservation.