A 51 year old female who, despite chemoradiotherapy for anal canal carcinoma, presented with a 3 cm ulcerated firm lesion at the dentate line, invading the sphincters. After mechanical/antibiotic bowel preparation and preoperative antibiotic prophylaxis, the patient was placed in the supine modified lithotomy position, bilateral ureteric catheters were placed and the abdomen, pelvis and perineum were prepped. Using 3-10 mm ports (supraumbilical, right iliac fossa, right paraumbilical), the left colon was mobilized from the splenic flexure to the pelvic floor, the inferior mesenteric artery was divided, a total mesorectal excision was performed, and the descending colon-sigmoid colon junction was laparoscopically divided. The perineal proctectomy was performed with electrocautery; the entire specimen was removed through the perineum. The pelvis was occluded to allow reinsufflation for drain placement and proper delivery of the divided bowel through the ostomy site. The perineum was closed in layers including the levators, subcutaneous tissues, and skin; the end colostomy was primarily matured. The patient had an uneventful 5-day postoperative hospitalization. Pathology revealed an invasive poorly differentiated squamous carcinoma of the anal canal extending into the muscularis propria (T2) with tumor free margins and 1/17 positive lymph nodes.