The restorative proctectomy performed by laparoscopic-transanal pull-through without service laparotomy (LTPT) has recently had sporadic reports. This method, ideal to minimize the surgical trauma and contamination of the operative field, has received contra stating judgements because of the referred reconstructive difficulties. The purpose is to explore the feasibility and the possible systematic adoption of LTPT with colo-Pouch-Ano Anastomosis (CPAA) in lower rectal cancer and to evaluate the early results. Between January 2002 and July 2003, 24 out of 38 primary mid-lower rectal cancers (<10 cm from the anal verge) curatively resected, have had a laparoscopic indication; 13 of them were cancers of the LR (<6 cm from the s.v.): LTPT could be employed in ten cases. Two of them required service minilaparotomy (due to the excessive volume of the specimen or for suspect insufficient colonic vascularization). One procedure required conversion. Among LTPT's, 6m and 4F, with a mean age of 58 years (range 44-79), six received preoperative radio-chemotherapy, and five cover ileostomy. The perspective results collected have been compared with those of 12 similar procedures (non-pull through) in the same period. The results where that there was no operative mortality. The morbidity includes 1 anastomotic failure (covered by ileostomy) and a transient hemorrhagic gastropathy in the LTPT group. At the 8-months follow-up (range 2-21), 3 patients out of 8 presented incontinence (1 moderate, 2 mild), while 4 of 6 wore a pad for more than six months. No relapses occurred. In conclusion, for cancers of the lower rectum with indication to laparoscopy, the LTPT with CPAA procedure appears reproducible and appropriate. Further experiences and extended controls are necessary to evaluate its steady-state efficiency.