With increasing experience, laparoscopic techniques have been applied even to extended colorectal operations as restorative proctocolectomy in ulcerative colitis and familial adenomatous polyposis. After initial medial transection of the three main vascular pedicles, the colon is dissected free laterally, from the sigmoid orally towards the ileum. The rectum is mobilized down to the pelvic floor. Over a Pfannenstiel incision, the bowel is extracted and the pouch is created. The anastomosis is completed in double-stapling technique. At two departments, 27 patients have been operated on. The median time of operation was 320 min (180-540). The median length of hospital stay was 8.1 days. There was no postoperative mortality. The complication rate was similar to conventional surgery at the same institutions. Three patients had to be re-operated on, two for ileal obstruction close to the pouch, one patient for bleeding from the pouch. In restorative proctocolectomy, laparoscopic techniques prove to be safely feasible. They have the potential to become an appealing alternative to open surgery.