Laparoscopic anterior resection is a technically demanding procedure with a steep learning curve. In expert hands, this procedure has a place in the operative armamentarium for the treatment of benign disease. Its application in the treatment of rectal carcinoma is more difficult to address. The evidence available suggests that laparoscopic anterior resection is a feasible and appropriate option for the treatment of rectal carcinoma. The skill and technology to perform the procedure are developing apace, and level 1 evidence to support its use is tantalizingly close. In this paper, we outline the development of the procedure, the operative approach, and the available evidence for its use in the treatment of rectal carcinoma.