Our traditional resection of low rectal cancer is often performed by combined abdominoperineal resection (APR), which has been widely performed worldwide for nearly a century and has saved many patients with low rectal cancer. However, studies in recent years have found that APR has a high recurrence rate of local rectal cancer, mainly due to the inadequate extent of resection, a significant narrow “surgical waist” of the resected specimen, a high positive rate of residual tumor at the cut edge, and the tendency of rectal tumor perforation during surgery, leading to tumor implantation and recurrence. In response to the inherent shortcomings of APR, Prof. Holm, who has long been devoted to this research, proposed the surgical method of “combined columnar ventral perineal resection”, which includes the entire anal raphe, rectal mesentery and anal canal, and the specimen is cylindrical in shape without a narrow waist, which obviously reduces the positive margin rate and the intraoperative rectal tumor perforation. Holm later pointed out that this procedure is more appropriately called combined extra-anal lift abdominal excision (ELAPE). It significantly increases the amount of surrounding tissues removed and reduces the chance of tumor residual and intraoperative rectal tumor perforation, thus greatly improving the curability of the tumor, which has obvious advantages over traditional surgery. However, the operation of ELAPE requires certain skills. Unlike the lithotomy position of traditional surgery, ELAPE surgery is better in the prone folding position when performing perineal surgery, which can effectively improve the operative field, look down on the operative field and complete the operation under direct vision, with clear hierarchy and fine operation, reducing neurovascular accidental damage, increasing tumor resectability and ensuring the safety of the operation. And when abdominal surgery is combined with laparoscopic minimally invasive technology, it can greatly reduce the trauma of surgery, reduce the pain of patients, and realize the organic combination of radical and minimally invasive, which brings great benefits to the majority of rectal cancer patients. At present, we perform radical surgery for low rectal cancer by laparoscopic transanal raphe extra-abdominal combined perineal excision (ELAPE), which is not only less traumatic but also completely radical. Our laparoscopic ELAPE is performed without a huge incision in the abdomen.