The transabdominal transmural interosseous rectal resection was originally introduced by Lyttle and Parks, and was originally designed for anal resection in patients requiring total colon and rectal resection due to inflammatory bowel disease, in which only the internal sphincter of the rectum was removed while the external sphincter of the rectum and surrounding tissues were preserved, thus avoiding long-term non-healing of the perineal incision. It is mainly used for the treatment of low rectal cancer without invasion of the internal anal sphincter, low malignancy rectal tumors and benign rectal tumors, and also for the treatment of rectal cancer in a slightly higher position with special pelvic stenosis. Surgery: The abdominal surgery for patients undergoing internal and external sphincter resection is the same as the conventional colon and rectal free. The procedure is performed in the lithotomy position and follows the TME principle. Because of the low position of the tumor, it is necessary to cut the vessels at the root of the inferior mesenteric artery and, in the case of patients with tumors, to clear the lymph nodes at the root of the mesentery. The pelvic surgery team cuts down the sacrorectal ligament and part of the levator muscle to reach the upper edge of the external anal sphincter ring, which corresponds to the level of the dentate line (recto-anal junction). In some thin patients, the sphincter ring and the wall of the intestinal canal (internal sphincter) can be removed by 1 to 2 cm, and the operation is divided into total and partial resection of the internal sphincter according to whether the internal sphincter is completely removed. In the case of complete removal of the internal sphincter, the skin and subcutaneous tissues are incised and the gap between the internal and external sphincters is found, and the two muscles are wrapped by the muscle membrane. In the case of partial resection of the internal sphincter, the hypertrophied internal sphincter was cut vertically at the intended resection level to reach the internal and external sphincter gap and then sharply peeled proximally. The proximal dissection reaches the level of the dentate line, and then continues upward to the point where the levator muscle meets the internal sphincter to join the pelvic surgery group. The ISR procedure even has the potential to break through the 2-cm distal margin, and its results are essentially the same as those of the mile’s procedure, although, of course, the number of reported cases is not large and strict case selection should be emphasized. In addition, there are many recent reports of lumpectomy and robotic ISR surgery, which also represent a way of thinking for future surgical exploration.