The rate of lateral lymph node metastasis for rectal cancer located below the peritoneal reflex and invading the whole intestinal wall is about 20%, so in principle, lateral lymph node dissection should be performed for rectal cancer and anal canal cancer located below the peritoneal reflex. Lateral lymph node dissection can improve the 5-year survival rate by about 9% and reduce the local recurrence rate by about 50%. The advantage of laparoscopy is that it can enlarge the surgical field, but the procedure should be performed with proficiency in open surgery and laparoscopic techniques. We recently performed this procedure under the careful guidance of Prof. Sanyuan Hu, as shown in the intraoperative pictures.