Objective:To explore the feasibility and efficacy of laparoscopic total mesorectal excision (TME) with preservation of anal sphincter for rectal cancer. Methods:From October 2001 to March 2004, 54 patients with rectal cancer underwent laparoscopic total mesorectal excision（TME) with preservation of anal sphincter. In 51 of the 54 cases, the operation was completed laparoscopically, including 14 cases of laparoscopic anterior resection (AR) with the anastomosis level above the peritoneal reflection; 20 cases of laparoscopic low anterior resection (LAR) with the anastomosis level more than 2cm above the dentate line; 16 cases of laparoscopic ultralow anterior resection (ULAR) with the level of anastomosis within 2cm of the dentate line; and 2 cases of laparoscopic coloanal anastomosis (CAA) with the level of the anastomosis at or below the dentate line. whereas conversion to an open approach was required in three cases.Results:The average operating time was 145 minutes (range 110~210min), and mean operative blood loss was 50 mL (range 30~80mL). Bowel function was restored and diet was resumed at 48 to 36 hours after operation. The average hospital stay was 9 days (range 7~14d). TME was completed successfully in 51 patients. Postoperative analgesics were used in 20 patients. No intraoperative or postoperative complications were observed.Followup time was from 6~36 months in 51 patiebts,and there was no portsite or local tumor recurrence.Conclusions:Laparoscopic TME is feasible and safe. It is a perspective technique with the benefits of minimally invasive technique and lower blood loss during operation, and rapid recovery.