Lateral pelvic lymphadenectomy (LPLD) is routinely performed in advanced lower rectal cancers in Eastern countries, whereas in the western world it has not progressed to a frequently performed technique because of the adoption of Total Mesorectal Excision that contributed to decrease local relapses. LPLD consists of a complete dissection of the endopelvic fascia together with the rectum and mesorectum. This video presentation shows a bilateral pelvic lymph node dissection in a low rectal cancer.