Laparoscopic TME is a technically demanding procedure. After initial hesitation regarding oncological safety and technical feasibility, increasing experience and better instrumentation have enabled progressive uptake of this technique by experienced laparoscopic colorectal surgeons. Most of the evidence for laparoscopic TME is from prospective or retrospective case series; it weighs heavily in favor of the laparoscopic approach. Currently, two major multicenter RCTs are being conducted in the Europe and the United States: the COLOR II trial and the ACOSOG-Z6051, respectively. Both these trials are designed to compare laparoscopic versus open resection for curable rectal cancer and it is envisaged that their results will provide vital information regarding the practice of laparoscopic rectal cancer surgery. Laparoscopic surgery for colon cancer has been well proven by randomized studies to benefit patients with better postoperative outcomes and comparable long-term oncologic outcomes. Using total mesorectal excision (TME) for rectal cancer can achieve rates of local recurrence well below 10%. Laparoscopic TME surgery is associated with very low mortality and low anastomotic leak rates with similar preservation of pelvic autonomic nerve function to open surgery. Training programs similar to those used for open TME need to be implemented for laparoscopic TME with an ongoing commitment to audit surgical and oncologic outcomes in all units undertaking this surgery. Robots provide freedom of 360o movements and three dimensional high quality images. Cost and availability may be the rate limiting steps for greater uptake of this technique.