The transanal approach for rectal resection is a promising approach, because it increases the circumferential radial margin, especially for difficult cases. Meanwhile, functional sequelae are frequent after rectal cancer surgery and are often due to neurological lesions. There is little literature describing surgical anatomy from bottom to top. We combined our surgical experience with our fetal and adult anatomical research to provide a bottom-up surgical description focusing on neurological anatomy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A148).