Background: The introduction of total mesorectal excision improved locoregional control for rectal adenocarcinoma significantly. Standardisation of the technique of LPLND is lacking in literature.

Methods: We describe the current practices of case selection and technical details of lateral lymph node dissection in rectal cancer. We also describe the approach when post neo-adjuvant fibrosis renders standard resection unsafe.

Results: Careful case selection and standardisation of the lateral lymph node dissection technique is important to ensure an oncologically sound and surgically procedure . Step-by-step procedures of LPLND are described in this article, and a video is demonstrated.

Conclusions: Standardisation of the techniques of lateral lymph node dissection is essential. The procedure has a definite learning curve, requiring considerable expertise to avoid complications and achieve optimal outcomes.

Keywords: Pelvic lymph node; Rectal cancer; Total neoadjuvant therapy.

© 2025. The Author(s).