Minimally invasive intersphincteric resection as a treatment modality for low rectal cancer is a technically demanding procedure which when performed well can lead to reasonable continence rates as well as good oncological outcomes. Advancements in minimally invasive surgery as well as improved imaging modalities and refinements in surgical technique allow sphincter preservation in most patients with low rectal cancer. While technically demanding, with a very steep learning curve, the magnification and visualization provided by both laparoscopy and robotic allow for more precise surgery deep in the pelvis. This chapter attempts to provide a comprehensive understanding of minimally invasive intersphincteric resection by reviewing the relevant anatomy, surgical considerations and technique, oncological and functional outcomes, while summarizing the current evidence available on the topic.