We describe the steps for laparoscopic anterior resection with colovesical fistula takedown. The patient is positioned supine in lithotomy. Laparoscopic access is obtained followed by mobilization of the sigmoid and descending colon. The rectum is then mobilized in the retrorectal space. The sigmoid colon is dissected free from the bladder followed by intracorporeal division of the mesentery. The bladder is tested for leaks and the specimen is extracted. Finally, a stapled colorectal anastomosis is performed.