Open lymph node dissection has become the gold standard for the treatment of lymph node metastasis in the inguinal region of penile cancer, which has largely improved the prognosis of patients. However, open inguinal lymph node dissection has a large incision and is prone to postoperative complications such as flap necrosis, lymphatic leakage, lymphatic cysts, delayed healing or even non-healing, which greatly increases the pain of patients. . Recently, some domestic and foreign scholars have reported laparoscopic inguinal lymph node dissection, which largely reduces postoperative complications and improves patients’ quality of life while ensuring surgical results. The patient, a 56-year-old male, was admitted to the hospital with the main reason of “finding a swelling in the coronary groove of the penis with pain for more than 2 weeks”. Two weeks ago, the patient found a hard mass of about 0.5 cm in diameter on the dorsal side of the coronary sulcus of the penis. 5 days ago, the patient underwent circumcision + penile mass excision in an outside hospital. Later, the patient consulted our hospital, and our pathology department showed that high-medium differentiated squamous carcinoma of penis with infiltration of subepithelial tissue. For further treatment, the patient was admitted to our department as “post-operative penile cancer with bilateral inguinal lymph node enlargement”. Auxiliary examination: ultrasound showed multiple enlarged lymph nodes in the inguinal region bilaterally, with a maximum of 2.35cm×0.76cm on the right side and 1.48cm on the left side, with a regular shape and blood flow signal. Routine blood and biochemical examinations did not show any abnormalities. The patient was given oral antibiotics for two weeks before surgery, followed by “laparoscopic bilateral inguinal lymph node dissection” under general anesthesia.2. Laparoscopic surgery method The patient was placed in a flat position after general anesthesia, and the thigh on the operated side was flexed and externally rotated (Figure 1). The towel was routinely disinfected and spread. A small incision of 2 cm below the left femoral triangle was made, and the fingers were separated along the Scarper’s fascia (Figure 2). A 10-mm trocar is placed, the pressure is injected to 14 mmHg, the laparoscope is introduced, and a 10-mm and 5-mm trocar are punctured on each side under surveillance to determine the extent of clearance with finger pressure and light from the end of the lumpectomy lens (Figure 3). The ultrasound knife and separator forceps were introduced to clear the lymphatic adipose tissue from the deep side of Scarper’s fascia to the fascial surface, superiorly to 3 cm above the inguinal ligament, laterally to the broad fascia, medially to the vastus medialis, and inferiorly to the tip of the femoral triangle. The saphenous vein was severed after Hemolok clamping, and the small vessels and lymphatic vessels were dissociated after Hemolok clamping. The femoral arteriovenous sheath was opened and the lymphatic adipose tissue in the oval fossa was cleared, and the saphenous vein was cut at the point where it converges into the femoral vein with Hemolok clamping. The extent of clearance was consistent with that of open surgery, and the visualization was clear (Figure 4). The cleared lymphatic adipose tissue was removed and sent for pathology (Figure 5). Two F10 porous drains were left in place and connected to negative pressure suction, and the incisions were sutured after counting the gauze instruments. The right inguinal lymph node was cleared in the same way. II. Results The patient had a smooth operation, with an operating time of 120 min on the left side and 110 min on the right side, with intraoperative bleeding of 50 ml, no blood transfusion was given, and no intermediate opening. On the first postoperative day, the patient was ventilated and got out of bed, given a semi-liquid diet, and gradually transitioned to a normal diet. The urinary catheter was removed on day 2 and the patient was discharged successfully after surgery. At follow-up, there were no surgery-related complications and no obvious signs of recurrence. Postoperative pathology showed: (left inguinal lymph node): reactive hyperplasia was seen in lymph nodes (0/11), and no metastatic cancer was seen. (Right inguinal lymph node): reactive hyperplasia and steatosis were seen in lymph nodes (0/22), and no metastatic cancer was seen. Through the diagnosis and treatment experience of this patient and review of related literature, the authors concluded that laparoscopic surgery can achieve the same range of lymph node dissection as open surgery, and can significantly reduce postoperative complications and achieve good tumor control, which is a more promising minimally invasive treatment than traditional open surgery and is worth promoting and applying. At the same time, we also got some experiences and insights: (1) When establishing the operation space, the separation and expansion was performed at the Scarper’s fascia layer to separate all the fat down instead of hanging over the operation field, which not only ensured the operation field and space, reduced the difficulty of the operation, and facilitated the smooth operation, but also ensured the blood supply of the flap and reduced the possibility of skin necrosis after the operation. (2) The gas injection pressure was 14 mmHg when the operating space was established and the puncture cannula was placed, and the gas injection pressure was subsequently adjusted to 12 mmHg to reduce the possibility of subcutaneous emphysema. (3) Lymphatic adipose tissue was cleared from the deep side of Scarper’s fascia to the fascial surface, with the upper border to 3 cm above the inguinal ligament, lateral to the broad fascia, medial to the vastus medialis, and inferior to the tip of the femoral triangle to ensure thorough lymph node clearance. (4) Preoperatively, the surgical range is marked on the skin surface with a marker, and intraoperatively, intermittent finger pressure can be applied to the skin boundaries on the surface to assist in localization and ensure the extent of clearance. (5) Intraoperatively, rapid pathological examination of inguinal lymph nodes is performed, and if tumor metastasis is found, pelvic lymph node dissection is performed at the same time. (6) Two drains are placed on each side to ensure postoperative drainage. It is recommended to place thicker drainage tubes to avoid blockage, such as F18 or F20 drainage tubes. (7) The patient should be advised to minimize bed activity for one week after surgery, and an elastic bandage should be applied to the groin to reduce the possibility of flap floating. (8) The postoperative drainage tube is connected to negative pressure suction, which can ensure drainage and reduce the possibility of flap floating at the same time. (9) The need for follow-up radiotherapy should be decided according to the pathological results after surgery. (10) Preoperative anti-inflammatory treatment is given for two weeks to exclude inflammatory lymph node enlargement. In conclusion, laparoscopic inguinal lymph node dissection is safe and feasible, which not only ensures the extent of lymph node dissection and achieves the same tumor treatment effect as that of open surgery, but also can largely reduce the postoperative complications of traditional open surgery, and is worth promoting.