Lateral pelvic lymph node metastasis was an major cause of locoregional recurrence of mid-low rectal cancer. Although long-term benefit of routine lateral lymph node dissection has not been proved by randomized controlled trial, retrospective studies have shown its efficacy in lowering local recurrence and increasing survival rate in patients with lateral lymph node metastasis. Recently, laparoscopic total mesorectal excision surgery was performed in patients with advanced low rectal cancer, followed by selective unilateral or bilateral lateral lymph node dissection based on pretreatment imaging after preoperative chemoradiation. This technique is safe and feasible with favorable short-term results. We will discuss it in this paper.