Inguinal lymphadenectomy plays a critical role in the diagnosis and treatment of several neoplastic diseases. Frequently, bilateral lymphadenectomy is undertaken for staging and/or treatment of genitourinary cancers. Our objective was to determine if bilateral endoscopic lymphadenectomy could be performed simultaneously, in an effort to decrease overall anesthetic and operative time. This was accomplished by utilizing two carbon dioxide insufflators concurrently. This approach requires careful positioning of the patient, surgical team, and instrumentation, as well as special anesthetic considerations necessary to avoid severe hypercarbia. Simultaneous bilateral endoscopic inguinal lymphadenectomy is a technically feasible and efficient surgical approach.