© 2013 Springer-Verlag London. All rights reserved. Adrenal surgery has been an operative niche shared by urologists and general surgeons. Traditionally, adrenal surgery has provided extirpative options for adrenal tumors, including those suspicious for adrenal cortical carcinoma, functional adrenal adenomas, and cases where metastectomy of adrenal lesions were targeted. With the advent of laparoscopy, minimally invasive surgical access to the adrenal glands forged ahead, beginning with its first report in 1992. The anatomic position of the adrenals located within the upper retroperitoneum inspired surgeons to further expand upon traditional transperitoneal laparoscopy and explore the retroperitoneoscopic approach.