With the increasing improvement of laparoscopic instruments and techniques, most urological surgeries can be completed laparoscopically, especially for the treatment of adrenal diseases. Traditional open adrenal surgery has the disadvantages of large trauma, poor visualization, bleeding, and slow postoperative recovery. Laparoscopic adrenal surgery has many advantages that cannot be compared with traditional open surgery: minimally invasive, less bleeding, less postoperative pain, shorter operation time, faster postoperative recovery, fewer complications, beautiful wounds, and high patient satisfaction rate, so laparoscopic adrenal surgery has become the gold standard for the treatment of adrenal diseases. Indications for laparoscopic adrenal surgery are primary aldosteronism, cortisolism, non-functioning adenoma of the adrenal cortex, pheochromocytoma, and teratoma. There are conflicting views on the laparoscopic surgical treatment of primary adrenal malignancies. Most people believe that primary adrenal malignant tumors have thin envelopes and large tumors, which are prone to rupture during operation and lead to tumor implantation and metastasis, and infiltrating malignant tumors are not easy to be excised cleanly, so laparoscopic surgery should be used cautiously for primary adrenal malignant tumors. For experienced urological cavity surgeons, laparoscopic surgery is also an option, but the following conditions should be excluded: tumor volume does not exceed 10~12 cm, no serious adhesions with surrounding, no invasion of surrounding organs, and no lymphatic infiltration. Single metastatic adrenal carcinoma is usually confined to the adrenal envelope, and laparoscopic surgery can be considered if there is no infiltration, no surrounding lymphatic or other organ metastasis outside the adrenal gland. At present, posterior laparoscopic adrenal surgery is considered to be an alternative to most open adrenal surgeries. There are several approaches to laparoscopic adrenal surgery, including anterior transabdominal, lateral transabdominal, posterior retroperitoneal, and transthoracic diaphragmatic pathways. Currently, the lateral transabdominal and lateral retroperitoneal approaches are most commonly used. The transabdominal approach has the following advantages: large operating space, clear visualization, and obvious anatomic markings; the disadvantages are the long operating distance, inevitable harassment of the abdominal cavity, and possible damage to the intra-abdominal organs. Compared with the abdominal approach, the retroperitoneal approach is often considered to have a small operating space, unclear anatomical levels, and more complex and time-consuming operations. However, because urologists are more familiar with the retroperitoneal anatomy, the retroperitoneal approach is more acceptable to urologists. The retroperitoneal approach is safe, less peritoneal irritation, less harassment of the abdominal organs, more direct separation of the adrenal glands, less risk of abdominal organ damage, and a history of previous intraperitoneal surgery and infection can still be used. However, the specific surgical approach should be determined by the patient’s specific situation (characteristics of adrenal tumor, tumor size, patient’s weight) and the operator’s habit. In our group, all 401 cases were operated by retroperitoneal approach, and all the remaining 396 cases were operated successfully except for 5 cases that were converted to open. For obese patients, the retroperitoneal approach is more advantageous than the transabdominal approach. In overly obese patients, the transabdominal approach is very difficult to operate due to excessive abdominal fat, and laparoscopic adrenal surgery is often difficult. In contrast, it is relatively easy to reveal and operate the adrenal tumor in the retroperitoneal approach, and the obesity has relatively less influence on the retroperitoneum, and the operation time is significantly shortened. In this group, there were 56 obese patients, including 37 cases of cortisol adenoma. If the operation is affected by excessive fat, the fat affecting the visual field can be removed by ultrasonic knife. If it is still difficult to reveal, a 5mm trocar can be added if necessary to help reveal. Using the above methods, all 56 obese patients in this group were operated successfully. 19 patients with pheochromocytoma were prepared by taking phenazopyridine hydrochloride 2 weeks before surgery, and the blood pressure did not fluctuate greatly during the operation, and the operation was smooth. At present, there is no definite conclusion on the maximum volume of adenoma that can be suitable for laparoscopic adrenal tumor resection. With the continuous development of laparoscopic instruments and techniques, the volume of laparoscopic resection of adrenal tumors is getting larger and larger, and there are reports of laparoscopic resection of adrenal tumors up to 15 cm in diameter. At present, it is recognized that laparoscopic adrenal surgery is suitable for tumors less than 6~8 cm in diameter. adrenal tumors with excessive volume should be carefully controlled and the operator should have rich experience in laparoscopic surgery, no serious adhesions between the tumor and the surrounding area, no invasion of surrounding organs and no lymphatic infiltration. In this group, there were 19 cases of adrenal adenoma >5cm in diameter, except for one case of adrenal sarcoma which was converted to open surgery due to bleeding, the remaining 18 cases were operated successfully, and the size of tumor is not absolutely contraindicated under skilled laparoscopic technical support.