OBJECTIVE: To investigate the modified transabdominal approach laparoscopic surgery for adrenal cortisolism and its safety and effectiveness. METHODS: There were 18 patients in this group, 8 males and 10 females, aged 18~57 years, mean age 32.5 years, tumor located on the left side in 10 cases and on the right side in 8 cases, tumor diameter 1.5~3.0 CM. All cases had a history of hypertension, disease duration 0.5~10 years, typical Cushing syndrome manifestation in 15 cases, atypical manifestation in 3 cases, ultrasound, CT/MRI and endocrine examination were performed before surgery. All 18 patients underwent modified transabdominal approach laparoscopic adrenal adenoma resection or total adrenalectomy on the affected side. The methods were as follows: the patients were placed in a healthy oblique position with the back at a 70o angle to the bed and the lumbar pad elevated. A small 1 cm incision was made at the intersection of the umbilicus and anterior superior iliac spine with the anterior axillary line, and a 10 mm Trocar was inserted to create an artificial CO2 pneumoperitoneum at a pressure of approximately 13-15 mm Hg, and a 30o speculum was placed. Under laparoscopic surveillance, a 5 mm and 10 mm Trocar were inserted as the second and third puncture holes at approximately 1 cm and 7 cm below the midclavicular line rib margin on the operated side, respectively. A fourth puncture hole was created in the mid-axillary line under the costal margin for retraction of the liver or spleen. The lateral retroperitoneum and the superior renal pole fascia were incised transversely, and the perirenal fascia was lifted and bluntly separated. The golden adrenal tissue can be successfully located by separating along the perirenal fascia. The superior and inferior adrenal arteries are revealed and cut with an ultrasonic knife. The central adrenal vein is separated and cut with a double titanium clamp or Hemolock clamp, and the adrenal gland is removed. If the adenoma is simple, the tumor is located and then isolated with an ultrasonic knife to stop the bleeding and remove the tumor. After rinsing and cleaning the surgical area, the adenoma or adrenal gland was placed in a specimen bag, removed through the first puncture hole, and a drainage tube was placed. RESULTS: The procedures were successful. One case of postoperative adrenal crisis was detected and treated promptly and recovered well. The rest of the patients had no serious complications and recovered well. At follow-up from 12 months to 30 months, blood pressure returned to normal in 10 cases, 8 patients still required antihypertensive drugs, but the type and dose of antihypertensive drugs were reduced compared with those before surgery, all patients had disappeared external manifestations of Cushing’s syndrome, and no recurrence was seen on repeat ultrasound and CT. Conclusion: 1. Patients with cortisolism are relatively obese, with a lot of fat around the adrenal glands, and the glands are sometimes difficult to detect, and the 70o lateral position is chosen for the transabdominal approach, which is effective; 2. The 1st hole camera of this procedure is far away from the surgical operation field, which avoids the interference of mutual collision with the instruments, and the puncture hole is almost located at the highest point of the abdominal cavity, with a large space for activity and far away from the intestine, so it can effectively prevent the camera The camera is located at almost the highest point of the abdominal cavity, with more space for movement and farther away from the intestine, so it can effectively prevent the friction between the camera and the intestinal wall and avoid postoperative intestinal wall edema leading to impaired intestinal evacuation; 3. The operating instruments of the 2nd and 3rd perforation holes can directly reach the adrenal gland with the shortest distance and make the adrenal gland directly face the operating channel, which can directly expose the adrenal blood vessels and can be clearly separated and cut off one by one when freeing the adrenal gland and reduce intraoperative bleeding; 4. A safe and effective method.