The incidence of renal tuberculosis has been on the rise in recent years, and due to the extremely low rate of early diagnosis, most of the tuberculosis has progressed to multiple abscess formation in the renal cortex, involvement of the collecting system, or complications of ureteral tuberculosis lesions, which in turn accumulate in the bladder by the time of clinical diagnosis. The selection criteria for posterior laparoscopic nephrectomy for TB kidney cases are basically the same as those for open surgery, and all patients should routinely undergo IVU, nephrogram and CT of the upper abdomen before surgery to understand the lesions of the affected kidney and the function of the contralateral kidney, and to clarify the indications for surgery. For patients with severe kidney destruction or loss of kidney function, or complicated ureteral tuberculosis, tuberculous kidney should be removed. Due to the long duration of tuberculous kidney, it is often accompanied by severe perinephric inflammation, extensive adhesions between the perinephric fat and the kidney tip, more pus in the affected kidney, high pressure, and thin cortex, which can easily cause tearing of the kidney envelope and lead to extravasation of pus during laparoscopic freeing, especially when blunt separation is used. Moreover, the extensive adhesions at the perinephric and renal tissues, the disturbance of normal anatomy, the difficulty of laparoscopic separation, the high bleeding, and the high rate of surgical conversion to open were once considered as relative contraindications to laparoscopic surgery. With the advancement of laparoscopic technology and the improvement of surgeons’ surgical experience and skills, more and more reports indicate that posterior laparoscopic nephrectomy for tuberculosis has the advantages of less trauma, less bleeding, and faster patient recovery compared with open surgery, and may now be the preferred method for removal of non-functional tuberculous kidney. A variety of routes are available for laparoscopic nephrectomy, such as extrafascial perinephric resection similar to radical nephrectomy for renal cancer, extrafascial resection with preservation of the perinephric fascia in the perinephric fat capsule, simple nephrectomy with incision of the renal fat capsule free on the surface of the kidney, and subperitoneal nephrectomy as reported by Zhang Xu et al. Perinephritis of renal tuberculosis is characterized by heavier inflammation the closer to the surface of the kidney and less inflammation away from the kidney. However, the perinephric fascia is heavily adherent to the peritoneum due to inflammatory stimulation, making it difficult to separate, and there is a risk of peritoneal rupture contaminating the peritoneal cavity by forcible separation, so separation at this level is not recommended. Foreign scholars have also reported freeing immediately outside the renal peritoneum. The author found that it is relatively easy to choose to separate in the relatively non-vascular gap between the perirenal fat capsule and the perirenal fascia, and although there are adhesions, it is not difficult, and in case of serious adhesions, cutting with an ultrasonic knife close to the fat capsule of the kidney can effectively keep the surgery in this gap. The separation should be done with patience and careful dissection, and generally the intact kidney and the encapsulated fat capsule can be freed. Moreover, the perinephric fascia and peritoneum, which are thickened by long-term inflammatory stimulation on the ventral side, are generally not easily penetrated, and this level is convenient to do a slightly blunt freeing to reduce the risk of intra-abdominal intestinal and other side injuries. Moreover, there is still a certain distance between this gap and the kidney, which is not easy to damage the renal parenchyma during surgery and avoid the spillage of intrarenal cheese-like material and contamination of the surgical area. Moreover, after entering the perirenal fascia at the beginning of the operation, a “tunnel” is first separated at this level, and it is not too extensive to separate the renal vessels and then further expand the separation at this level. If the vessels are treated and then separated at this level, it is not easy to separate them because of the pneumoperitoneum pressure. The separation and treatment of the blood vessels at the renal hilum is a difficult and critical part of nephrectomy for tuberculosis. In addition to the conventional methods, a careful preoperative review of the renal artery in relation to the enlarged lymph nodes at the hilum can help to find the renal artery quickly. In addition, because the tissue at the hilum is more brittle and prone to bleeding due to long-term inflammation, it is generally inappropriate to do too much blunt separation here, and the ultrasonic knife is usually used to do sharp freeing. For those whose lymph node obstruction affects the separation, the ultrasonic knife transects the lymph node if necessary, or carefully separates and searches at its proximal end (renal artery trunk) or distal end (renal artery into renal branches). Despite the difficulties, the renal artery was successfully isolated in all cases in this group except for two cases in the early stage where the separation failed to open in the middle of severe bleeding. The renal vein is more difficult to separate than the artery because it is deeper and more obviously affected by inflammatory stimulation, and in three cases in this group, the renal vein and surrounding tissues were cut off using a linear cutter after the kidney was completely free. The author suggests that, for the sake of surgical safety and to prevent tearing and bleeding of the renal vein during separation, the linear cutter, although more expensive, may be an ideal choice in some cases. Maintaining the integrity of the specimen intraoperatively is important for the prevention of TB dissemination and incisional healing. In addition to separating the specimen under the perinephric fascia as much as possible, away from the surface of the kidney to prevent accidental injury to the kidney and titanium clips at the end of the ureter, care should be taken when removing the specimen, extending the incision to an appropriate size, and not neglecting the principle of asepsis in the pursuit of “minimally invasive”. This procedure uses the gap between the perirenal fat and perirenal fascia to avoid perirenal adhesions, which saves surgical time and is less likely to accidentally injure the kidney and peritoneum. The present data suggest that this procedure is less bleeding, less likely to damage the surrounding organs, especially suitable for inflamed kidney with severe adhesions, and can ideally free the tuberculous kidney with severe adhesions, further broadening the indications for laparoscopic treatment of renal tuberculosis. We believe that posterior laparoscopic tuberculosis nephrectomy is an ideal surgical treatment for tuberculosis nephrectomy because it is less traumatic, faster recovery, and does not cause more surgical complications than open surgery.