Of all the laparoscopic surgical techniques that have been developed in recent years, laparoscopic adrenalectomy has become one of the most preferred methods for excising adrenal lesions. The purpose of this study was to investigate and compare the results of 2 different approaches to adrenalectomy-retroperitoneal laparoscopic adrenalectomy and open adrenalectomy-through a retrospective review of case reports for 53 patients. Thirty-two retroperitoneal and 21 open laparoscopic adrenalectomies were performed between June 1999 and December 2006. The groups were matched for age (in years; p=0.516) and body mass index (in kg/m²; p=0.269). The mean tumor sizes were 54.0 mm (16~130) and 45.4 mm (13~80) in the retroperitoneal laparoscopic and open adrenalectomy groups, respectively (p=0.086). The affected adrenal glands were successfully removed. An open surgical procedure became necessary in one of the retroperitoneal laparoscopic patients because of severe adhesion to retroperitoneal fat. Retroperitoneal laparoscopic adrenalectomy was found to be better than open adrenalectomy in terms of estimated blood loss (141 vs. 202 ml; p=0.039), duration of postoperative hospitalization (6.2 vs. 8.8 days; p=0.001), time to return to oral intake (1.2 vs. 1.7 days; p=0.005), time to ambulation (1.2 vs. 1.4 days; p=0.013), and time to drain removal (3.7 vs. 4.7 days; p=0.001). No statistically significant difference in operative time (115 vs. 128 minutes; p=0.61) was observed. Laparoscopic adrenalectomy was safe and effective for removal of almost all of the adrenal lesions and was associated with early oral intake, early ambulation, and a low number of hospitalization days.