Many endocrine disorders of the adrenal gland, including primary aldosteronism, Cushing's syndrome, and pheochromocytoma and malignant adrenal disease may be treated surgically with adrenalectomy (1). The large abdominal skin incision employed in past decades to achieve the large open surgical exposure—mandatory to perform adrenal surgery—was dictated by the anatomic characteristics of the adrenal, namely its retroperitoneal high location, small size, friability, and abundant delicate vascularity. For the same very anatomic reasons, minimally invasive approaches, including laparo-scopic adrenalectomy, have found rather dramatic application in the field of adrenal surgery since their first description in the early 1990s by Gagner et al. (2)

Laparoscopic adrenalectomy has achieved established status and is increasingly performed at many institutions worldwide in the majority of patients with benign surgical adrenal disease (3).

Although open surgery remains the technique of choice in patients with primary adrenal cancer, the laparoscopic radical dissection of a small, organ confined, solitary adrenal metastasis or primary adrenal carcinoma is associated with acceptable oncological outcomes (4).

Laparoscopic adrenalectomy can be performed either transperitoneally (5) or retroperitoneally (6), and 2 mm needlescopic instruments and optics may be utilized to further minimize the morbidity of conventional laparoscopic adrenalectomy (5).

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