Given the multiple surgical options available when performing an adrenalectomy, this chapter focuses on the benefits and challenges associated with transabdominal and retroperitoneal approaches. The chapter describes the history of laparoscopic and retroperitoneoscopic adrenalectomy, provides the technical considerations for these procedures, and offers a brief review of the literature that compares these options. Additionally, the chapter introduces multiple case scenarios with imaging and commentary to provide additional context that may help other surgeons when navigating the difficult decision about how best to approach removing the adrenal gland.