Background:
We evaluated the results of the up-to-dated literature and compared, in our experience, the results of the laparoscopic (LA) versus open (OA) approach in the treatment of the various kind of adrenal pathology.

Material and Methods:
From 2000 to 2013 we treated 61 patients (33 female, 28 male; mean age 57, 2 bilateral adrenalectomies). We performed 33 LA with lateral transperitoneal approach (13 right;20 left) and 28 anterior transperitoneal OA (16 right;12 left). The pathologic features were: Cushing's syndrome (4), primary hyperaldosteronism (15), pheocromocytoma (14), lymphoma (1), nonfunctioning adrenal adenomas (29).

Result:
Among the immediate results a greater blood loss was evident in the OA; whereas we had a rather longer operative time in LA. There were three conversions to a laparotomic procedure (4.9%). In the postoperative period there were some pulmonary infections (6) and infection of the laparotomy (3) in the OA; in the laparoscopic group there were two parietal hematomas that cleared up spontaneously, in correspondence of a trocar access.

Conclusion:
The size of the adrenal lesions for the LA is increased in the last years, but the standard indications are for lesions no more that 8-10 cm in size and confined within the gland. The morbidity in the miniinvasive approach is much lower than the open technique due to minor surgical stress and in the LA there is a very rapid resumption of the normal activities in the postoperative course. In conclusion the laparoscopic adrenalectomy with lateral transperitoneal approach is a safe and efficacious procedure.