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The choice in between the laparoscopic lateral transabdominal (LTA) or the posterior retroperitoneoscopic (PRA) approach for adrenalectomy is usually based on surgeon's preference, rather than on objective arguments. We compared the intraoperative and postoperative outcomes of LTA and PRA to determine whether there is a preferable approach.Thirty-eight consecutive patients successfully underwent PRA for benign adrenal tumors ≤6 cm. A case-control study including 38 patients who successfully underwent LTA was performed. Operative time, intraoperative ventilatory parameters (CO2 production [Vco2], whole body oxygen consumption, arterial partial pressure of carbon dioxide [Paco2], and arterial partial pressure of oxygen [Pao2]), final histology, complications, postoperative stay, analgesic requirement, time to regain normal bowel function, and time to return to work were recorded and compared between the 2 groups.The 2 groups did not differ in terms of operative time, analgesic requirement, time to first flatus, complication rate, duration of postoperative stay, or final histology. Patients in the LTA group showed significantly lower Paco2, Pao2, and Vco2 at the end of the operation. Patients in the PRA group experienced a significantly faster return to work.No procedure can be considered preferable overall. In cases of bilateral adrenalectomy and previous abdominal surgery, PRA may offer some advantages. Surgeon's preference and experience will continue to guide this choice.