OBJECTIVE To compare the intraoperative and postoperative outcomes of laparoscopic versus open adrenalectomy for surgical adrenal disease. METHODS Prospectively collected data from 22 consecutive laparoscopic adrenalectomies, performed by one surgeon (MGH) over a period of 18 months at the Royal Alexandra Hospital, Edmonton, Alberta, were reviewed. Laparoscopic adrenalectomy was performed by both the transperitoneal and retroperitoneal approaches. In addition, a retrospective chart review was performed for all open adrenalectomies, performed at the same institution, over a 6 year period. Exclusion criteria were locally invasive lesions and masses greater than 8 cm in diameter. Adrenal pheochromocytomas were included in both groups. The two groups were evaluated with respect to intraoperative and postoperative outcomes. RESULTS Twenty-two laparoscopic and 19 open adrenalectomies were reviewed. Both groups were similar with regard to gender, age, body mass index, and ASA class. Two laparoscopic cases, both with a history of prior ipsilateral adrenal surgery, were converted to the open approach. The laparoscopic group had a longer mean operative time (171 minutes versus 104 minutes), yet had a lower estimated blood loss (146 cc versus 455 cc), blood transfusion rate (0% versus 16%), and intraoperative complication rate (5% versus 16%). Both groups were similar with regard to specimen size and pathology. The laparoscopic group required less post-operative analgesia (44 mg morphine versus 478 mg morphine), resumed a regular diet sooner (1.1 days versus 3.7 days), and had a shorter hospital stay (2.2 days versus 5.4 days). CONCLUSIONS In our experience, prior ipsilateral adrenal surgery greatly increases the risk of open conversion. This study is consistent with the findings of a number of previously reported studies, supporting the emergence of laparoscopic adrenalectomy as the standard of care for surgical management of benign adrenal disease.