Laparoscopic adrenalectomy (LA) has become the gold standard in the operative approach to tumors of the adrenal gland. It has been 20 years since it was first described in the literature and the technique has afforded improved operative and perioperative outcomes compared to the open approach to the adrenal gland. These include improved cosmesis, less post-operative pain, and reduced morbidity, and have allowed patients to be discharged from hospital earlier and return to normal activity. LA has been proven to be safe and effective when dealing with functioning and non-functioning adrenal incidentalomas, pheochromocytoma, and Cushing’s and Conn’s syndrome, and has even been used for primary and secondary adrenal malignancies. Here, we describe the laparoscopic transperitoneal approach to the adrenal gland and its evolution since its inception.