The adrenals are ideal candidates for laparoscopic surgery because of the associated morbidity of open surgery and their location in the upper retroperitoneum. However, the vasculature and neighbouring organs differ between the left and right adrenal glands. Therefore, profound knowledge of anatomy and delicate surgical skills is required. Whereas nowadays, laparoscopic and retroperitoneoscopic surgery are preferred in the majority of cases, open access is still recommended in large tumours or potentially malignant tumours. The benefits of robotic systems in adrenal surgery are limited but may become apparent in complex cases as for instance in partial adrenalectomy. Complete surgical excision is of paramount importance in adrenocortical carcinoma where residual disease dramatically compromises survival. Finally, ablative techniques such as radiofrequency ablation, microwave ablation and cryotherapy can be valid alternatives to surgery in small adrenal metastases originating from various malignancies.