Adrenalectomy is the most effective means available to eradicate localized cancers that arise within the adrenal glands, to eliminate adrenal sources of hormone overproduction, to relieve symptoms caused by mass effect, and to promptly establish definitive diagnoses for potentially malignant adrenal masses. Minimally invasive laparoscopic approaches for adrenalectomy have evolved dramatically and are now commonly practiced in high-volume endocrine surgery centers. Laparoscopic adrenalectomy can be safely performed by experienced surgeons, is effective treatment for selected adrenal conditions, and is consistently associated with prompt resumption of full patient activity. Open adrenalectomy remains the standard operation for resection of large adrenal tumors and adrenal cancers. In addition to surgical advances, success in treating patients with adrenal disorders is also due to improved understanding of endocrine pathophysiology, more sensitive and specific radiologic imaging and localization studies, and advances in anesthesia in perioperative patient care. This chapter presents the surgical perspective to assessing and treating the varied disorders of the adrenal glands.