The posterior retroperitoneoscopic adrenalectomy was first described by Martin Walz in 1994. It is becoming the standard approach to performing minimally invasive adrenalectomy due to its shorter operating times and time to recovery. It can be challenging to learn in the initial period for the general surgeon accustomed to operating in the peritoneal cavity due to the smaller working space and lack of familiar landmarks. We describe our approach to performing this operation and provide tips and tricks that may help the surgeon starting out with this procedure.