This paper describes the use of urological laparoscopy in borderline patients, focussing on geriatric patients and those with renal failure. Laparoscopy must not only be feasible but also at least as effective concerning operative and postoperative parameters when compared to standard open surgery. For laparoscopic nephrectomy most of these factors have tested positive. However, only a few papers have been published concerning borderline patients. In some cases the pneumoperitoneum may not be suitable for borderline patients and open operative techniques are preferred. Apart from this, the current literature supports the effectiveness of laparoscopy even when certain risk factors are present. Especially borderline patients can benefit from the laparoscopic approach for nephrectomy. Although data are scarce concerning other laparoscopic procedures in borderline patients, the results of laparoscopic nephrectomy should probably apply to other laparoscopic procedures.