We report our experience with the transperitoneal (TP) and retroperitoneal (RP) approaches for performing laparoscopic nephrectomy for benign disease. Thirty-three patients with benign renal disease underwent laparoscopic nephrectomy, 23 by the TP and 10 by the RP approach. The average age of the patient, ASA score, and specimen weight were similar for the two groups. The average operating time for the TP approach was 5.6 hours v 5 hours for the RP approach. The average hospital stay was 2.8 and 3 days for TP and RP groups, respectively. The use of postoperative analgesics was similar in the two groups (37 mg of morphine sulfate equivalent v 39 mg of morphine sulfate equivalent for the TP and RP groups, respectively). However, the RP group required less time to resume normal oral intake than the TP group (0.3 v 0.6 days). When assessed according to specimen weight of 100 or less, there was a significant reduction in the postoperative analgesia requirements for the RP group of patients (11 mg of morphine sulfate equivalent v 28 mg of morphine sulfate equivalent for the TP group). In this subgroup of patients, the resumption of oral intake also occurred more quickly in the RP than the TP group (0.4 v 0.5 days). The hospital stay and total convalescence time were similar for the two groups. Four complications occurred in the 33 patients: 2 patients (1 TP and 1 RP), required conversion to open surgery, 1 asthenic patient developed a vastus lateralis bruise undergoing a TP approach, and a brachial nerve palsy occurred in a morbidly obese patient who failed a TP approach. The RP approach to laparoscopic nephrectomy reduces the time to resuming normal oral intake for patients postoperatively and, in those patients with a small specimen, may significantly reduce their postoperative analgesia requirements. However, the RP approach for laparoscopic nephrectomy for benign disease does not significantly improve the length of hospital stay or the patient's ultimate postoperative return to normal activity in comparison to the TP approach. There does appear to be a trend toward a shorter operative time for the RP approach. The RP laparoscopic approach is our method of choice for patients with benign renal disease.