Between April 2002 and March 2004, 21 patients with clinical T1-T3a renal cell carcinoma underwent laparoscopic radical nephrectomy at the Kobe City General Hospital. A transperitoneal approach was chosen in 9 patients with clinical T2 stage, tumors more than 5 cm in diameter at the upper pole of the kidney, and posteriorly protruded tumors at the middle portion. Otherwise, a retroperitoneal approach was chosen in 12 patients. The mean (range) operative time for the transperitonal and retroperitoneal approaches was 355 (290-410) min and 342 (275-490) min, respectively. There were no major intraoperative complications. Postoperatively, one patient underwent emergency operation due to the perforation of duodenal ulcer. In the mean follow-up of 15.9 months, lung metastasis was seen in one patient under adjuvant immunotherapy. Significant differences between transperitoneal and retroperitoneal approaches were seen in mean time to renal artery clipping (170 versus 85 min, p < 0.01), mean blood loss (548 versus 281 ml, p < 0.05) and concurrent adrenalectomy (66.7 versus 16.7%, p < 0.05). Laparoscopic radical nephrectomy is a safe and feasible procedure when suitable approaches are chosen depending on tumor size and location.