The relationship between surgical methods and clinical parameters was analyzed retrospectively in 32 patients operated for adrenal pheochromocytoma (laparoscopic surgery, 13 patients; open surgery, 19 patients) in Jikei University Hospital from 1997 to 2006. The mean tumor size was higher in open surgery patients. Preoperative hypertension was recorded in 7 open surgery patients and 15 laparoscopic surgery patients; 5 and 16 patients, respectively, were administered an alpha1-blocker preoperatively. Despite only slight differences in background data, blood loss was significantly less in the laparoscopic surgery patients than in the open surgery patients. However, intraoperative variation in blood pressure was greater in the former, probably because of technical difficulties or inadequate preoperative management. The duration of operation was not significantly different between the 2 groups. Tumor size did not show a significant correlation with either duration of surgery or blood loss. On the other hand, a significant correlation was noted between blood loss and duration of surgery only in open surgery patients. Postoperative recovery time was significantly shorter in laparoscopic surgery patients. After considering factors such as tumor size, hormone activity, preoperative management, and surgeon's skill, we believe that compared to open surgery, laparoscopic surgery is a less invasive and more useful method for adrenal pheochromocytoma.