Posterior retroperitoneoscopic approach (PRA) has become an established procedure for retroperitoneal lesions. The authors encountered a 30-year-old male patient who had β-thalassemia major and received splenectomy 15 years previously. Bilateral suprarenal tumors were noted on follow-up sonography. Subsequent computed tomography of the abdomen showed a right adrenal tumor and a left intraperitoneal lesion with homogenous enhancement. Successful bilateral PRA was performed, and histology confirmed the diagnosis of right adrenal myelolipoma and an accessory spleen. For the present case who had a large abdominal scar, PRA is technically feasible for treating patients with intraperitoneal and/or retroperitoneal suprarenal lesions while eliminating the necessity of dissection for intra-abdominal adhesions and patient repositioning for bilateral lesions.