An 80 year old woman with an incidental finding of a left adrenal tumor was evaluated for surgery. Her past medical history was significant for an abdominal hysterectomy and for Crohn's disease with multiple bowel resections, complicated by fistula formation. As a result, the patient had a right lower quadrant end-ileostomy. She had no other co-morbidities. An abdominal CT scan revealed a 3.7 x 3.6 cm solid adrenal gland mass, which was suspected to be an adrenal adenoma. Hormonal functional tumors such ass aldosteronomas, pheochromocytomas, and Cushing's disease were not suspected confirmed by biochemical work-up. At exploration, the patient was positioned in the right lateral decubitus position. Three trocars were introduced in a straight line along the left subcostal margin. Dissection was begun to mobilize the spleen from the splenoparietal ligament to the left crus using the ultrasonic dissector. The plane of dissection was then identified between the tail of pancreas and the "periadrenal areolar" tissue. During mobilization of the adrenal gland, multiple adrenal arteries, and the single adrenal vein were identified, doubly ligated, and divided using clips. The adrenal gland and tumor were removed intact in a specimen bag and was measured to be 7.0 x 4.0 x 3.5 cm. Estimated blood loss was 75 ml and operative time was 109 minutes. The patient's postoperative course was uneventful, and she was discharged home on the second postoperative day tolerating a regular diet. Keys to success include proper patient positioning, appropriate trocar positioning, thorough mobilization f the spleen, and meticulous handling and dissection of adrenal gland and tumor.