Laparoscopic adrenalectomy is now generally regarded as the therapy of choice for benign adrenal tumors. This video demonstrates the technique of laparoscopic adrenalectomy with the disruption of anatomical landmarks due to an ipsilateral ectopic pelvic kidney. Intraoperative ultrasound was used to assist in localizing the lesion and gland. The patient is a 50 year old white male with a 12 year history of hypertension peaking at 200/130 uncontrolled with 240 mg of Nadolol, 150 mg of Avapro, and 150 mg of Nicardipine per day. His potassium levels even with supplemental replacement preoperatively fell as low as 2.7 mEq/l. Endocrine testing revealed plasma aldosterone levels of 75.6 ng/dl (normal 4-31 ng/dl) and low but detectable levels of plasma renin. Adrenal venous sampling found the aldosterone:cortisol ratio on the left (11.0) to be more than twice that on the right (4.15), which is virtually diagnostic for adenoma. Abdominal CT scan revealed a focal lesion in the left adrenal gland and the ectopic pelvic location for the ipsilateral kidney. A diagnosis of Conn's syndrome was made. We performed a laparoscopic left adrenalectomy via a lateral transabdominal approach. Lacking the usual anatomical landmark of the ipsilateral kidney, the left adrenal gland was difficult to identify and we used intraoperative ultrasound to assist in localizing the lesion. Our patient tolerated the procedure well and was discharged home one day post operatively in stable condition with minimal abdominal pain. With routine follow up, 4 months after the operation our patient's blood pressure had normalized at 120/82 with a reduction in his anti-hypertensive medications. The 150 mg of Avapro has been stopped completely, the 240 mg of Nadolol has been reduced to a total of 180mg, and his 150 mg of Nicardipine per day has been decreased to 90mg. He remains on 325 mg of aspirin once a day. He has also ceased to take potassium supplementation with normalization of his serum potassium at 5.2 mEq/l at 4 months after the operation. This case represents the first documented report of a laparoscopic adrenalectomy performed for adrenal adenoma with the anatomical disruption of an ipsilateral pelvic kidney.