Primary retroperitoneal teratomas are quite rare. The surrounding inflammatory reaction creates a difficult dissection even through traditional open surgery. Herein we describe methods of approaching challenging cases from a minimally invasive approach. Methods:We retrospectively reviewed of an operative video from a laparoscopic removal of a retroperitoneal teratoma in a 6-year-old boy. We analyzed the techniques used to overcome challenging aspects of the case and present it as a case study for how to approach unusual cases with a minimally invasive approach. Results:General concepts include: (1) If you do not start laparoscopic, you will never finish laparoscopically; (2) Coordinate with consultants on oncologic cases for options of specimen removal; (3) Thoroughly review anatomy prior to operating; (4) Stay laparoscopic if you are continuing to make safe progress; (5) Advanced energy devices are not a panacea, use all options at your disposal, and keep switching until you find what works; (6) Avoid "tumor frenzy" as the case nears the end to prevent needless errors. The final pathology revealed Primary Retroperitoneal Immature Teratoma. Conclusion:Challenging cases are daunting to consider performing in a minimally invasive fashion. By using stepwise approach prior and during the case, many can be completed in a minimally invasive way.