As technology has advanced, the options for the surgical management of adrenal disorders have also increased. An understanding of the basic evaluation of adrenal tumors, patient specific factors, and the risks and benefits of available techniques will allow the clinician to select an appropriate treatment for each individual. Available techniques include open anterior and posterior, transabdominal laparoscopic, retroperitoneal laparoscopic, thoracoabdominal, and even partial adrenalectomy. Surgery remains the mainstay of treatment for functional adrenocortical adenomas including aldosteronomas, cortisol-producing adenomas, and pheochromocytomas. While minimally-invasive techniques offer shorter recovery times and less potential morbidity, more traditional approaches remain necessary for management of known or suspected adrenocortical carcinoma. Except in the case of pheochromocytoma, large adrenal tumors >6 cm should not be removed laparoscopically due to the risk of adrenocortical carcinoma. This article will review basic surgical adrenal disorders, operative approaches, and delineate principles of patient and procedure selection.