Surgical difficulty in laparoscopic adrenalectomy for pheochromocytoma increases with tumor size.We compared single surgeon outcomes of laparoscopic adrenalectomy for pheochromocytomas in patients with tumors smaller or greater than 4 cm to assess safety of the procedure.A retrospective review was performed of laparoscopic adrenalectomies for pheochromocytoma by a single surgeon over a 3 year period.All patients underwent lateral transperitoneal surgery.Operative and outcome data was retrieved and compared for tumors ＞4cm versus smaller tumors.We performed 28 laparoscopic adrenalectomies on 24 patients including 4 simultaneous bilateral surgeries.15 tumors were greater than 4 cm in size (mean 6.3 cm) while 13 were smaller (mean 2.9 cm).Both groups had similar operating time (138 min vs.116 mins;p =0.2) and blood loss (181 mL vs.143 mL;p =0.41).The small tumor group had 4 Clavien-Dindo grade 1 and 1 grade 3a complications while the large tumor group had 3 grade 1 complications.There were no conversions to open surgery.18 patients (75％) did not require any anti-hypertensive medications post-operatively.Laparoscopic adrenalectomy can be safely performed for patients with pheochromocytomas greater than 4 cm in size.Larger tumors are associated with similar operative time, blood loss and complications.