Objective To compare the effects of different approaches of laparoscopic adrenal tumor resection in treating functional adrenal tumors.Methods Sixty patients with functional adrenal tumors admitted to the Anyang District Hospital from September 2012 to September 2022 were selected as the research subjects.According to different laparoscopic approaches,the patients were divided into a retroperitoneal laparoscopic adrenalectomy group(n=31)and an intraperitoneal laparoscopic adrenalectomy group(n=29).The operation related indexes,stress indexes,immunological indexes,and postoperative complications were compared between the two groups.Results The amount of bleeding and treatment cost in the retroperitoneal laparoscopic adrenalectomy group were lower than those in the intraperitoneal laparoscopic adrenalectomy group,and the operation time,the first meal time after operation,and the hospital stay were shorter than those in the intraperitoneal laparoscopic adrenalectomy group(P＜0.05).There was no statistically significant difference in serum cortisol(Cor),noradrenaline(NE)and adrenaline(E)levels between the two groups before and after operation(P＞0.05).After operation,the levels of serum Cor,NE and E in the two groups were significantly higher than those before operation(P＜0.05).Before operation,there was no statistically significant difference in CD4+level,CD8+level,and CD4+/CD8+ratio between the two groups(P＞0.05).After operation,the CD4+level and CD4+/CD8+ratio in both groups were significantly lower than those before operation,while the CD8+level was significantly higher than that before operation(P＜0.05).After operation,the CD4+level and CD4+/CD8+ratio in the intraperitoneal laparoscopic adrenalectomy group were significantly lower than those in the retroperitoneal laparoscopic adrenalectomy group(P＜0.05);there was no statistically significant difference in the CD8+level between the two groups(P＞0.05).The incidence of postoperative complications in the retroperitoneal laparoscopic adrenalectomy group and the intraperitoneal laparoscopic adrenalectomy group was 6.45％(2/31)and 31.03％(9/29),respectively;it was significantly lower in the retroperitoneal laparoscopic adrenalectomy group(x2=6.048,P＜0.05).Conclusion Laparoscopic adrenalectomy via intraperitoneal approach and retroperitoneal approach is effective in the treatment of functional adrenal tumors.The degree of stress response generated by the two approaches is similar,but the retroperitoneal approach has shorter operation time,less intraoperative bleeding,faster postoperative recovery,less damage to immune function,lower incidence of postoperative complications,and fewer costs.