ObjectiveTo compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. MethodsA total of 258 patients underwent transperitoneal(n=116) or retroperitoneal(n=142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. ResultsThe operation time was 80-315 min(a mean of \[167±66.8\] min) for transperitoneal approach and 85-280 min(a mean of \[152±48.8\] min) for retroperitoneal approach(P=0.034).The blood loss was 50-1,000 ml (a mean of \[181±140.4\] ml) for transperitoneal approach and 50-800 ml(a mean of \[171±132.9\] ml) for retroperitoneal approach(P=0.544). The fasting period of surgery was 1-5 d (a mean of \[2.8±1.3\] d) for transperitoneal approach and 1-5 d (a mean of \[2.9±1.2\] d) for retroperitoneal approach(P=0.801). The hospital stay was 3-9 d (a mean of \[6.6±1.5\] d) for transperitoneal approach and 3-8 d (a mean of \[6.5±1.6\] d) for retroperitoneal approach(P=0.477). ConclusionTransperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.