BACKGROUND & OBJECTIVE: With the development of laparoscopic technique, more and more renal cancer patients have accepted laparoscopic radical nephrectomy instead of open radical nephrectomy. This study was to introduce our experiences of retroperitoneoscopic radical nephrectomy, and evaluate its therapeutic efficacy. METHODS: Between Nov. 2003 and Aug. 2006, retroperitoneoscopic radical nephrectomy was performed in 43 renal cancer patients; retroperitoneal approach was structured without water balloon, and Hem-o-lok clips were used to control renal vessels during operation. In the same period, open radical nephrectomy was performed in 34 renal cancer patients. Treatment outcomes of the 2 groups were compared. RESULTS: There was no significant difference in operation time between laparoscopy group and open approach group (149 min vs. 140 min, P=0.24). The amount of blood loss during operation was significantly less in laparoscopy group than in open approach group (53 ml vs. 199 ml, P<0.01). The time of intestinal function recovery, ambulation, indwelling drainage tube, and hospitalization stay after operation were significantly shorter in laparoscopy group than in open approach group (P<0.01). Incision infection occurred in 2 patients in open approach group; no severe perioperative complications presented in laparoscopy group. During the follow-up of 1-32 months, 1 patient in open approach group had lung metastasis; none in laparoscopy group had recurrence or metastasis. CONCLUSIONS: Retroperitoneoscopic radical nephrectomy has the advantages of mini-invasion and rapid recovery. The method of structuring retroperitoneal approach without water balloon is safe and effective. Hem-o-lok clip is a reliable and economical device for renal vascular control.