OBJECTIVE To compare the perioperative outcomes and cosmetic results for transumbilical (TU), transperitoneal subcostal (TS), and retroperitoneal subcostal (RS) laparoendoscopic single-site surgery (LESS) adrenalectomy (AD). MATERIALS AND METHODS An observational study was conducted of patients who were had undergone LESS-AD using a TU (n = 9), TS (n = 17), or RS (n = 16) approach. The perioperative outcomes and comprehensive cosmetic results were analyzed statistically. RESULTS The RS-LESS-AD patients were more likely to have an indication for surgery of a right adrenal mass (TU-LESS-AD 11.1% and TS-LESS-AD 5.9% vs RS-LESS-AD 43.8%, P = .016) or partial AD (0% vs 9% vs 87.5%, P < .001). The TU-LESS-AD procedures had a longer median operative time but significantly lower postoperative pain. The median cosmesis rating for the TU-LESS-AD, TS-LESS-AD, and RS-LESS-AD scar photographs was 10, 8, and 9, respectively (P = .010). Only the cosmesis ratings after the photograph viewing were statistically significant across the surgical approaches (9.5 vs 8 vs 9, P = .048). Assuming equivalent surgical complication risks across the approaches, the preference for future TU-LESS-AD, TS-LESS-AD, RS-LESS-AD was 86%, 6%, and 8%, respectively. As the theoretical risk of TU-LESS-AD increased, the preference for TU-LESS-AD decreased and the preference for TS-LESS-AD and RS-LESS-AD increased. CONCLUSION LESS-AD is an effective procedure with a high level of cosmesis using a TU, TS, or RS approach. The surgeon's background, patient characteristics, and cosmetic perception must be carefully considered as a part of the entire clinical picture so that LESS-AD can be used for patients who will derive the most benefit.