Objectives　Mayo　adhesive　probability　(MAP)　score　affects　the　outcomes　of　adrenaletomy.　Aimed　to　determine　whether　the　modified　retroperitoneal　laparoscopic　adrenalectomy　(MRLA)　overcomes　periadrenal　fat　adhesion　compared　to　Classical　retroperitoneal　laparoscopic　adrenalectomy　(CRLA)　to　achieve　better　surgical　outcomes.　Patients　and　methods　Patients　admitted　from　January　2016　to　December　2022　were　retrospectively　analyzed　and　systematically　categorized　into　two　distinct　cohorts:　the　MRLA　group　and　the　CRLA　group,　based　on　specific　criteria.The　main　surgical　techniques　modified　of　MRLA　is　third　separation　level:　between　the　edge　of　adrenal　gland　and　the　peripheral　renal　fat.　The　baseline　characteristics　and　perioperative　data,　e.g.,　age,　gender,　BMI,　tumor　position,　tumor　size　(cm),　MAP　score,　P　distance　(cm),　perinephric　stranding,　and　periadrenal　stranding,　estimated　blood　loss,　Operating　time,　were　analyzed,　with　statistical　significance　defined　as　p　＜　0.05.　We　analyzed　the　differences　between　groups　using　the　t　test.　For　measurement　data　that　didn＇t　follow　normal　distribution,　we　described　the　concentration　and　dispersion　trended　using　M　(Q25,　Q75)　and　analyzed　the　differences　between　groups　using　the　M-U　test.　For　data　that　met　certain　conditions　like　being　linear,　normal　and　independent,　we　used　linear　regression　analysis.　For　binary　classification　of　dependent　variables,　we　used　binary　logistic　regression　analysis.　Results　A　total　of　731　patients　underwent　adrenaletomy,　and　651　patients　had　adequate　data,　were　available　for　MAP　score　assessment.　Of　these　patients,　247　were　in　the　MRLA　group,　whereas　404　were　in　the　CRLA　group,　baseline　characteristics　weren＇t　found　to　be　different　between　the　two　groups　(p　＞　0.05).　The　MRLA　group　exhibited　superior　outcomes　in　terms　of　operating　time,　duration,　postoperative　hospital　stay,　estimated　blood　loss,　and　complications,　in　comparison　to　the　CRLA　group.　Further　analysis　revealed　that　periadrenal　stranding　could　be　the　underlying　cause　for　this　discrepancy.　Conclusions　The　MRLA　effectively　overcame　the　impact　of　adhesive　periadrenal　fat　(APAF)　compared　to　CRLA.　We　recommend　to　employ　the　MRLA　for　patients　with　preoperative　CT　images　indicating　periadrenal　fat　adhesion.