Abstract Purpose The access technique for retroperitoneoscopy is not well established, and differs from transperitoneal laparoscopic access in 3 key aspects: 1) location and technique of primary trocar placement, 2) optimal positioning of the balloon dilator and 3) technique for safe placement of secondary ports. Our method of obtaining retroperitoneoscopic access addresses these issues. Materials and Methods A total of 37 patients underwent retroperitoneoscopic surgery of the kidney and upper ureter. Results Our technique facilitates balloon placement within Gerota's fascia, minimizes peritoneal injury and optimizes port placement during retroperitoneoscopic surgery. Conclusions Although our success rate for placing the balloon within Gerota's fascia has improved, additional experience is required to achieve subfascial balloon placement more consistently.