Laparoscopic surgery for kidneys with xanthogranulomatous pyelonephritis or autosomal dominant polycystic disease has proved to be technically difficult but is possible. The Harmonic Scalpel facilitates the dissection of inflammatory tissues and does not inflict burns. Hand-assisted laparoscopy may be useful. Pain relief is obtained by most patients undergoing cyst drainage, although recurrence after a year or two is common. A specific and detailed preoperative diagnosis and treatment plan are essential to a successful outcome.