The objective of this study was to evaluate the outcome of the initial 100 consecutive laparoscopic nephrectomies using a transperitoneal or a posterior prone retroperitoneoscopic approach. The medical records of 97 consecutive children who underwent laparoscopic nephrectomy between January 2000 and December 2003 were reviewed. Children having concomitant operative procedures were excluded from the study. Laparoscopy was performed by a transperitoneal (TP) or a posterior prone retroperitoneoscopic (PPR) approach based on the preference of the operating surgeon. A total of 100 procedures were successfully completed laparoscopically. Two children required conversion to open surgery. The median operating time was 112 min for the TP approach and 96 min for the PPR approach (P = 0.002). There was no significant difference in the analgesic requirements between the two groups. The rate of complications was similar, as was the length of hospital stay. This was despite the fact that the children in the TP group were somewhat older in age. In children having bilateral native kidney nephrectomy, peritoneal dialysis was successfully established within 48 h after surgery in the PPR group. Taking into account the heterogeneous nature of our group of patients, a reliable conclusion in regard to the difference in operative time, analgesic requirement or approach could not be ascertained. There is the suggestion however, that both the TP and PPR approaches for nephrectomy are equally applicable in children. The posterior prone retroperitoneoscopic approach may have an advantage in children who require peritoneal dialysis.