A retroperitoneal laparoscopic (retroperitoneoscopic) lateral approach to achieve decompression for a far lateral disk lesion in the lumbar spine or to remove a paravertebral neurinoma without disrupting the facet is described. The operating space is maintained using a powered mechanical lift and a flat inflatable retractor mainly to make a longitudinal separation between the psoas major and the quadratus lumborum. This technique has been performed successfully in 22 cases using retroperitoneoscopy. The best indications of this new procedure are lateral disk herniation at the L5-S1 level or around the conus medullaris at the L1-L2 level. The described procedure provides adequate exposure necessary for extraforaminal exploration, discectomy, and nerve root decompression, and it is sufficient for treating extreme lateral lumbar herniation localized to the L1-S1 level and spinal nerve root tumors.