Objectives: To assess the efficacy and safety of helium as an insufflant for transabdominal laparoscopic renal surgery. Methods: The charts of all patients undergoing laparoscopic renal surgery with helium insufflation by a single physician between May 2003 and April 2006 were reviewed. Ventilatory parameters and postoperative recovery were reviewed. Results: Ten patients underwent laparoscopic renal surgery with helium. These patients had a mean age of 64 years and suffered from a variety of comorbid conditions, including chronic obstructive pulmonary disease (5), congestive heart failure (1), chronic hypoxia from an intrapulmonary shunt (1), malignant hyperthermia (1), and chronic hypoxia from multiple pulmonary infarcts (1). All patients tolerated helium pneumoperitoneum, with mean O2 saturation of 98.6% ± 0.6%, end-tidal CO2 31.4 ± 1.7 mm Hg, respiratory rate 9.3 ± 0.7 breaths per minute, tidal volumes 598.2 ± 38.0 mL, and peak airway pressures 26.0 ± 1.2 cm H2O. One patient developed an end-tidal CO2 of greater than 45 mm Hg. Mean operative time was 146.8 ± 59 minutes, and estimated blood loss was 280.1 ± 334 mL. Postoperatively 3 patients required continued maintenance of the endotracheal tube, although none required intubation longer than 22 hours. Five patients had critical care monitoring (1.7 ± 2.9 days on average). Conclusions: Helium can be used safely as an insufflant during laparoscopic renal surgery. Patients who may benefit are those with potential difficulty in clearing CO2 gas from their bloodstream or those who rely on sensitive monitoring of end-tidal CO2 to manage comorbid pathology.