Metastasis from non-small cell lung cancer (NSCLC) is traditionally considered as a contraindication to surgery. Favourable long-term survival following staged lung resection and resection of synchronous isolated adrenal metastasis has been reported in N0 patients. Considering the retroperitoneal location of the adrenal gland, the transdiaphragmatic approach offers an attractive alternative to standard approaches to adrenal tumors. We describe a technique of simultaneously completing a lung resection and adrenalectomy safely through the VATS approach.