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[1]. In the US, there is a growing disparity between The advantages of the laparoscopic live donor operathe organ supply and demand. This has resulted in tion arise from the ability to utilize small incisions and prolonged waiting times on the cadaveric renal transto place them at sites remote from the location of the plant waiting list [2]. Commensurate with the increased kidney, therefore avoiding a debilitating large flank waiting times has been an increase in the number of incision. Thus, a 5 cm lower midline or Pfannenstiel deaths of patients awaiting transplantation. Live incision suffices to deliver the kidney. The operation kidney donors have remained an under-utilized source can be performed by either a transperitoneal or of transplantable organs. retroperitoneal approach. We prefer the transperitoneal Live donor renal transplantation offers several approach because it affords more laparoscopic working advantages over cadaveric transplantation. First, the space. It also allows the kidney to be removed easily long waiting times are eliminated. Second, there is a from the abdomen through a relatively low pain, lower incidence of delayed function. Third, both midline incision. A pneumoperitoneum of 15 mmHg is patient and graft survival rates are significantly better created using CO2. Other centres have reported using with live donor transplantation [3]. Thus, not only are abdominal wall lifters. Dissection of vascular structures more organs made available, the need for repeat transis facilitated by the magnification achieved via the plantation is reduced. Also, live donor renal translaparoscope. The renal vasculature is divided using an plantation is more cost effective than cadaveric donor endo-GIA stapler. This device lays down two rows of transplantation [4]. However, despite these advantstaples and cuts between them simultaneously. On the ages, there exist significant disincentives to live kidney right side, use of this stapler results in loss of donation. 1.0–1.5 cm of vein, leaving the recipient surgeon with The long hospitalization and recuperation time assoa short thin vein to contend with. Therefore, the donor ciated with open nephrectomy via a flank approach operation is modified slightly for right kidneys. can pose significant financial and logistical problems However, because of technical considerations, we in terms of time out of work, lost income, job security prefer to utilize the left kidney, even if multiple left and inability to care for dependant children. Also, a renal arteries are present. The exception to this is if number of individuals express concerns about fear of there is a clear advantage to the donor by leaving the pain and the cosmetic results of major abdominal left kidney in situ. surgery. Thus, by reducing these disincentives, we

Laparoscopic live donor nephrectomy: the four year Johns Hopkins University experience