■ The introduction of laparoscopic donation has increased the number of donors at many transplant centers. By the year 2001, nearly two-thirds of the living donor nephrectomies in the United States were performed using a laparoscopic technique.

■ Laparoscopic donor nephrectomy requires much more skill and finesse than laparoscopic radical nephrectomy. There is no margin of error. Superb technique is absolutely essential for good donor outcome and recipient graft function.

■ The laparoscopic approach, while not perfect, is considered the first-choice approach for the majority of donors.

■ Good short-term follow-up of graft survival after laparoscopic donor nephrectomy has been demonstrated at many centers.

■ During laparoscopic donor nephrectomy, the biggest risk to the donor is potential vascular catastrophe.

■ Laparoscopic donor nephrectomy is associated with longer warm ischemia time when compared to open surgery. However, the duration of warm ischemia does not correlate with recipient creatinine levels or delayed graft function.

■ Total operating time of laparoscopic donor nephrectomy is comparable to that of open surgery, whereas blood loss and hospitalization are decreased.

■ The laparoscopic approach is more expensive than open donor nephrectomy.

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