Of the various options for patients with end stage renal disease,
kidney transplantation is the treatment of choice for a suitable
patient. The kidney for transplantation is retrieved from either a
cadaver or a live donor. Living donor nephrectomy has been developed as
a method to address the shortfall in cadaveric kidneys available for
transplantation. Laparoscopic living donor nephrectomy (LLDN), by
reducing postoperative pain, shortening convalescence, and improving
the cosmetic outcome of the donor nephrectomy, has shown the potential
to increase the number of living kidney donations further by removing
some of the disincentives inherent to donation itself. The technique of
LLDN has undergone evolution at different transplant centers and many
modifications have been done to improve donor safety and recipient
outcome. Virtually all donors eligible for an open surgical procedure
may also undergo the laparoscopic operation. Various earlier
contraindications to LDN, such as right donor kidney, multiple vessels,
anomalous vasculature and obesity have been overcome with increasing
experience. Laparoscopic live donor nephrectomy can be done
transperitoneally or retroperitoneally on either side. The approach is
most commonly transperitoneal, which allows adequate working space and
easy dissection. A review of literature and our experience with regards
to standard approach and the modifications is presented including a
cost saving model for the developing countries. An assessment has been
made, of the impact of LDN on the outcome of donor and the recipient