Introduction: Almost two decades ago laparoscopic living donor nephrectomy (LLDN) technique was developed to reduce living donor complication rate. However, the requirement of experienced surgeons, the use of mainly left donor kidney and technical challanges for multiple arteries are the main limitations that inhibit the application of LLDN technique in some centers.  We aimed to share the initial results of LLDN in high volume university center, which is performing laparoscopic nephrectomies for other indications.
Materials and Methods: During year 2017, we performed 4 LLDN. Transperitoneal approach was used in all cases and kidney was removed using suprapubic incision. All donors and recipients were prospectively analyzed within 6 months follow-up. Patient clinical, laboratory, operation-related data were collected from directly interviewing them and from medical records. All patients have their written informed consent.
Results and Discussion: 1 male and 3 female donated left kidney by using LLDN technique. Mean age 58 ∓9 y, 2 of them with history of previous cholecystectomy. All donated kidney had a single renal artery and renal vein. Pre-operative average eGFR was 94.2 ∓7.1 ml/min/1.73m2, immediately after LLDN – 57.5 ∓10.3 ml/min/1.73m2, after 1 month – 56.0 ∓9.1 ml/min/1.73m2. There were no intraoperative complications, surgery duration 223.75 ∓21.74min, cold ischemia time was 77.5 ∓28.77 min, warm ischemia time – 6.37 ∓3.14 min. The donors were discharged within 5-6 days after LLDN. Postoperative donor complications: acute kidney injury – 1; prolonged postoperative abdominal pain – 1. Posttransplant recipient complication: acute kidney rejection – 1 case of atypical hemolytic syndrome; no cases of delayed graft function.
Conclusion: Our initial experience confirms that LLDN is an approach which is easy to learn, especially in a high volume university hospital with expertise in performing laparoscopic nephrectomies for other indications. Therefore, we would like to encourage centers, which are still performing open living donor nephrectomies, to introduce laparoscopic method into everyday practice.  We believe, that changing the nephrectomy technique could increase living donation numbers in the center.