101 © Springer Science+Business Media New York 2017 J.H. Kaouk et al. (eds.), Atlas of Laparoscopic and Robotic Single Site Surgery, Current Clinical Urology, DOI 10.1007/978-1-4939-3575-8_10 Laparoendoscopic Single-Site Donor Nephrectomy Matthew J. Maurice, Önder Kara, and Jihad H. Kaouk Introduction From a recipient and societal standpoint, kidney transplantation is the optimal treatment for end- stage renal disease, improving recipient survival and quality of life and decreasing cost compared to dialysis [1, 2]. In particular, living donor kid- ney transplantation offers unique advantages to the recipient, namely, decreased time to trans- plantation, decreased risk of rejection, and improved allograft and overall survival, com- pared to deceased-donor transplantation [3]. Despite the proven safety of kidney donation, one of the greatest barriers to donation is donor bur- den, including pain, convalescence, and cosmetic concerns [3, 4]. In fact, while the waiting list for kidney transplantation continues to grow, dona- tion has been decreasing, especially among young donors [1]. While the reasons for this decline are unclear, donor burden may be a con- tributing factor. Over the last 20 years, advancements in minimally invasive surgery have improved the morbidity of living donor kidney procurement. By decreasing blood loss, minimizing surgical pain, shortening convalescence, and improving quality of life for the donor, laparoscopic donor nephrectomy (LDN) helped mitigate the disin- centives to live donation without compromising transplant quality [5–8]. Since the first laparo- scopic donor nephrectomy reported in 1995, over 90 % of donor nephrectomies are now per- formed laparoscopically [4, 9]. With the goal of further expediting recovery and improving cos- mesis, surgical techniques have continued to evolve, from pure transperitoneal laparoscopy to hand-assisted and retroperitoneal approaches, and most recently to laparoendoscopic single- site surgery (LESS), natural orifice transluminal endoscopic surgery (NOTES)-assisted laparos- copy, mini-laparoscopy, and robotic-assisted laparoscopy [9–15]. LESS nephrectomy offers unique benefits compared to conventional laparoscopy, including decreased postoperative pain, faster recovery, and better cosmesis [16]. In a recent meta- analysis of 1,467 cases, specifically looking at the outcomes of LESS LDN, Autorino et al. showed that LESS patients had lower analgesic requirements and similar surgical and functional outcomes compared to standard LDN [17]. However, LESS was associated with longer oper- ative times (without a significant difference in the duration of warm ischemia) and higher rates of M.J. Maurice, MD (*) • Ö. Kara, MD Department of Urology, Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave Q10-1, Cleveland, OH 44195, USA e-mail: mauricm2@ccf.org; karao@ccf.org; onerkara@yahoo.com J.H. Kaouk, MD, FACS Professor of Surgery, Cleveland Clinic Lerner College of Medicine, Zagarek Pollock Chair in Robotic Surgery, Center for Robotic and Image guided Surgery, Glickman Urologic Institute, Cleveland, OH, USA e-mail: kaoukj@ccf.org 10