title: Laparo-endoscopic single-site donor nephrectomy: techniques and outcomes.
abstract: OBJECTIVE
  Living donor nephrectomy is a unique surgical procedure in urological practice and must optimize the trifecta of: patient safety, minimal morbidity and  successful graft function. The laparoscopic technique has become the gold standard over the last decade for harvesting the kidney from a living donor. Laparo-endoscopic  single-site (LESS) surgery is an attempt to further enhance cosmetic benefits and reduce the morbidity for potential kidney donors. We have summarized  and reviewed the  literature of LESS-DN and described the techniques and outcomes.
  
  
  METHODS
  Using the National Library of Medicine database, the English language literature was reviewed from 2006 to 2011. Keyword searches included LESS, Donor, Nephrectomy,  Living, Single-site, e-NOTES, Mini-invasive, Laparoscopic, Single-port. Within the bibliography of selected references, additional sources were  retrieved.
  
  
  RESULTS
  After Gill's description of the first four patients to undergo LESS-DN, we found five series published describing the surgical techniques of  LESS-DN  as well as the  outcomes. We have outlined in detail the various techniques of the trans-umbilical LESS-DN and compared the outcomes with conventional LDN. We also  briefly discuss new  innovative techniques of LESS-DN.
  
  
  CONCLUSIONS
  LESS-DN is a safe albeit technically challenging alternative to LDN. LESS-DN appears to have comparable results to LDN in terms of graft function,  patient  morbidity, and cosmesis. Further long term results and the development in parallel with other LESS procedures is required before LESS-DN is to be considered  a standard of care.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, USC Institute of Urology, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Lewandowski
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
mesh_terms: D000328:Adult; D000758:Anesthesia; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061214:Patient Safety; D013525:Surgical Instruments; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome