 A living donor kidney is the best possible option for a patient that needs a kidney transplant. University of Maryland Medical Center is one of the few hospitals in the region that is equipped and has the expertise to offer a minimally invasive living donor kidney nephrectomy. My name is Josue Alvalet-Casas. I'm the director of organ procurement here at University of Maryland and we are drawing outside the lines to discuss the advances we've made in order to make the living donor procedure less invasive. Here in front of me you can see a depiction of a patient how they are positioned in the OR for a left kidney donation. The head, neck, and shoulders are to your left, the patient's legs are to your right, and the belly button is here in the center. We offer two different options for kidney donation. The first option which we've been offering since 2009 is the single port donor nephrectomy. In this case we make a six and a half centimeter or two and a half inch incision right through the belly button. We place a special port that allows us to introduce our standard laparoscopic instruments and an articulating camera to perform the kidney dissection. The kidney is located here in the upper left quadrant. Once we dissect the kidney and separate the kidney from the donor we are able to extract it through the single port. The advantage of this approach is that it offers the best possible cosmetic result. In most cases the incision, the scar, the resulting scar will be mostly hidden inside the belly button and six months after the surgery it's hard to tell that the patient ever had a procedure. In 20% of the cases however, we do require additional ports, there are five millimeter ports and they will be positioned one here and one slightly below here and these are necessary in certain cases to get proper exposure of all the structures and good visualization of the kidney. The second and most advanced option we offer is the robotic assisted donor nephrectomy. In this case we use the DaVinci XI robot to assist with the surgery and it is a multi-port approach. The ports required for the DaVinci robot are one for the left arm, another port lower for the right arm, a camera port in the middle, an assistant port lower on the midline and finally the extraction site will be much lower. The camera on the robot gives the surgeon a 3D image in high definition with zooming capabilities. This gives the surgeon the best possible view and allows us to dissect closer to the vessels with higher level of accuracy. The arms are articulating so they articulate in any direction inside and that also allows us to get more length on our artery, vein and ureter. The kidney at the end of the procedure is extracted from the lower abdominal incision which carries a significantly reduced rate of hernia, much lower than the standard approach. And in general the patients experience less pain. They usually go home one day after surgery. Donating a kidney has never been safer and easier than it is today. Every donor has their unique features and at University of Maryland we are equipped to handle every situation.