*Purpose: Introduction: Retrieval of kidneys in obese donor with excessive peri-renal fat has been reported to be more technically challenging with increased incidence of surgical damage, greater blood loss and operative time. Aim:To assess the safety and practicality of a radical approach to laparoscopic donor nephrectomy when compared with conventional retrieval techniques.

*Methods: Patients with a BMI greater than 25 and MRI/intraoperative evidence of excessive peri-nephric padding of fat underwent a radical approach nephrectomy [RAN]. In this approach, we leave the gerota’s fascia and peri-renal cushion of fat intact. The adrenal gland is preserved. We retrospectively reviewed all laparoscopic donor nephrectomy patients who were operated via radical and conventional approach from Jan’17 to Dec’17. Operative time, intra-operative blood loss and iatrogenic injury to renal capsule were assessed.

*Results: Of the 46 patients that underwent laparoscopic donor nephrectomies, 5 had a radical approach nephrectomy. Mean BMI of RAN group was higher(30) as against(27) in conventional group. Mean operative times were comparable (238min in RAN vs 222min in conventional). Mean blood loss in RAN group was slightly higher(125cc) as against(50cc) in conventional group. No injury to the renal capsule was noted in both groups.

*Conclusions: We report an alternative technique to the usual laparoscopic donor nephrectomy in obese donors and in non-obese donors with excessive peri-renal fat. By avoiding mobilization within gerota’s fascia, we reduce the chances of bleeding, thermal injury to the graft and fat planes obscuring surgical view. This radical approach in selected candidates enables faster retrieval of the graft without compromising on safety and precision.

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