*Purpose: To evaluate the safety, efficacy, and outcomes of trans-umbilical single port laparoscopic donor nephrectomy (SPLDN).

*Methods: We performed a retrospective review of 100 SPLDNs between 04/2017 and 11/2019, performed by two surgeons at a single institution. Right nephrectomies were excluded. Standard laparoscopic equipment were used. All patients were offered SPLDN with no exclusion criteria.

*Results: From 04/2017 to 11/2019 we performed 100 left SPLDNs for living kidney donation. The average donor age was 42 years, and 45% of donors were men. Average operative time was 220 minutes (range 144-324 minutes). The mean length of hospital stay was 3.86 days (range 3-6 days). Aberrant renal arterial anatomy was noted in 28% of patients (27 with two arteries, 1 with three arteries). One patient had two renal veins, and one patient had two ureters. Average intra-operative blood loss was 50 milliliters, and no patients required transfusions intra-op or post-op. Additional 5mm ports were required in 8 patients. Five patients required 1 additional port, two patients required 2 additional ports, and one patient required 3 additional ports. There were no conversions to open or hand assisted laparoscopy. Our overall complication rate was 8%. Two patients experienced transient rhabdomyolysis with full recovery. Two patients had superficial wound infections managed outpatient with oral antibiotics. Two patients were readmitted within 4 weeks, one for persistent nausea and one for persistent pain, both resolved with no interventions. Two donors developed port site hernia within 1 year of donation. Both underwent laparoscopic repair. In outpatient follow-up patient satisfaction with cosmetic appearance was high, and all patients returned to their normal lifestyles within 4-6 weeks.

*Conclusions: Single port laparoscopic donor nephrectomy is safe and efficient. It can be used as a standard approach for renal donation without additional donor risk, and with short length-of-stays and excellent cosmetic outcomes. Moreover the procedure can be easily converted to multiport or even hand assist laparoscopy if needed. Easy conversion to multi-port or hand-assisted nephrectomy makes it a versatile operation that will become increasingly utilized in the future.

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