We have performed Laparoscopic donor nepohrectomy (Lap Nx) since 2000. In June 2002, we modified the technique to minimize the known disadvantages of ATN and delayed graft function. We review our series of lap Nx before and after introduction of these modifications, respectively. Four technical modifications of Lap Nx were introduced following the initial 28 cases (GroupI) and applied to the consecutive 42 cases (GroupII): 1) decreasing the intra-abdominal pressure from 15mmHg to 8mmHg, 2) early dissection of the ureter and gonadal vein followed by vascular dissection, 3) leaving the left gonadal vein in continuity with the left renal vein, and 4) early introduction of the Endocatch™ bag. Operative time was 276.6±67.1 min vs. 210.00±38.0 min for Groups I and II, respectively (P=0.04). Warm ischemia was 4.9±1.9 min vs. 1.5±0.9 min for groups I and II. There was one vascular insult in the initial 5 Rt Lap Nx that comprised transection of a segmental artery, reconstructed by bench repair without impacting the outcome. Conversion was needed in 3/28 (10.7%) in GroupI, but none in GroupII. Outcome of Lap Nx can be significantly improved by applying technical modifications that simulate open Nx.