Ever since the first successful renal transplant involving live identical twins in 1954, increasing emphasis has been placed on minimising morbidity and mortality in the living donor.

For many conditions, traditional open surgery has been replaced by a variety of minimal access techniques, mainly laparoscopy. These have important benefits for patients in terms of less intraoperative loss of blood, lower postoperative morbidity, and quicker recovery and return to normality.1^–4

For living donors of renal transplants it is important to determine which minimal access technique is best in terms of quality of life. In this issue of the BMJ Kok and colleagues report a randomised controlled trial that compares the effect of laparoscopic and mini incision open donor nephrectomy on quality of life in living donors after renal transplant surgery.5 The authors found that patients who had laparoscopy had better scores for physical fatigue (MFI-20) and physical function (SF-36) at one year than those who had the mini incision technique. They conclude that in centres with a highly experienced laparoscopic surgeon the laparoscopic technique is superior.5 …