Recently, the field of organ transplantation has reached a high level of clinical success because of significant improvements in immunosuppressive strategies. However, in the last decade, no significant technical innovations have significantly modified the approach to clinical organ transplantation in the recipient's operation. The success of transplantation has widened the gap between potential candidates and available cadaver donor organs. In fact, since 1995 the number of cadaveric donors for kidney transplants in the United States reached a plateau at approximately 8,000 a year, while the number of potential recipients continues to grow exponentially. In liver transplantation, the trend is similar. Interestingly, the mortality rate on the waiting list was 14.7% in 1995, almost unchanged compared to 17.6 % in 2003. Clearly, the main obstacle to further expansion of organ transplantation is the lack of adequate number of cadaveric donors. The most successful strategy to mitigate the donor shortage has been a more extensive use of living donors. In fact, the recent growth in the number of kidney transplantations performed in the United States has been entirely supported by an increased number of living-donor-related transplants in the face of a static supply of cadaveric donors. According to a recent United Network for Organ Sharing (UNOS) report, the number of kidney transplants from living donors has increased from 2,851 in 1993 to 6,464 in 2003 [1, 2]. Furthermore, in the last few years, living-donor liver transplantation, originally limited to pediatric recipients, has been successfully applied to adults. Living-donor liver transplantation has contributed to the reduction of donor organ shortage, and has allowed treatment for patients previously excluded from liver transplantation (i.e., those with large liver tumors) [3-5].

In our judgment, the most important, recent technical innovations in the field of organ transplantation have been the result of the increased focus on safe and reliable procurement of donor organs from living donors.

The aim of this chapter is to illustrate the impact of modern technologies in surgical techniques related to kidney and liver grafts procurement from living donors. In particular, it describes in detail laparoscopic robotic-assisted techniques for living-donor nephrec-tomy for kidney transplantation, as well as new strategies for safe parenchymal transection in hepatectomy for living donor liver transplantation.

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