Living donor kidney transplant has considerably expanded over the last ten years, in order to increase the pool of renal donors. Selection and extensive work-up of the kidney provider is of paramount importance. The technique of harvesting has evolved simultaneously with minimally-invasive surgery. In our experience, the most appropriate technique is performed through hand-assisted retroperitoneoscopic access, since it ensures the high security of open harvesting, and provides the donor with the minimal invasiveness of endoscopic surgery.