This article reports experience and outcomes in minimally invasive living-donor nephrectomies (MILDN): laparoscopic, natural orifice transluminal endoscopic surgery (NOTES)-assisted, and laparo-endoscopic single-site surgery (LESS) since their introduction in March 2002. Findings demonstrate safety of MILDN techniques for donors and grafts, with low complication.

• In this retrospective observational study of donors receiving MILDN between March 2002 and March 2020, a total of 714 MILDNs were included.

• In 541 cases (75.88%), conventional laparoscopic approach was employed, NOTES was used in 116 (16.9%), LESS in 55 (7.7%), and one mini open (0.14%).

• Mean donor age was 52.87 years (SD 10.93), and the right kidney was removed in 17.8% of cases.

• The NOTES and LESS groups had higher warm ischaemia time.

• Eight conversions were reported.

• The global intraoperative and postoperative complication rates were reported to be 6.8% and 4.9%, respectively.

• During follow-up (mean 3.68 years), renal disease did not develop in any of the donors.

• The 5-year recipient and graft survival rates were documented to be 98.8% and 96.8%, respectively.