The laparoscopic approach to kidney surgery is rapidly becoming the global "gold standard." There is now sufficient evidence that, with proper patient selection, the laparoscopic approach is an alternative to open renal surgery. In this report, Pareek and colleagues (Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY. — J Urol. 2006 Apr;175(4):1208–13) described complications associated with various laparoscopic approaches using a meta-analysis of literature data. The following procedures were included in this analysis: laparoscopic radical nephrectomy (LRN), hand-assisted laparoscopic radical nephrectomy (HALRN), laparoscopic partial nephrectomy (LPN), hand-assisted laparoscopic partial nephrectomy (HALPN), laparoscopic donor nephrectomy (LDN), hand-assisted laparoscopic donor nephrectomy (HALDN), laparoscopic simple nephrectomy (LSN), laparoscopic nephroureterectomy (LNU), and retroperitoneal laparoscopic nephrectomy (RLN). The authors reviewed the literature using a variety of search technologies. To begin, 75 references were eligible for the search between 1995 and 2004. Of these 75 references, 56 cases fully met the criteria. The median study duration was 9 months (range, 3–20 months). Serious complications of laparoscopic renal surgery accounted for 9.5%, minor complications accounted for 1.9%. The most common serious complications were recorded in the groups that underwent laparoscopic partial nephrectomy LPN (21%) and laparoscopic nephroureterectomy LNU (18.8%). Frequent minor complications were noted in the groups that underwent laparoscopic simple nephrectomy LSN (5.7%) and radical nephrectomy HALRN (3.4%). The incidence of complications was compared between laparoscopic radical nephrectomy LRN and hand-assisted laparoscopic radical nephrectomy HALRN, and between laparoscopic donor nephrectomy LDN and hand-assisted laparoscopic donor nephrectomy HALDN. These cases did not differ significantly, while the complication rate between laparoscopic partial nephrectomy LPN and hand-assisted laparoscopic partial nephrectomy HALPN was 21% versus 3.3%, respectively (p=0.02). The authors noted a significant difference in wound infection rates between laparoscopic radical nephrectomy LRN (0.2%) and hand-assisted laparoscopic radical nephrectomy HALRN (1.5%) (p=0.02). A high wound infection rate was observed in the group of patients who underwent hand-assisted laparoscopic donor nephrectomy HALDN (p=0.03). In contrast to other recently published studies, there was no difference in the incidence of incisional hernias between the different groups. Complications in laparoscopic renal surgery reach 10%, this figure is based mainly on literature data. The most serious complications occur with laparoscopic partial nephrectomy of the LPN, which remains a technically challenging procedure. A high rate of wound complications is associated with the hand-assisted approach. This is due to the high level of stress on the hand access site, which is not used in the traditional laparoscopic approach. However, its addition helps novice physicians mastering the hand-assisted approach minimize other, more serious complications.