As surgical laparoscopy advances and new techniques are developed for specific procedures, it is important to consider how such techniques may be useful in other surgical specialties. This video demonstrates how a technique developed for laparoscopic aortic surgery can be applied to a totally laparoscopic nephrectomy. The technique may be most useful for removal of small kidneys or adrenalectomies. In the case shown here, the patient suffered from malignant hypertension and had an atrophic left kidney. Minimally invasive nephrectomies have generally been performed using either a ;hand-assisted method or laparoscopic-assisted method. In both cases an incision of at least 6 to 8 cm is made. The totally laparoscopic procedure shown here uses a technique described by Y.-M. Dion, in which an "apron" of peritoneum is created to hold back bowel from intruding into the operative field, facilitating a transperitoneal-retroperitoneal approach. The peritoneum is incised at the left lateral aspect of the rectus sheath and then dissected laterally to create the apron. Three trocars are placed in the mid-line and three more in the left anterior axillary line. The free edge of the apron is fixed to the right paramedian region with 3-0 Prolene sutures using straight needles. Two laparoscopic retractors are inserted and the kidney is exposed by following the ureter superiorly. The renal vessels are transected by Endo GIA staples, and the kidney is placed in an endobag and removed through the umbilical port.