Background: We aimed to confirm the advantages of a modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) compared to the performance of standard retroperitoneoscopic living donor nephrectomy (RPLDN). Methods: One hundred twenty-eight consecutive surgical cases were categorized into 2 groups, one receiving standard RPLDN (group 1) and one receiving modified HARPLDN (group 2). Perioperative factors of both groups were evaluated retrospectively, including donors' demographics, overall operating time, warm ischemia time (WIT), graft vessel length, blood loss, complications, pain visual analogue scale (VAS) scores, hospital stay, and matched recipients' perioperative outcomes. One-year follow-up data were also examined. Results: The standard RPLDN group (n = 44) and modified HARPLDN group (n = 84) had comparable age, gender, and body mass index. The RPLDN group donors had longer operative time, shorter vein length and longer WIT than the modified HARPLDN (all p < 0.001). RPLDN had higher VAS scores (p < 0.001), longer carminative time (p = 0.002) and higher morphine requirement (p = 0.039) than the modified HARPLDN. No complications occurred in either group. All recipients and grafts had survived at 1-year follow-up. Conclusion: The modified HARPLDN technique is safe and effective for living donor nephrectomy and has shorter operating time, shorter WIT and better pain control. Further study is required to evaluate donors' long-term quality of life and recipients' long-term outcomes.

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