Abstract: Objective To compare the clinical results of hand-assisted retroperitoneoscopic live donor nephrectomy (HRPLDN) and open 1ive donor nephrectomy (ODN). Methods Clinical data about 110 patients (HRPLDN in 65 cases and ODN in 45 cases) who underwent live donor nephrectomy in the 309th Hospital of Chinese PLA from March 2009 to March 2014 were retrospectively analyzed. Results Compared to ODN, HRPLDN donors had less estimated blood loss (85±41) ml vs (205±53) ml (P< 0.05), longer warm ischaemia time (121.5±48.2) s vs (93.4±47.3) s (P< 0.05) and shorter length of stay (7.3±1.5) d vs (10.6±2.3) d (P< 0.05). Complications were found in 6 cases, including lymphatic leakage, hematoma of renal subcapsule, lumbar vein injury in 3 patients respectively in HRPLDN group, inferior vena cava injury in 1 patient, incision fat liquefaction in 2 patients in ODN group. The recipients of two groups had similar serum creatinine and eGFR levels after two weeks. The incidence of delayed graft function (DGF), acute rejection (AR), urinary leakage (UL) in HRPLDN and ODN recipients were 7.6% (5/65) and 8.8% (4/45), 4.6% (3/65) and 4.4% (2/45), 1.5% (1/65) and 4.4% (2/45), respectively, which showed no significant differences (P> 0.05). All the 110 donors and recipients were followed up for 5-21 months, and their serum creatinine levels were normal. Conclusion Compared to ODN, HRPLDN shows superior results in terms of shorter length of stay and less estimated blood loss without increasing complications of donors and recipients. HRPLDN is as safe and reliable as ODN for living relative donors, which can replace open live donor nephrectomy.