Background. We compare the anatomic and functional outcomes of right live-donor nephrectomy (LDN) using either a hand-assisted approach (HALDN) or a pure retroperitoneoscopic approach (RLDN) in two institutions. Patients and Methods. Data were recorded prospectively in 59 patients undergoing right LDN using either hand-assisted (n=31) or pure retroperitoneoscopic (n=28) approaches. All HALDN cases were performed at the University of Cincinnati, and all RLDN cases were performed at the Cleveland Clinic Foundation. Results. Demographics were similar with respect to age (41.1±11.5 vs. 44.5±8.5 years) and human leukocyte antigen mismatches (2.7±1.8 vs. 2.6±1.6). Operative times were longer for HALDN (3.4±0.7 vs. 3.0±0.7 hours, P<0.04), whereas warm ischemia time was shorter (3:55±1:47 vs. 4:55±0:55 minutes, P<0.001). Length of renal vein and artery were equivalent (2.4/3.4 vs. 2.3/3.2 cm, P=0.5). Complication rates were similar (10% vs. 7%, P=0.5), including conversion to open surgery (n=1), accessory upper pole artery transection (n=1), and swollen testicle (n=l) in the HALDN group, and a small parenchymal injury (n=1) and a capsular tear (n=1) in the RLDN group. Donor length of stay and convalescence were similar in both groups (43.5±14.1 vs. 45.7±25.3 hours, P=0.1; convalescence 23.5±5.3 vs. 20.2±4.1 days, P=0.5). One-week, 1-month, and 1-year serum creatinine levels were equivalent with both approaches. No grafts were lost in either group. Conclusions. This study confirms that the HALDN and RLDN techniques can provide kidney grafts with equivalent-length vessels and excellent function.