*Purpose: There are no objective parameters for predicting the difficulty of laparoscopic donor nephrectomy (LDN). Our aim was to identify the correlation between demographic and radiologic variables and surgical difficulty, in order to realise a scoring system for donor selection.

*Methods: We analysed the following data on 78 living kidney donors: sex, age, BMI nephrectomy side, operative time and qualitative and quantitative CT scan parameters. Each operation was classified as easy, moderately difficult and very difficult, depending on the difficulty perceived subjectively by the operator based on the evaluation of specific intraoperative parameters. Validation of this judgment was performed by analyzing the correlation between demographic parameters and objective preoperative CT scan measurements with the level of difficulty.

*Results: The operation was easy in 60/79 cases (76.9%), moderately difficult in 14/79 (17.7%), very difficult in 4/79 (5%). Statistical analysis confirmed a significant correlation between the level of difficulty and male sex (p 0.021), BMI>27 (p 0.0001), operative time (0.005) seven CT scan parameters (p< 0.001). These parameters were used to develop a difficulty scoring system (LAP DOCTOR: LAParoscopic DOnor nephreCTomy scORe) that showed accuracy in detecting the level of difficulty and is currently undergoing validation in a prospective multicentric study.

*Conclusions: The combination of preoperative CT scan parameters and demographic variables correlates with the level of difficulty of LDN and allows for the development of a scoring system which will be useful in assessing the operative risk and possibly reducing the morbidity of LDN. This system will need validation in a prospective multicentric study.

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