Indian Journal of Urology 508 | October-December 2009 | In this regard we summarize the current status of NSS – open partial nephrectomy (OPN) for renal cell carcinoma (RCC) in the era of minimal invasive surgery. NEPHRON SPARING SURGERY - OPEN PARTIAL NEPHRECTOMY Radical nephrectomy has been considered as gold standard for the treatment of localized or locally advanced RCC. Laparoscopic radical nephrectomy has emerged as a less morbid alternative to open surgery in the management of low- to moderate-volume (8 to 10 cm or smaller), localized RCC cases with no local invasion, renal vein involvement, or lymphadenopathy. Nevertheless, studies have demonstrated the onco-surgical adequacy of NSS compared to the radical nephrectomy. Although operative time was found to be more with partial nephrectomy, [6] the perceived benefit of partial nephrectomy is preservation of renal parenchyma. EVOLUTION OF NSS NSS started with cases for which the partial nephrectomy was a must (imperative) to those where it could be performed safely (elective). The current indication of NSS can appropriately be categorized into imperative, relative and elective [Table 1]. INTRODUCTION Renal Cancer surgery has recently shown a trend towards parenchymal sparing and minimal invasive approach. The technique of nephron sparing surgery (NSS) has evolved through the phases of experimental surgery to surgery for patients with marginal renal reserve and now extending to those for elective setting. There has been an increase in NSS done due to the dramatic increase in the lower stage lesions, better prognosis of incidentally diagnosed tumor [1,2] and the excellent outcome of NSS. The rationale for performing NSS is - increased longevity, improved health, early diagnosis in younger age group along with a better understanding and improvement in the surgical techniques. Moreover, rising incidence of incidentally diagnosed renal tumors [3, 4] and up to 40% of benign renal masses in final histopathology have served as an impetus for the potential expansion of the indications for elective NSS. Where the selection of open NSS is a complex decision for physicians and patients alike, laparoscopic NSS is further associated with its technical difficulties. [5] Role of open nephron sparing surgery in the era of minimal invasive surgery Gaurav Gupta, Sameer Grover, Santosh Kumar, Nitin S. Kekre Department of Urology, Christian Medical College and Hospital, Vellore - 632004, Tamilnadu, India ABSTRACT Objective: Objective: The study aims to review the current status of nephron sparing surgery – open partial nephrectomy (OPN) for renal cell carcinoma in the minimal invasive era. The literature search was done using National Library of Medicine database (PubMed). Results: Results: Early experience with laparoscopic partial nephrectomy is promising. It has an inherent advantage of less operative time, decreased operative blood loss and a shorter hospital stay at the expense of prolonged ischemia and operative time. Complex scenarios for partial nephrectomy such as centrally located tumor, tumor in a solitary kidney, predominantly cystic tumor, and multifocal disease probably are managed best with an open technique. All these challenging situations have been addressed successfully by experienced laparoscopic surgeons, therefore these conditions are best considered relative rather than absolute contraindications for laparoscopic partial nephrectomy. Conclusions: Conclusions: Laparoscopic partial nephrectomy faces the problem of technical complexity and availability of expertise. Open partial nephrectomy continues to be the gold standard for nephron sparing surgery. Key words Key words: Renal cell carcinoma, nephron sparing surgery, partial Nephrectomy, open, laparoscopic partial nephrectomy DOI: 10.4103/0970-1591.57930 PMID: 19955678 Symposium Symposium For correspondence: Dr. Nitin S. Kekre, Department of Urology, Christian Medical College, Vellore, Tamilnadu - 632 004, India. E-mail: uro2@cmcvellore.ac.in