Abstract
Nephron Sparing Surgery (NSS) is the established treatment of choice for most T1 renal masses (1). By contrast a large and/or endophytic mass usually requires radical nephrectomy (RN) to reduce the risk of disappointing oncological outcomes. Yet, when a complex mass arises in a solitary kidney and partial nephrectomy (PN) is imperative, the oncological and the technical risks must be balanced against the benefits of avoiding dialysis. Complexity of renal tumours is best quantified by validated nephrometry scores e.g. PADUA (2). A PADUA score ≥10 is considered complex, typically indicating an endophytic, large (>7cm), central tumour. For a complex mass in a solitary kidney open excision under cold ischaemic conditions is still commonly performed as it can preserve renal function if prolonged ischaemia is anticipated (>30mins) (3).
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