**3.2.2 Complications: Open versus Laparoscopy**

Open NSS is well established in T1a tumours and is becoming increasingly accepted in T1b tumours. In the last few years, a tendency to apply a laparoscopic approach for T1a renal tumours has been observed. In some centres this is already the standard of care. Indeed, in experienced hands, the laparoscopic approach achieves intermediate-term oncological and renal function outcomes comparable to open surgery.

In a multicenter study (Porpiglia et al., 2010), 63 patients underwent a laparoscopic partial nephrectomy by enucleo-resection with intraoperative ultrasound. The conversion rate was 7.3%: always for bleeding but without requiring RN. Postoperative complication rate was 26%: acute hemorrhage, urinary fistula, fever, chyluria and retroperitoneal hematoma. Acute hemorrhage was the most frequent (9.7%). Half of them were treated with embolization, the other half with reoperation. One patient required a RN. Urinary fistulas (4.4%) required a double J placement and one patient necessitated a re-operation. 6.5% of patients had PSM. There was no correlation between PSM status and tumour size or location.
