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Secondary to the widespread use of the modern imaging techniques of computed tomog-raphy, magnetic resonance imaging, and ultrasound, 70 % of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45 % of renal tumors have indolent or benign pathology; and (3) PN pre-vents or delays the onset of chronic kidney disease, a condition associated with in-creased cardiovascular morbidity and mortality. Although PN can be technically de-manding and associated with potential complications of bleeding, infection, and uri-nary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank " open surgical approach that is highly effective and, cou-pled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay