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This review examines the modern role of open partial nephrectomy (OPN), indications for this surgical approach, and outcomes associated with the open technique in the era of robotic surgery.

Robotic-assisted partial nephrectomy (RAPN) now predominates for small renal masses and is increasingly applied to larger and more complex masses. Across multiple comparative series and meta-analyses, RAPN offers equivalent oncologic control and functional preservation compared to OPN, while demonstrating reduced perioperative morbidity. Nonetheless, OPN remains valuable for tumors in hostile or re-operative fields, certain hereditary syndromes, solitary kidneys when cold ischemia is preferred, and settings without reliable robotic access. Declining open case exposure during training raises concerns about maintaining surgical competency. OPN remains an important option when use of the approach provides improved surgical exposure, ischemia management, intra-operative safety, or feasibility of nephron sparing. A pragmatic, surgeon-experience-based approach that prioritizes oncologic control, parenchymal preservation, and patient safety best serves individualized care.