 Björl Lundberg is going to make the case for sticking with the traditional techniques tried and tested over many years rather than using new machines. Moderators and gentlemen, ladies, thanks for the invitation to this meeting. Well, it's a pleasure being here and it's a challenge to be after such a nice presentation for the technique, but is a robot-assisted partial nephrectomy the new standard for treatment of small renal masses? While it's a question for the patients to give an optimal oncological results, the renal functions should remain good, there should be few complications, low morbidity. And we know that the oncological risks are equal between radical nephrectomy and partial nephrectomy, although small renal cell carcinomas can be local aggressive, metastasized also, but when we compare the data from partial and radicals, we know they give similar oncological results, both for smaller renal masses and for renal masses up to seven centimeters. The patients, they are not healthy, they have concomitant diseases, they have conditions that will impair or have impaired renal function already. And we know from a study of hanging at all for many years ago now, 2006, that even four patients with the renal cell carcinoma, less than four centimeters, having a normal contralateral kidney and normal creatinine serum, 26 percent already have impaired glomeral filtration rate of less than 60 milliliters per minute. And we can see that in the same publication that when they look at freedom from new onset of GFR less than 60, for partial only 60 for three years and for radicals only 35 remain free from GFR less than 60 centimeters of radical nephrectomy. And that's of course a difference in renal function. What does that mean? Well, if you get reduction in the renal function, you also risk to be dead due to other causes. You have a risk for early cardiovascular events and hospitalization of any cause. So it's a risk factor having the kidney function reduced. We can see the same thing when we look at patients particularly treated for with partial nephrectomy and radical nephrectomy. So this is just that the cardiovascular events are larger in patients. Can I show it in something? No. You can see the upper curve is partial and lower in the red is a radical nephrectomy and they have more cardiovascular events and more overall mortality also. In Sweden we have looked at this data from compared with a population relative survival of patients with PTA renal cell carcinoma according to surgical technique. And we can see in the total and higher Sweden that patients treated with nephransparing surgery survive good as good as the population, but those treated with radical nephrectomy survive less good probably due to the other causes. So we know that nephransparing surgery is good, similar oncological outcome. They say renal function, but as we heard it is technically more demanding, more time consuming and more complications, but it's recommended for instance by EIU. In Sweden we have used this nephransparing surgery more and more during the coming years. That's depending on guidelines on the registration itself and educational efforts. And we can see from 2005 the nephransparing surgery increased from 20% in the population up to now 55% in the population. And that perhaps is the most important thing to have for these patients. So when the patients look at this, they wish to have negative margins, they wish to have a good oncological result. They want to have a short warmest in their time. They want to have very few complications and they wish to have low morbidity. And that's a question then, when you have different techniques. Could you do this in every hospital, every doctor, every situation? That's a problem. When we looked at data from the literature comparing robot assisted partial nephrectis with OPEN, we can see it's very few really published comparative studies and no random study. This is some informations. Lucas et al. This is from 2012, looked at only 27 robot assisted, 54 OPEN. And they found that the operative time was better in OPEN. One mission year time was better in OPEN. But the blood loss was better in robot. And the length of stay was better for a robotic. And we look at the multi-center match pair analysis from Italy. So also here that one mission year time was better for the OPEN. Blood loss was better for a robot and postoperative complications was better for a robot, but the rest of the factors were rather similar between the surgical procedures. In the more complex re-enlightened lesions, we can see that mostly when you compared the OPEN had higher pathological stage and size. And operative time were in that comparison better also for the OPEN, but blood loss was better for robot and hospital stay was less with robot complications similar. When they have compared the situation for matched patients, matched tumors, they can see that robot offers comparable perioperative and early in the functional outcomes. But perhaps robot has the advantage of improved postoperative pain and shorter lengths of stay. This is a rather new publication from Voo at all. They made a systematic review of what's published and they made a meta analysis of comparing robot assisted partial effect misversus OPEN. And they found that the robot assisted partial effect mishad a shorter, longer postoperative time, but they have less post-operative complications, shorter lengths of stay and less blood loss, but other factors were rather similar. So what I mean is that even if there's interest towards robot assisted partial effect in minimally invasive surgery, the benefits of what we do must be waged against what we have for renal function, what will leave after us as post-immortals and recurrent tumors and bleeding and postoperative complications. On the other side also we must look at society's cost, the net cost for instrument, robotic platform and maintenance costs and that's another subject. And really the overall need for an optimal treatment of such a patient is to perform an optimal partial nephrectomy. That's more important than the technique really. The conclusion is that for high level evidence-based data we need, we haven't that for these surgical techniques. We could do this single-port surgery, everyone, but possibly we can't do it. Each approach seems to have its advantages and disadvantages and we must compare these techniques to know what to do. We need randomized trials. So no robot assisted partial nephrectomy is not the new standard for the treatment of small renal masses, but it's an optimal treatment. Optional treatment for patients with these tumors and nephransparing surgery is the standard treatment for patients with T1 RCC, whenever feasible. Thank you.