Objective To assess the feasibility and outcomes of retroperitoneal laparoscope-assisted small incision partial nephrectomy for patients with complex T₁ renal cell carcinomas (RCCs). Methods The clinical data of twenty-eight patients with complex T₁ RCCs, who underwent retroperitoneal laparoscope-assisted small incision partial nephrectomy at our institution between Jul. 2010 and Dec. 2013, were retrospectively analyzed. The tumor diameter was (3.76±1.28) cm and the PADUA score was 9.07±1.25 in this group. There were 13 patients with endophytic tumors, 12 at T_1b stage, 7 reniportal RCCs, and 2 cases of solitary kidney. Results All the patients successfully underwent operations, with no severe postoperative complications such as leakage of urine or massive hemorrhage. The operative time was (213.82±40.04) min, the renal cold ischemic time was (23.86±5.98) min, the estimated blood loss was (191.07±94.33) mL, the skin incision length was (9.48±1.56) cm, and the postoperative pain score was (1.11±0.31). Two patients developed transient hyperpyrexia postoperatively and were successfully managed with expectant treatment. And all the patients were discharged safely after a hospital stay of (11.54±3.98) days after surgery. The patients were followed up for (21.46±12.15) months. At the 1^st month postoperation, the glomerular filtration rate (GFR) deceased by an average of (21.71±11.48)%. No recurrence or metastasis occurred during the follow-up. Conclusion Retroperitoneal laparoscope-assisted small incision partial nephrectomy is a safe, feasible method for complex T₁ RCCs, especially for the larger, endophytic, and reniportal tumors. The method is easy to learn and has small incision, but the long term effect needs to be observed by large sample randomized studies.