Purpose <p>This study aims to evaluate the clinical impact of three-dimensional (3D) reconstruction in partial nephrectomy for ipsilateral multifocal renal tumors (MIRTs), focusing on surgical precision, ischemia management, and postoperative outcomes.</p> Methods <p>A retrospective analysis was performed on 56 MIRTs patients who underwent PN at two hospitals. Patients were divided into two groups: Group A (33 patients) received standard preoperative CT scans, while Group B (23 patients) underwent 3D reconstruction. Surgical data, including operative time, blood loss, ischemia time, and complications, were compared. Renal function was assessed using serum creatinine and eGFR levels preoperatively and postoperatively.</p> Results <p>Baseline demographics, including age, body mass index, preoperative hemoglobin levels, and tumor characteristics (size, multifocality), showed no significant intergroup differences (<i>p</i> &gt; 0.05). The 3D reconstruction group demonstrated a 2.2 days reduction in hospital stay (9.43 vs. 11.63 days, <i>p</i> = 0.025) and achieved 100% adherence to preoperative surgical plans (vs. 81.9% in the 2D group, <i>p</i> = 0.037). Operative metrics, including operative time, estimated blood loss, ischemia time, and rates of collecting system injury, showed no significant differences (<i>p</i> &gt; 0.05). Safety outcomes, such as conversion to radical nephrectomy (13.0% vs. 21.2%) and transfusion rates (8.6% vs. 9.1%), were comparable (<i>p</i> &gt; 0.05). Postoperative renal function preservation, assessed by ΔeGFR and ΔSCr, also revealed no intergroup disparities (<i>p</i> &gt; 0.05).</p> Conclusion <p>Three-dimensional reconstruction technology enhances surgical precision and adherence to preoperative plans. It can be considered as a transformative tool in nephron-sparing surgery due to its potential to redefine standards for managing multifocal renal tumors.</p>