Management of renal cell carcinoma (RCC) has evolved in the middle of the last century and particularly in the last decade, and this is due to a significant improvement in surgical techniques and the arrival of new technologies that can help both during the operation and in preoperative staging. Surgery remains the definitive therapy and the means of a cure. According to the American and European Urological Association guidelines, partial nephrectomy (PN) should be offered to all patients who have T1 tumours (i.e. tumours <7 cm), and it has been found to have comparable, possibly better, survival than radical nephrectomy (RN). In this context, in recent years we have seen an increasing use of intraoperative ultrasound (IOUS) probes. The use of ultrasound (US) in intraoperative renal surgery is able to provide indications regarding the parenchyma and vascularization of the kidney, which currently no intraoperative radiological method is able to give, and this can help improve the treatment of this malignant disease. The integration of IOUS in robotic-assisted renal surgery represents a stride forward in refining treatment strategies for renal cell carcinoma.