The surgical history of renal cell cancer dates back to the nineteenth century. The first nephrectomy occurred by accident during surgery to remove live cysts. Intentional nephrectomy followed shortly after, but it was not until improvements in antiseptic technique and anesthesia that renal surgery became commonplace. Radical nephrectomy was the mainstay of treatment for renal tumors for more than 100 years. Most patients had a normal, contralateral kidney, and removing the diseased kidney and surrounding tissue was thought to provide the best oncological outcome. Fortunately, improvement in renal imaging and surgical technology in the past few decades has allowed the rise of effective renal-sparing treatments This chapter reviews the development of renal surgery, from its infancy in the latter part of the nineteenth century to its current use in urology today.