In recent years the incidence of small renal carcinoma is increasing, and nephron sparing surgery(NSS) becomes the mainstream to treat it. NSS is considered based on comprehensive analysis: the imaging examination, systemic evaluation of the patients, and the indications of NSS. There are three common surgical approaches: intraperitoneal approach, retroperitoneal approach and the joint approach. It is recommended to do intraoperative frozen pathology. If the edge is positive, it is better to cut a deeper layer of the tissue around the renal tumor or transform to radical nephrectomy. Attention should also be paid to reduce heat ischemia time, in order to protect renal function and reduce postoperative renal atrophy. In addition, there are some factors, such as the accurate preoperative evaluation of renal function and surgical skill of the doctors, which can reduce the incidence of postoperative complications and improve survival and quality of life.