Nephron-sparing surgery (NSS) is being increasingly employed for the management of patients with localized renal cell carcinoma (RCC) and a normal opposite kidney. Ideally, such an approach should be reserved for patients in whom the risk of local recurrence and morbidity related to NSS are relatively low. In this article, we will review the technical considerations associated with performing elective partial nephrectomy and discuss the surgical complications specifically related to NSS, with emphasis on prevention, diagnosis, and management. Recent improvements in our technique for performing NSS will be described, and the current data regarding proper patient selection for elective partial nephrectomy will be reviewed.