In the last two decades, the diagnosis and treatment of renal cancer were influenced by new technologies and surgical techniques. The new radiologic methods had a major impact in detecting smaller and asymptomatic tumors, while the minimally invasive options have offered a low-morbidity and high-efficacy individualized treatments to the patients, based on tumor characteristics and associated comorbidities. Herein we present a contemporary review of the minimally invasive approaches to the renal cancer, supported by the large experience with these therapeutic methods at the Cleveland Clinic.