The surge of technological advancements has changed the way we treat diseases. In the realm of nephron sparing surgery there is a raging debate on the role of ischemia in the preservation of renal function. We set about discussing this issue by conducting a literature search of pertinent articles of interest. Our narrative synthesis of these articles sheds light on the matter as well as discusses recent innovation that modifies or even eliminates the use of mechanical ischemia in renal surgery.