The treatment of kidney tumors with the technique of nephrone sparing surgeries continues to evolve. The oncological efficacy and outcomes in the treatment of small tumors in carefully selected patients treated with partial nephrectomy is similar with those of radical surgery. However, in some cases, partial nephrectomy is a challenging task for urologic surgeons-like too large renal mass or multifocal hereditary tumors. Renal autotransplantation was first performed in 1963 for ureteral injury by J.D. Hardy. In the following decade many surgeons used and improved the ex situ bench surgery and autotransplatation for benign or malignant renal conditions. These techniques have been used in the surgical management of complex ureteral injuries, renal artery aneurysms, renovascular hypertension, and complex renal tumors. The development of techniques for preserving renal functions during the ischemia and surgical skills has allowed good functional results of renal autotransplantation. However, it is important to remind that extensive excision and prolonged ischemia can lead to a poor graft function after renal autotransplantation. Nowadays, in clinical fields, the role of ex situ bench surgery and autotransplantation has become very limited, but remains an another option for preserving renal functions in various benign and even in malignant renal diseases, ranging from multiple artery reconstructions to complex renal tumors.