First we had no refactor tools at all, and how we survived I'll never now
Then basic refactor tools where introduced. You could call up a dialog to do explicit refactoring.
Then the generate functionality was introduced and you could start doing things like typing out a class name that didn't exist, right-click and generate a class and file with that name.
Now everything been taken to the far end. I can just edit parameters, types etc directly in the editor, a light bulb will appear, I click it and choose how it will apply refactoring regarding my changes. If I want to change the type returned from a method inherited from a base class I can just edit it in the derived class and have it apply it on the base class.
Same with generate, just type a lot stuff like you want it to be, a light bulb will appear and it generates everything with correct parameters and all.
If I want to break stuff out of a blob class to a another class called by the original class, I just highlight the methods in the editor and chose "create new class" and it will add initialization for the new class, a field or property for it.
Sometimes when I need to split a class in two there really isn't any good refactoring tool. So what do you do? Copy the class and rename it so you have them side by side in the same file. Eliminate the fields and properties for each that you don't want in either. It will now highlight all the code you've broken. Now delete and change all that has been highlighted. Then just click the light bulb and choose "move class to file named whatever.class". Voila! It's such a streamlined process.
Or just things like Ctrl-clicking something to navigate to it (or pressing F12). Or quickly finding what code calls a method. Or snippet templates like ctor or prop.
To put the cherry on the cake I can press Ctrl-M+Space and Ctrl-M+Z to have the Code Maid plugin reorganize the code and normalize white space.
Seeing, doing and navigating has all come together so nicely and totally changed the way I code. It has made constant and continuous refactoring feasible and effortless. The only downside is that I'm not always sure where Visual Studio ends and Resharper begins :)
The thing I miss though is unit testing being as "on-the-fly" and integrated into the editor. I'd love to be able to write mini-tests as annotations to methods and have VS highlight when it breaks them.
... and maybe continuous background compiling and "live-updating" of apps :)