Experimental as well as clinical studies proved percutaneous renal RF-ablation to be an accurate and safe alternative to open or laparoscopic surgery in the treatment of small renal tumors. It is well tolerated in patients with percutaneously accessible lesions. Moreover, it is known to be less costly than open or laparoscopic partial nephrectomy. Considering recent data comparing RF-ablation and surgery as well as the increasing volume of long-term data, it holds the potential to replace surgery as first line therapy in small renal cell carcinomas (RCCs).