Small renal tumours (SRT) are increasingly detected as incidental findings because of widespread use of imaging and can be benign or malignant. Percutaneous ablation treatment of SRT plays a role in clinical T1a and T1b renal cell carcinomas (RCC) in patients unfit to undergo "gold standard" surgical treatment because of medical co-morbidities or those patients with hereditary multiple RCC syndromes or those with chronic renal failure (CRF). Oncological outcomes so far have shown to be equivalent between radical nephrectomy and nephron sparing surgery or partial nephrectomy and are favourably comparable to cryo-ablation and radio frequency (RF) ablation treatment of SRT. The percutaneous techniques are minimally invasive and can be performed under intravenous sedation and as day only procedures under computed tomography guidance. A combined interventional radiology and urology assessment is required for optimum patient selection for tumour ablation. The results of Dr Vladica's 10-year oncology follow up of RFA treatment of SRT at Westmead Hospital (one of the longest and largest follow up series) demonstrates it to be a cost effective, safe and optimum treatment option for carefully selected patient population.