was not impacted by the advent of hand-assisted laparoscopic radical nephrectomy.

offers metastatic recurrence-free survival and cancerspecific survival similar to that of radiofrequency ablation and cryoablation.

is the predominant treatment modality employed in the United States for the management of small renal masses.

offers equivalent cancer-specific and overall survival when compared with radical nephrectomy.

when performed laparoscopically is associated with fewer complications than radiofrequency ablation (RFA) or cryoablation.

−60° C

−40° C

0° C

−19.4° C

−20° C

treatment under real-time image guidance.

treatment to beyond 1╯cm of the targeted lesion.

all of the above.

achieving a critical target temperature.

a double freeze-thaw cycle.

none of the above.

inability to use RFA laparoscopically.

inability to monitor treatment under image guidance.

higher risk of hemorrhage following RFA.

inferior cancer-specific survival.

comparable or fewer complications with renal tumor ablation compared with extirpative treatments.

higher local recurrence rates with ablative technologies when compared with partial or radical nephrectomy.

conflicting results regarding the superiority of cryoablation versus RFA.

all of the above.

a lack of uniformity regarding evaluation, patient selection, treatment, and follow-up of patients undergoing renal tumor ablation.

reducing impedance by improving current conductivity.

using higher RF currents.

using bipolar electrodes.

clamping hilar vessels.

applying RF currents faster to achieve better heating.

HIFU acts through local thermal and cavitary processes to generate tissue temperatures in excess of 65°

Because renal HIFU is performed under real-time image guidance, targeting is not significantly impacted by respiratory movement.

Animal and human studies have demonstrated consistent tissue necrosis following treatment.

The most commonly cited complication following HIFU for the treatment of renal lesions is post-treatment hemorrhage.

Preliminary data suggests equivalent oncologic outcomes with HIFU when compared with alternative ablative technologies or extirpative options.

biopsy of the treatment area with reduced nicotinamide adenine dinucleotide (NADH) diaphorase staining.

biopsy of the treatment area with hematoxylin and eosin (H&E) staining.

follow-up CT or MRI with contrast that demonstrates complete loss of contrast enhancement and stable or decreased size of the treated area.

follow-up CT or MRI without contrast that demonstrates a decrease in size of the treated area.

all of the above.

Its use in the management of renal cell carcinoma remains investigational and should be performed under protocol.

Stereotactic radiosurgery employs 3-dimensional coordinates to target and focally ablate tissue using high-dose external beam radiation.

Renal cell carcinoma (RCC) is radioresistant, and stereotactic radiosurgery has consistently demonstrated poor outcomes with treatment of RCC.

Radiation scatter is minimized, and higher doses may therefore be applied in a focal manner that effectively ablates masses in the kidney without compromising overall renal function.

Stereotactic treatment systems compensate for respiratory movement and radiation scatter by automatically tracking, detecting, and correcting for tumor and/or organ movement without interrupting the treatment or repositioning the patient.

a 64-year-old woman with a 1.7-cm enhancing mass concerning for RCC in her transplant allograft. She has previously undergone bilateral native nephrectomy.

a 54-year-old man who has undergone prior left nephrectomy, right partial nephrectomy, and prior right tumor ablation for pathologically proven RCC. He now presents with an independent 2-cm enhancing renal lesion abutting the psoas muscle.

a 47-year-old man who is otherwise healthy and demonstrates a 3.1-cm mesophytic enhancing lesion of the right kidney.

a 74-year-old man with a 2.5-cm enhancing renal mass oriented posterior to the axis of the kidney. The patient has multiple comorbidities and desires a minimally invasive treatment approach.

an otherwise healthy 81-year-old woman with a 3.2-cm lower pole enhancing renal mass that is anterior to the axis of the kidney. The patient desires treatment.