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

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

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

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

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

−20° C

−19.4° C

−40° C

−60° C

0° C

all of the above.

a double freeze-thaw cycle.

treatment under real-time image guidance.

achieving a critical target temperature.

treatment to beyond 1╯cm of the targeted lesion.

inferior cancer-specific survival.

inability to monitor treatment under image guidance.

inability to use RFA laparoscopically.

none of the above.

higher risk of hemorrhage following RFA.

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

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

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

conflicting results regarding the superiority of cryoablation versus RFA.

all of the above.

using bipolar electrodes.

using higher RF currents.

applying RF currents faster to achieve better heating.

clamping hilar vessels.

reducing impedance by improving current conductivity.

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

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

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

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

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

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.

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

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

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.

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

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

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

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

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.

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.

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.

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.