Renal cell carcinoma (RCC) accounts for approximately 3% of malignancies and 80-90% of malignant neoplasms of the kidney in adults. Theincidence of RCC continues to increase. Due to widespread use of cross-sectional imaging modalities, small and localized tumors are now beingdetected at an early stage. Percutaneous image-guided thermal ablation for early stage RCC is a minimally invasive technique that has rapidlygained acceptance as an alternative to surgery. This technique provides a low incidence of complications, shorter operative-time, protection of renalfunction, lack of inherent surgery risks, and shorter hospital stay while remaining an effective method of adequate destruction of tumor tissue.The current ablation techniques include cryoablation, radiofrequency ablation (RFA), high-intensity focused ultrasound and microwave ablation(MWA). Image-guided percutaneous MWA has been effectively and safely applied to treat renal tumors in select patients. In contrast to RFA,percutaneous MWA has the advantage of providing higher temperatures in a shorter time. Thus, MWA allows a more uniform tumor necrosis thanRFA. The indications for renal MWA include T1a or T1b tumors (≤4 cm or 4-7 cm), patients with multiple comorbidities who are poor candidates forresection, a tumor in a solitary kidney, bilateral renal tumors, hereditary renal tumors, renal insufficiency, von Hippel-Lindau syndrome, and palliativetreatment of hematuria. In conclusion, percutaneous MWA appears to be a safe and effective treatment option for T1a and T1b tumors and for patients who are poor surgical candidates.