The incidence of renal cell carcinoma is increasing due to the incidental detection of small renal masses, The standard of care for small localized renal neoplasms is open or laparoscopic, partial nephrectomy. Active surveillance and minimally invasive techniques are emerging and most are reserved for poor surgical candidates, or as part of a clinical study. While long-term data have demonstrated durable outcomes for nephron sparing surgery, extended oncological efficacy is lacking for ablation and surveillance strategies.