Percutaneous ablation (PA) for renal cell carcinoma (RCC) offers similar outcomes to partial nephrectomy for patients with T1a RCC (≤4 cm in maximal diameter) with fewer complications, shorter hospital stays, and improved preservation of renal function. PA can also be used in nonsurgical candidates with T1b RCC (4.1–7 cm in maximal tumor diameter); although the outcomes are less favorable. As such, PA for RCC is a well-accepted therapeutic option for select patients by the American Urological Association (AUA), the National Comprehensive Cancer Network (NCCN), and other professional organizations. All ablative techniques have shown efficacy in RCC with the decision to use one over the other being left to operator preference, tumor size, location, and clinical presentation. Regarding outcomes, PA of RCC is an overall safe procedure; however, with any intervention, there is an inherent risk of complications, with bleeding being the most common adverse event. Operators improve their outcomes when they become familiar with the positives and negatives of their available ablation technologies and plan procedures accordingly.