title: New developments in renal focal therapy.
abstract: BACKGROUND
  The aim of this study was to review recent advances and to provide future perspectives in renal focal therapy.
  
  
  METHODS
  Most relevant available data from current literature and reports from major urological meetings as well as clinical and experimental experience at our institution have been considered.
  
  
  RESULTS
  Effective treatment of incidentally detected small renal masses continues to evolve. Major recent advances have been made toward three main directions: enhancing accuracy of probe positioning, improving ablative energy efficiency, and reducing treatment-related morbidity.
  
  
  CONCLUSIONS
  Renal focal therapy can offer the advantage of combining a nephron-sparing surgery together with a minimally invasive approach. Technical refinements will include emerging clinical data for radiofrequency and cryoablation. Single-port access renal cryotherapy has been shown to be feasible and safe. Although in its infancy, natural orifice translumenal endoscopic surgery might represent a further step toward scarless surgery. Radiosurgery is under investigation and oncological outcomes are awaited to determine its role. Stereotactic surgical navigation and robotic needle placement would facilitate and increase the accuracy of percutaneous probe placement.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D017115:Catheter Ablation; D003131:Combined Modality Therapy; D003452:Cryosurgery; D004724:Endoscopy; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D012371:Robotics; D013238:Stereotaxic Techniques