The purpose of this review was to identify the specific technical considerations to adequately perform microwave ablations (MWA) of renal tumors and analyze the currently available clinical results.

Using Medline, a systematic review was performed including articles published between January 2000 and September 2016. English language original articles, reviews and editorials were selected based on their clinical relevance.

MWA has several theoretical advantages over radiofrequency ablation in consistently providing higher intratumoral temperatures. MWA is less dependent of electrical conductivities of tissues and the delivered energy is less limited by desiccation of heated tissues. While there are insufficient data, especially because of a lack of studies with mid- to long-term follow-up, to determine the oncologic effectiveness of MWA, this technique appears safe and effective for the ablation of T1 renal tumors. There is evidence for using mid-level settings based on experimental and clinical data. Power set at 50–65W for 5–15min appears adequate in kidney but close clinical and imaging follow-up have to be performed.

Renal MWA offers theoretical advantages by comparison with other available techniques to treat renal tumors. However, MWA suffers of less cumulative data compared to radiofrequency ablation or cryoablation. Moreover, microwaves still require further studies to identify the optimal tumor characteristics and device settings leading to predictable ablation.