For large renal malignancies the clinical practice guidelines in oncology recommend radical nephrectomy. This is the surgical removal of the entire kidney and Gerota’s fascia plus or minus the removal of the ipsilateral adrenal gland. Radical nephrectomy is indicated in patients with kidney tumors measuring greater than 10 cm or in patients with multiple kidney tumors in the same kidney. However, the use of radical nephrectomy means complete cessation of renal function of the removed kidney and potential to hasten renal replacement need.