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Simple Summary: Ultrasonography-guided percutaneous radiofrequency ablation is a relatively simple, safe and inexpensive treatment method for patients with small renal tumours and thus an attractive alternative in such cases. It has been, however, reported to be associated with an increased risk of recurrence in comparison with the current standard—partial nephrectomy. The aim of this study is to evaluate tumour characteristics associated with an increased risk of residual disease/recurrence and to find which tumours can be treated with ultrasonography-guided percutaneous ablation without an increased risk of recurrence. Ultrasonography-guided percutaneous radiofrequency ablation was safe and well-tolerated. Its effectiveness depended on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours were successfully re-treated with ultrasonography-guided percutaneous ablation. Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours—only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26–30 mm and 84.4% for lesions 26–30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA. [ABSTRACT FROM AUTHOR]