Percutaneous surgical procedures are rapidly growing in popularity as they significantly reduce patient morbidity and recovery time when compared to more traditional open techniques. However, percutaneous procedures are often difficult. Percutaneous renal surgery is one example. Gaining access to the renal collecting system requires targeting of a specific calyx while avoiding critical internal structures and requires experience in the interpretation of radiographic images. Currently, this procedure is essentially done manually by trial and error. We present a system which automates the task of image-guided percutaneous needle placement. It is generally applicable to procedures for which the precision and accuracy of a percutaneous needle insertion is of primary concern. It can also be used, with minor modification, as a sub-component of larger systems for more involved procedures, for instance, percutaneous treatment of liver cancer . A prototype system has been implemented, and we present validation of its applicability to renal access with in vitro, ex vivo, and in situ studies. Additionally, we discuss what work remains on the path to a complete system.