Eighteen patients of hepatocellular carcinoma were treated by percutaneous transthoracic radiofrequency ablation (RFA) with computed tomographic (CT) guidance. In this series, artificially induced pnemothorax was made to allow the access route to the tumor clear from the pulmonary parenchyma. The RFA needle electrode was punctured with transthoracic extrapulmonary transdiaphragmatic access. Hemothorax was found just after RFA in 1 patient, however, he had no fatal postoperative course without transfusion. No complication was observed in other patients. All patients survive with 343 days of a mean follow up duration. Intrahepatic single recurrence after RFA developed in 6 patients and multiple recurrence in 3. Among them, one patient had local recurrence at RFA site. No extrahepatic tumors or seeding tumors were developed. Artificially induced pnemothorax should be useful technique to achieve safe and effective transthoracic RFA.
