The majority of patients who have primary or metastatic tumours of the liver are not amenable to surgical excision at the time of presentation because of tumour size, multifocality, or inadequate functional hepatic reserve. Unfortunately, most patients with primary or secondary liver cancer are not candidates for resection. Moreover, many patients recur within the liver following resection and few of these are candidates for re-resection. For these reasons, increasing interest has been focused on regional treatment methods as they represent new treatment options for such patients. Although radiofrequency thermal ablation is a relatively new modality, promising results have been obtained with. So radiofrequency ablation (RFA) is becoming the most commonly used and perhaps most promising modality for tumour ablation. The aim of this study was to evaluate feasibility, safety, and effectiveness of readiofrequency thermal ablation, performed during laparoscopy, for the treatment of unresctable hepatocellular carcinoma in cirrhotic patients. During a two years period, 30 patients affected by "unresectable” hepatocellular carcinoma were treated, 15 patients by laparoscopic radiofrequency thermal ablation. (Group A) 13 patients (86.6%) were in child class B and two patients (13.3%) were in child class A. A total of 19 hepatic lesions were detected. Another 15 patients (group B) were treated by percutaneous radiofrequency thermal ablation. Ten patients (73.3%) were in Child class B and 4 patients (26.6%) were in child A. Under sonographic guidance the needles were inserted into the hepatic lesions. A total of 21 hepatic lesions were detected.All patients were followed-up post operatively to asses complications, treatment response, and local recurrence of malignant disease. There were no treatment related deaths. Bleeding from radiofrequency ablation needle track occurred only in one lesion (5%) after needle electrode withdrawal, it was minimal (10cc), and controlled easily with cauterization of the liver capsule puncture site. But in group (B) it was occurred in 4 lesions (19%), in 4 patients (26.6%) and managed conservatively, 2 cases had been resolved and the another 2 cases complicating by abscess formation that treated by drainage. Triphasic spiral CT scan detected a complete tumour necrosis in 14 patients (93%) and partial necrosis in one case (7%) in group A, but in group B complete necrosis was observed in 11 patients (73.3%) and partial necrosis in 4 cases (26.7%). The median follow-up was 15 months. Tumour had recurred in 6 patients (40%) in Group A, and in 7 patients in group B (46.6%). The liver was the site of recurrence in 4 (66.6%) of patients in group A and in 5 (71.4%) of patients in Group B. One patient died of causes not related to HCC (6.6%) in Group A, and another one with multifocal HCC died due to recurrent HCC and rapid progress of the disease. In group B 3 patients were died due to HCC (20%). In group A 12 patients (80%) are currently disease free, and in Group B 10 patients (66.6%).The initial experience with laparoscopy guided radiofrequency thermal ablation indicates its safety, well tolerability, and therapeutic potential in cirrhotic patients with unresectable hepatocellular carcinoma. Possible indications to laparoscopic radiofrequency thermal ablation are: Large hepatocellular carcinoma (3-4cm), defective coagulation, superficial lesions, multiple lesions, tumour located near major vascular or biliary structures. Because patients are at risk for the development of new mastatic disease after radiofrequency ablation, use of combination therapies seems to be encouraging but randomized trials are lacking and the most effective combinations have yet to be detected.