RFA can be carried out percutaneously, laparoscopically, or at open surgery. The laparoscopic and open approaches increase the chance of detection of unknown intrahepatic and extrahepatic tumors, as they allow complete abdominal exploration and intraoperative ultrasonic assessment. The additional advantages of open and laparoscopic approaches are accurate placement of electrodes and possible treatment of tumors in percutaneously inaccessible regions of the liver and tumors in close proximity to or invading adjacent organs. The move from open to laparoscopic to percutaneous techniques loses the advantages of the open but gains the advantages of the minimal invasive approach. Tumor size, number of tumors, site of tumors, liver functional reserve, and general condition of patients are also important considerations in the choice of the RFA approach. Absolute contraindications to RFA are uncorrectable coagulability, extensive ascites not correctable with medication, extensive venous tumor thrombi, and poor associated medical condition, which renders the patient not suitable for any form of sedation or anesthesia. The relative contraindications to RFA are poor liver functional reserve and large HCCs. RFA can still be considered in patients with extrahepatic metastasis or with multiple bilobar HCC if the treatment aims at palliation, especially in patients who receive multidisciplinary treatment for HCC. Therefore, a thorough medical history taking, clinical examination, laboratory investigations, and imaging assessment must be performed on a patient to plan for RFA. Particular attention should be paid to check whether the patients are taking any anti-platelet or anti-coagulation drugs. All anti-platelet drugs should be stopped at least 1 week before RFA, and warfarin should be converted to heparin before RFA treatment. All underlying medical diseases should be put under control, and any forms of ascites should be controlled with diuretics. Alcohol should be stopped, and patients with hepatitis-B-related hepatitis should have their HBV-DNA checked. It is our belief that patients who are hepatitis B antigen positive should receive antiviral treatment before RFA. Prophylactic antibiotics are commonly given. It is especially indicated in patients with heart valve disease or who has a cardiac/neurological/surgical implant. Thus, a history of drug sensitivity is also important to determine the appropriate prophylactic antibiotic regimen.