OBJECTIVE: To evaluate the advantages of percutaneous radiofrequency ablation (PRFA) therapy with contralateral single lung ventilation (SLV) for liver carcinoma in the hepatic dome (LCHD). METHODS: The clinical data of 10 patients (the SLV group) with LCHD consecutively treated from January to December 2006 were retrospectively analyzed. And another 10 cases (the control group) with LCHD treated from January 2004 to December 2005 were selected with a strict inclusion criterion for compared test according to rules of same diagnosis, similar tumor bulk and site, same sex, similar age and liver function. The patients' ages and tumor diameters of the 2 groups were compared with t-test and the rates of complications and incomplete tumor ablation were compared with chi2-test. RESULTS: There was no statistical difference in ages and tumor diameters between the 2 groups (P > 0.05). The average number of radiofrequency ablation needle punctures in the SLV group was significantly less than the control group (3.4 +/- 0.4 vs. 6.1 +/- 0.8, P < 0.01). There was no bronchial intubation related complications like hypoxemia, atelectasis, lung infection and no puncture related complications like pneumothorax, hemothorax, hemoperitoneum and bile leakage in the SLV group. Two cases in the control group had complications including pneumothorax (n = 1) and pleural effusion (n = 1). There was no mortality in the 2 groups. Though the rate of incomplete tumor necrosis in the SLV group was not statistically lower than that in the control group (10% vs. 40%), the occurrence rate of the undesirable event (complication and incomplete tumor necrosis) of the SLV group was significantly lower than that of the control group (10% vs. 60%, P < 0.05). The durations and costs of operating procedure were not significantly different between the 2 groups. CONCLUSION: Left SLV makes PRFA for LCHD more efficient, effective and safe.