Since the first report of the opacification of the biliary system by percutaneous direct puncture of the gallbladder in 1921, biliary interventions have evolved a great deal becoming readily available in most hospital settings. This minimally invasive technique has revolutionized, together with the endoscopic approach, the treatment of patients with biliary obstruction. In the past, the treatment of biliary obstruction had required surgery under general anesthesia and an extended hospital stay. Today, the same patient can most often be treated as an outpatient or during a short hospital stay under sedation. In order to perform a percutaneous biliary drainage and obtain a satisfactory drainage of all the sectors of the liver, a good understanding of the anatomy of the liver and the biliary tree is mandatory. The procedure should be performed in a sterile setting under both ultrasound guidance and fluoroscopy control.