Complex hepatic cystic lesions with inconclusive imaging pose a recurring diagnostic problem: cyst-fluid cytology and conventional core-needle biopsy seldom capture the epithelial lining needed for a histological diagnosis, and current guidelines advise against simple cyst aspiration. We describe a sheath-assisted percutaneous forceps biopsy technique for direct cyst-wall sampling under ultrasound guidance, illustrated in two male patients (76 and 48 years). After Seldinger placement of an 8-Fr sheath into the cyst, rat-tooth forceps obtained direct biopsies of the wall epithelium, and the tract was embolized with Gelfoam. Technical success was achieved in both cases; histology showed columnar biliary epithelium consistent with mucinous cystic neoplasm, whereas fluid cytology was non-diagnostic. No complications occurred. This technique offers a feasible means of obtaining a histological diagnosis in complex hepatic cystic lesions when conventional methods are inconclusive.