The normal liver is rich in blood circulation and has an additional set of venous system “portal vein system” compared with other organs of the body. Surgery is the most effective way to cure liver cancer, but it is prone to heavy bleeding and blood transfusion will increase the incidence of postoperative complications such as recurrence, metastasis and liver failure. Intrahepatic bile duct stones also often require lobectomy to completely remove the lesion. Therefore, “bloodless liver resection” has always been the clinical goal of liver surgeons to achieve safe removal of tumors and lesions without bleeding. What are the common bloodless liver resection techniques in hepatobiliary surgery? 1) First hilar block or selective blockade of the incoming hepatic blood flow has the advantage of simple and convenient operation, but the disadvantage of not completely avoiding bleeding from hepatic vein sources.2) Total hepatic blood flow block (total blockade of hepatic outgoing and incoming blood flow) is the most effective method to obtain bloodless hepatectomy in the past, with the advantage of solving the bleeding problem during hepatectomy, but the disadvantage is that blocking the inferior vena cava brings about huge hemodynamic changes and requires complex intraoperative anesthesia management. The disadvantage is that blocking the inferior vena cava brings about huge hemodynamic changes and requires complex intraoperative anesthesia management, while some patients cannot tolerate total hepatic flow block due to special circumstances.3) Nowadays, selective access hepatic flow block technique is mostly used, which is a mature technique and relatively complicated operation. Among them, hemipelvectomy with complete hepatic flow blockade is the most common, which requires blocking the hepatic artery, hepatic portal vein and hepatic vein. Each technique is usually used flexibly in conjunction with the specific situation during surgery.3 What are the advantages of the selective access hepatic flow blocking technique? This method is the most advanced and rational technique available. During surgery, depending on the location of the lesion, some of the entry and exit vessels to and from the liver are selectively blocked, instead of blocking all of the entry vessels to the liver as was done in the past. The advantages are many: 1) Intraoperative bleeding can be significantly reduced and blood transfusion can be reduced. 2) The tissue of the healthy side of the liver can be preserved to the maximum extent, and the blood flow to the healthy side of the liver is not blocked, which can avoid the occurrence of ischemia-reperfusion injury to the healthy side of the liver and reduce the possibility of postoperative liver failure and increase the safety of surgery. 3) After selective access to the liver is blocked, the appearance of the healthy and affected side of the liver is different in color due to the difference in blood flow, and a clear demarcation appears. This is especially beneficial for patients with cirrhosis. 4) The duration of hepatectomy can be prolonged, and liver lesions can be treated with ease and care.4 What is the scope of application of hemorrhage free hepatectomy? Bloodless hepatectomy is used to treat various liver tumors such as hepatocellular carcinoma, hemangioma, hepatic adenoma, etc. It is especially suitable for huge liver tumors and tumors that invade important blood vessels in the liver. Patients with complex intrahepatic bile duct stones often require regular (segmental) lobectomy to remove the stones and the diseased liver lobe, and the use of bloodless hepatectomy greatly increases the safety of the procedure. Our hepatobiliary surgery department performs nearly 100 cases of various lobectomies each year, and the intraoperative and postoperative transfusion rate is less than 3%, with high safety. Yin Yaoxin, Department of Hepatobiliary Surgery, Peking University Shenzhen Hospital