The patient was a 60-year-old woman admitted to the hospital with recurrent right upper abdominal pain for half a month. At the time of admission, the patient’s condition was not optimistic. CT showed that the tumor in the hilar region was large in scope, invading to more than secondary bile ducts bilaterally and even reaching the opening of tertiary bile ducts, as well as invading several important blood vessels around the right side, which was Bismuth type IV hilar bile duct cancer. During the preoperative discussion, several doctors thought that the patient’s surgery was too difficult and suggested to give up the radical surgery and adopt a palliative treatment. However, through detailed preoperative evaluation, Director Wang found that the tumor had invaded the right hepatic artery and portal vein branches, but the left vasculature was still intact. Although the tumor invaded the opening of the left tertiary bile duct, which was considered unresectable according to the traditional evaluation, it was not completely technically infeasible if the left tertiary intrahepatic bile duct was assembled and shaped through precise perihilar operation, and then a high bile duct jejunostomy was performed. Therefore, there is still a chance for the patient to survive! After active communication with the family, Director Wang decided to make a bold attempt to break through the surgical barrier and perform a difficult radical surgery (right hepatectomy + caudate lobectomy + skeletal clearance of the hilar region + high bile duct jejunostomy Roux-Y anastomosis) for the patient. Although the operation was very difficult, Director Wang Jian always carried out the hepatobiliary surgery concept of precision, accuracy and refinement, and fought for more than 10 hours to successfully complete the difficult operation, which revealed that: Bisumth type IV hepatoportal cholangiocarcinoma, tumor 5*4cm, invaded the opening of the right and left hepatic duct tertiary branches, the right hepatic artery and the right branch of portal vein were invaded by the tumor, which was exactly the same as the preoperative judgment. The bleeding was only 200ml, and the previously considered forbidden area of surgery for hilar cholangiocarcinoma invading bilateral tertiary hepatic ducts has been broken! At present, the patient has been transferred out of the care unit and is recovering well.