Abstract: Hilar cholangiocarcinoma (h‑CCA) is a serious health hazard in China, of which the morbidity and mortality rates are on the rise. Radical surgical resection is the only effective cure to h‑CCA. However, due to the advanced stage at diagnosis, complex anatomy of the hilar region and the inability to accurately locate high‑grade bile duct tumors, the rate of radical resection is low. As a result, the long‑term survival rate of patients with h‑CCA in China is much lower than the interna-tional leading level. With the extensive development of high‑precision imaging methods and endos-copic biopsy, it is now possible to accurately assess the invasive range of h‑CCA before surgery. While the assessment of the intraoperative high bile duct dissection point can only be determined by the surgeons′ experience, which mainly based on the anatomical relationship between the bile ducts and blood vessels in the hilar region, as well as the hardness and softness of bile ducts on palpation. There is an urgent need for intraoperative imaging aids that can provide real‑time imaging of the h‑CCA invasive extension and precisely guide bile duct dissections to increase the radical resection rate, reduce postoperative complications, thus improving the long‑term survival rate of h‑CCA. The authors summarize the status of preoperative planning methods and intraoperative navigation tech-niques for h‑CCA and analyze the first international example of intraductal ultrasound guided tumor real‑time bile duct dissections, which present a prospective view for the development of intraopera-tive navigation techniques.