Abstract: Objective To explore the clinical value of three-dimensional (3D) reconstruction visualization technology combined with 3D laparoscopy in the radical resection of hilar cholangiocarcinoma.Methods A total of 11 patients who were admitted in Department of Hepatobiliary Surgery, Xuzhou Central Hospital from September 2021 to April 2023 and underwent radical resection of hilar cholangiocarcinoma by 3D laparoscopy were selected and their clinical data were retrospectively analyzed. Before operation, the CT enhanced thin-layer scanning image data of their abdomen were reconstructed by the 3D reconstruction visualization software. We determined the three-dimension location of the tumor, observed the relationship between tumor and surrounding vessels as well as the enlarged lymph nodes and anatomical abnormality, in order to determine the specific surgical approach and procedures. All the patients underwent radical resection of hilar cholangiocarcinoma under 3D laparoscopy.Results 3D reconstruction visualization clearly displayed hilar cholangiocarcinoma and the adjacent tissues, especially the vascular structure and anatomical abnormality. According to Bismuth classification, there were 3 cases of type I, 3 cases of type Ⅲa, 3 cases of type Ⅲb and 2 cases of type Ⅳ. All the surgeries were successfully completed, without transfer to open surgery. The operative time was (581.0±91.0) min, the amount of intraoperative blood loss (840.0±280.0) ml, the time to first postoperative exhaust was (2.2±0.5) d, the time to postoperative drainage tube removal was (8.5±2.6) d and the length of postoperative hospitalization stay was (15.1±3.7) d. All the patients achieved R0 resection and the numbers of dissected lymph nodes were (12.0±2.4). Two patients (type Ⅲ 1 case and type Ⅳ 1 case) presented postoperative bile leakage, and were cured after conservative treatment. There were also two cases of pleural effusion which were cured after symptomatic treatment. The other patients had no complications such as postoperative bleeding, intestinal leakage, incision infection and pulmonary infection. All the patients were discharged and regularly followed-up for 3-22 months, with good survival, without relapse or metastasis.Conclusions 3D reconstruction visualization technology and 3D laparoscopy can be used in combination for the radical resection of hilar cholangiocarcinoma, which is safe and feasible, and further studies are still needed to confirm benefits of this approach.