A novel ultrasound-guided technique to compress the middle hepatic vein allows for better detection of left-sided communicating veins, improving surgical options.

• Left-sided communicating veins were detected in 71% of patients using this method.
• Surgical strategies were modified in 57% of patients, enabling more parenchyma-sparing resections.

This technique could expand the criteria for liver resections and improve patient outcomes in cases involving the caval confluence.

• Major complications occurred in only 5%, with no perioperative mortality.