The seriousness of the lesion, the difficulty in determining the extent of involvement, and the necessity for avoiding infection from the required preoperative studies in an obstructed jaundiced patient requires meticulous preoperative evaluation. Early endoscopy of the common duct and consultation with an expert in interventional radiology are essential. The jaundiced patient should undergo transcutaneous transhepatic cholangiography with bile cultures taken and appropriate antibiotics given. These diagnostic procedures are usually performed by an interventional radiologist familiar with the technic. Following cholangiography, ring catheters may be placed bilaterally, directed if possible through the obstructing lesion into the duodenum with palliation of the jaundice (Figure 1). If there is cholangiographic evidence of tumor extending into the right or left hepatic ducts, the patient may eventually be explored to relieve the obstruction on the side of the involved duct. Palliation, however is usually possible with internal drainage into the duodenum through the ring catheters. The catheters also serve as invaluable technical aids to the surgeon at the time of laparotomy.