Objective: To investigate the clinical efficacy of anatomic hemihepatectomy guided by middle hepatic vein (MHV). Methods: The clinical data of 58 patients undergoing hemiliver resection from March 2010 to December 2011 were retrospectively analyzed. In all the patients, the liver transection plane was defined following the course of MHV after it was completely exposed during the early stage of operation, and then the anatomic left or right hemihepatectomy was performed. Results: In the entire group, the average operative time was 5.78 (4.5–13) h, and average intraoperative blood loss was 238.3 (100–2 000) mL. No complications such as subphrenic abscess, bile leakage or hemorrhage occurred, and the average length of hospital stay of the patients was 12.5 (9–25) d. Conclusion: Resection plane along the course of MHV is a rational and correct option for anatomic hemihepatectomy.