The placement of a Trans Jugular Portosystemic Shunt (TIPS) demands a precise and rigorous surgical technique. The steps for insertion are: 1) Puncture of the right internal jugular vein with ultrasound guidance; 2) Selective catheterization of the right hepatic vein; 3) Transparenchymal direction of the catheter into a branch of the right portal vein; 4) Dilation of the parenchymal tract; 5) Deployment of an expanding metallic veno-venous shunt. Post-operative care and the most common complications are discussed.