The treatment concept of adopting precise hepatic resection with the most thorough lesion removal, the smallest traumatic blow, the greatest degree of liver function protection and the fastest health recovery is the development direction of modern complex liver surgery. Recently, the Department of Organ Transplantation of Renji Hospital successfully removed a huge liver hemangioma with a diameter of nearly 45 centimeters and weighing 6 kilograms for a patient, preserving part of the patient’s liver and saving him from liver transplantation. The success of this surgery also marks the arrival of the era of precision liver surgery. The patient, a woman from Shanghai, was told by more than ten hospitals that there was no chance of surgery, and it was concluded that conventional resection was not possible and liver transplantation was the only way out. After being introduced, the patient’s family came to Renji Hospital to find Director Xia Qiang of Organ Transplantation Department with the last line of hope. After perfecting all the examinations, the complicated condition was beyond imagination. The liver was covered with 5 or 6 large and small hemangiomas that had fused together, the largest of which was nearly 45 centimeters in diameter, equivalent to the size of 5-6 normal livers in terms of volume, and there was also a large amount of ascites. Because the hemangiomas were tightly encircling the hepatoportal and important blood vessels in the abdominal cavity, although liver transplantation could be performed to resect the hemangiomas including normal liver tissues, the patients were faced with lifelong immunosuppressant treatment after the surgery, which resulted in a greater quality of life and economic burden. If hemangioma resection is performed, because the hemangioma and normal liver tissue grow and adhere together, once the thin blood vessel wall is damaged during separation, the hemorrhage cannot be stopped at all; moreover, because the hemangioma is huge in size, there is little normal liver tissue being squeezed, and the surgery must ensure that the residual liver tissue is free from ischemic injury, and fully survives and functions. In case of failure, the patient will suffer from fatal liver failure. Therefore, the surgery must be carefully performed next to the huge hemangioma with careful anatomical clipping to preserve the normal liver tissue that sustains the patient’s life. After repeated discussions in the department, the bold surgical plan of “partial hepatectomy using the technique of living liver transplantation and the concept of precise hepatectomy” was formulated. Before the operation, the medical team made a comprehensive and detailed preoperative assessment and precise calculations for the patient, including the precise calculation of liver volume by 3D stereo CT, reconstruction of liver vessels and bile ducts, computerized virtual resection, and regularization of surgical routes, and the application of ICG evaluation of liver reserve function, etc. The whole operation was carefully crafted. The whole operation was a meticulous procedure, which took 6 hours, and the resection of hemangioma-like tissue weighed 6 kg, with 50% of liver tissue preserved. The patient’s postoperative abdominal circumference was reduced from 110cm to 74cm, and the patient was able to save the huge medical expenses and follow-up treatment that would have been required for a liver transplant. It is reported that with the continuous development of living liver transplantation, the precision hepatectomy approach is being promoted by more and more liver surgeons. Especially in complex liver surgery, it can improve the radical resection rate of liver tumors and the safety of surgery, reduce the traumatic blow of surgery to the body and the incidence of complications, and greatly improve the prognosis and quality of life of patients with liver surgery; however, there are many prerequisites for the application of this technique, which, in addition to preoperative preparations, include hepatic blood flow and hemorrhage control techniques, dissociation of hepatic parenchyma, residual liver function protection techniques, etc.