Polycystic liver is an autosomal dominant disorder. On imaging, multiple cysts in the liver can be found, usually more than 20 cysts. The disease is mostly asymptomatic in the early stage of the course. When liver function becomes abnormal or the patient develops symptoms such as abdominal distension, active treatment is needed to avoid delaying the best treatment and having to undergo liver transplantation. Regular laparoscopic opening of liver cysts can achieve satisfactory results. Case sharing: Just after the Spring Festival this year, an elderly man over 60 years old was pushed by his family in a wheelchair to our hospital for consultation. The old man had been found to have polycystic liver for more than 30 years and had started to have abdominal distension 10 years ago, but was not actively treated. The disease has gradually progressed and now he is unable to walk and squat. The stomach was compressed by the cyst and the amount of food was significantly reduced. At present, the liver function has become abnormal and several hospitals have been consulted, most of which recommended liver transplantation. After review at our hospital, it was found that multiple cysts in the liver occupied more than 70% of the liver, with the largest cyst being about 12 cm. After a thorough evaluation, we thought there was a ray of hope for minimally invasive surgery, and after full communication with the patient and family, the patient underwent laparoscopic hepatic cystotomy. The operation went smoothly and nearly 3000ml of cystic fluid was released in total. After the operation, the patient felt a significant reduction in abdominal distension and tried to move down to the floor, and his appetite and food intake increased compared with before. At the time of discharge, the patient walked out of the ward accompanied by his family, full of smiles to make the best affirmation of the treatment effect. Surgical treatment modalities for polycystic liver are usually: i. Laparoscopic liver cyst opening: suitable for most cases, it can drain the cysts on the surface of the liver sufficiently, reduce the pressure in the abdominal cavity and make room for the recovery and growth of normal liver. Second, percutaneous puncture liver cyst aspiration and sclerotherapy: suitable for the treatment of larger cysts in the liver parenchyma, which can be minimally invasive to achieve the purpose of cyst reduction. Third, liver segment or lobe resection: suitable for cysts concentrated in a certain liver segment or lobe, which can be treated by liver resection to obtain better results. IV. Liver transplantation: for patients with less residual liver tissue and obvious abnormal liver function and difficult to recover, liver transplantation has to be taken. After the diagnosis of polycystic liver, patients should visit the hospital in time, follow the recommendations of hepatobiliary surgeon for regular review and choose surgical treatment at the right time in order to obtain the maximum benefit of quality of life through the least trauma. The choice of treatment will also depend on the patient’s specific situation. However, it is reminded that one must not wait until liver transplantation is the only option before coming to the hospital.