The first attempt to apply laparoscopic techniques to liver surgery was the laparoscopic liver biopsy in a patient with lymphoma, followed by case reports and small sample summaries of laparoscopic resection of benign perihepatic lesions. In recent years, additional cases of laparoscopic resection of the left and right lobes of the liver have been reported. Along with the expanding scope of laparoscopic and minimally invasive surgery of the liver, new concepts and techniques have changed the treatment paradigm of liver diseases, especially benign and malignant tumors of the liver. Liver cyst surgery: Decision-making is no longer indecisive: Before laparoscopic liver cyst openings were performed, surgeons often struggled with the incision for liver cyst surgery. To adequately free and expose the liver, a subcostal incision must be made below the right costal margin and extended toward the midline or below the left costal margin. Although this incision is always routinely used during hepatectomy, surgeons are often hesitant to perform an exploratory procedure at the cost of this large incision in patients with liver cysts, especially asymptomatic liver cysts. With the use of laparoscopic techniques, surgeons have an easier time making decisions about surgery for liver cysts. They can decide on the procedure by taking a laparoscopic biopsy of the cyst wall. Of course, the advantages of performing the procedure laparoscopically are self-evident from the cosmetic point of view of the young patient. In addition, the small incision of laparoscopic surgery reduces the incision-related complication rate and perioperative mortality in elderly patients. We have performed more than 30 cases of triple-port approach laparoscopic liver cyst openings with an average hospital stay of 4.5 days and no postoperative complications such as bile leakage due to strict control of surgical indications. Adenoma surgery: more comfortable to handle: The development of liver imaging technology has led to an increasing number of asymptomatic benign liver tumors being detected incidentally, and the management of these lesions needs to be urgently standardized. The differential diagnosis of benign hepatic lesions mainly includes adenoma of the liver and focal nodular hyperplasia. Despite significant advances in the diagnostic methods for these two diseases, there is still a great deal of uncertainty. Even with biopsy, the diagnosis can only be made if Kupffer cells or scarring consistent with focal nodular hyperplasia are seen microscopically, which is very difficult to achieve. Thus, liver biopsy also has uncertainty. Also, because both diseases often occur in young female patients, the aesthetics of the incision is of particular concern. The surgical incision of a standard hepatectomy is a serious aesthetic concern, which may seem acceptable for patients with hepatic malignancy or a confirmed diagnosis of hepatic adenoma, but has to be carefully considered for those patients who do not have a clear preoperative diagnosis. Today, laparoscopic lesion resection is an excellent option for small liver lesions with an unclear diagnosis. With the accumulation of surgical experience, laparoscopic resection can be considered not only for small lesions in the periphery of the liver, but also for large lesions in the depths to clarify the diagnosis. The maturity of laparoscopic techniques has allowed surgeons to be more comfortable with those liver lesions with an unclear diagnosis. On the other hand, patients treated conservatively do not have to undergo frequent imaging, making treatment more economical and humane. Hepatic hemangiomas: like dancing on a knife edge: Hepatic hemangiomas are relatively common benign tumors of the liver, with cavernous hemangiomas accounting for the vast majority of them, and surgical resection is the most effective treatment. The traditional surgical approach is highly invasive, with many complications and slow recovery. Therefore, colleagues at home and abroad have long pinned their hopes on laparoscopic surgery and have made strenuous efforts to explore it. However, the liver is brittle, the intrahepatic structures are complex, and the hepatic veins are thin-walled. Once ruptured, a large amount of CO2 in the pneumoperitoneum will enter the pulmonary circulation and lead to fatal gas embolism, so laparoscopic hepatic hemangioma resection is more risky than traditional open hepatectomy, in which bleeding and CO2 gas embolism are the most difficult problems to solve. We used ultrasonic knife as the main liver resection instrument and completed laparoscopic resection of hepatic hemangioma in 9 cases. Including 6 cases of local resection of hepatic hemangioma and 3 cases of left outer lobe resection. The operative time ranged from 75 to 225 min, intraoperative bleeding ranged from 200 to 1000 ml, and postoperative hospitalization ranged from 3 to 10 days, with no serious complications except for one case of subcutaneous emphysema. It is therefore reasonable to assume that for patients with normal liver function, hepatic portal flow blockade under certain abdominal pressure and within a certain time frame is safe and feasible. Malignancy: Another option for patients with advanced disease: Laparoscopic resection of hepatic malignancies is still highly controversial. Proponents believe that laparoscopic hepatectomy for hepatocellular carcinoma is less invasive and does not differ significantly from open surgery in terms of intraoperative bleeding. Moreover, with the improvement of laparoscopic surgical techniques, there is a tendency to significantly reduce the operative time. In addition, the intrahepatic recurrence rate of hepatocellular carcinoma is 50% to 70%, which requires re-treatment, including anhydrous alcohol injection, hepatic artery embolization, microwave curing or re-operation. However, conventional surgery often leads to more severe intra-abdominal adhesions, which will interfere with the next step of treatment and even with routine ultrasound examinations. In contrast, laparoscopic surgery leaves ample room for subsequent treatment because of the small incision and the few adhesions formed. Laparoscopic surgery is safe in patients with coexisting chronic liver disease, even in patients with cirrhosis in the decompensated phase of liver function. Foreign scholars have reported that three patients, all with liver function Child Class C, had a mortality rate of 50% to 90% during postoperative liver failure and hospitalization in this class. The results showed that the reported patients were relatively uneventful and all were discharged within 10 days. Ascites is also an important cause of death in patients with cirrhosis after cesarean surgery, and even in a simple exploratory cesarean procedure, preoperative ascites is a high risk factor for postoperative liver failure, often leading to renal failure and ascites leakage from the incision site. The small incision of laparoscopic surgery is more conducive to leak control, while less postoperative pain and better diaphragmatic activity will be very conducive to ascites absorption. This also shows that laparoscopic surgery is not only an option for the treatment of liver cancer, but also a good treatment method for cases that are not suitable for open surgery. The development of laparoscopic techniques has led to their increasing use in liver surgery, but the technique is not yet very mature and the long-term results depend on large randomized controlled studies. Clinical indications for laparoscopic liver surgery should be strictly controlled in order to avoid unnecessary pain and risk to patients.