Severe acute pancreatitis is a common surgical acute abdomen with dangerous condition, difficult treatment, many complications, and high mortality rate, and its lesions are not only limited to the pancreas itself, but also often involve multiple organs of the body, causing patients to experience the double blow of local tissue necrosis and systemic inflammatory response. Although the clinical treatment of SAP has gone through several important stages, such as non-surgical, surgical and comprehensive treatment, and has made great progress, the mortality rate is still as high as about 30%, and the debate on its treatment concept has never been settled. In recent years, with the continuous research on the pathogenesis of SAP, the important role played by minimally invasive treatment in the comprehensive treatment of SAP has received increasing attention from scholars at home and abroad. The continuous progress of imaging technologies such as laparoscopy, endoscopy, and color ultrasound has provided a safe and effective guarantee for the development of minimally invasive treatment of SAP, and in clinical practice, different minimally invasive treatment methods can be selected to improve the efficacy, reduce the mortality rate, complication rate and hospitalization cost, and thus improve the prognosis of patients according to the etiology, stage and severity of SAP and individual differences of patients. In view of this, this paper introduces the research progress of minimally invasive treatment for SAP in recent years. In China, biliary pancreatitis accounts for a high proportion of SAP patients each year. For this group of patients, endoscopic retrograde cholangiopancreatography (ERCP) is recommended in the early stage of the disease. During the procedure, the specific etiology can be determined based on ERCP and other imaging findings, and endoscopic papillary sphincterotomy (EST) lithotomy, stent placement or nasobiliary drainage (ENBD) can be performed selectively. Shelat et al. found that endoscopic treatment of 834 patients with acute cholestatic pancreatitis was effective in the early stage (within 72 h), which not only shortened the course of the disease, but also reduced the cost of treatment and improved the recovery rate of SAP. ERCP has gained much attention and is widely used in clinical practice because of its advantages of less trauma and fewer complications during treatment. However, at the same time, we should also pay attention to the limitations of this operation: first, ERCP is only suitable for the early treatment of biliary SAP, and the location of obstruction is low biliary tract; second, its effect on the management of patients with multiple biliary tract stones is often unsatisfactory, which may lead to postoperative recurrence. In addition, the EST operation itself can aggravate the degree of pancreatitis lesions and can increase the incidence of other complications such as gastrointestinal perforation. It is worth mentioning that not all patients can tolerate the “shock” caused by the ERCP operation. In recent years, the natural orifice endoscopic technique (NOTES) has developed rapidly and is gradually being used in the treatment of patients with SAP. The cure rate is high. However, some scholars still believe that the clinical effectiveness of NOTES for SAP is not supported by a large enough sample of cases, and the results are not convincing. Biliary pancreatitis accounts for about 75% of the annual incidence of pancreatitis, and endoscopic techniques have more obvious advantages in the treatment of biliary pancreatitis, which make endoscopic techniques an important part of the treatment of SAP. However, in clinical treatment, we should also be aware of the limitations of the operation and screen appropriate patients for the relevant treatment strictly according to the indications. In addition, due to the limitations of the instruments, techniques and patient acceptance, endoscopic techniques are not fully and widely available in clinical practice, and a large number of randomized, controlled studies are needed to determine their safety and efficacy in the treatment of SAP. Laparoscopic treatment The clinical treatment of SAP has gone through several important stages, such as non-operative, operative and comprehensive treatment. At present, the concept of early non-surgical treatment has been widely accepted. Studies have confirmed that early surgery will aggravate the metabolic disorder of the internal environment of some patients and destroy the defense barrier of the body, thus increasing the incidence of complications and leading to higher mortality. Laparoscopic surgery has the advantages of less trauma and faster postoperative recovery compared with traditional open surgery, and it effectively intervenes in the progression of SAP while avoiding the risks associated with early open surgery, so that patients can obtain good treatment results at an early stage. With the continuous development of laparoscopic technology, its clinical application has not only been limited to the early stage of SAP treatment, but also integrated into all stages of the SAP disease process. At present, laparoscopic techniques that are more frequently used in clinical practice include laparoscopic laparotomy and irrigation drainage, dilation and removal of necrotic tissue, abdominal tube drainage and drainage of pancreatic cysts and abscesses. Drainage of abdominal fluid and removal of necrotic tissue can reduce the absorption of toxic products, which is the theoretical basis for the application of laparoscopic lavage and drainage. In addition, the effectiveness of laparoscopy in the treatment of SAP has been confirmed by a large amount of research data at home and abroad. However, we should also be aware that laparoscopic techniques are not foolproof, and there are technical and spatial limitations in their treatment modalities, and the process of establishing laparoscopic pneumoperitoneum may aggravate the degree of intra-abdominal infection, all of which need to be further addressed and discussed. On the other hand, in some specific cases, traditional open surgery may be more desirable for patients, and Bagnenko et al. have evaluated different treatments for patients in different stages of SAP and concluded that when there is a large amount of peripancreatic necrotic tissue, traditional open surgery is appropriate to prevent the occurrence of infectious shock. Percutaneous puncture and drainage (PCD) PCD is a technique of percutaneous puncture and drainage of the pancreas and peripancreatic necrotic infected tissues and flushing and drainage of peritoneal fluid in patients with SAP under the guidance of ultrasound or CT. Studies have confirmed that after applying PCD, more than 30% of patients with pancreatic infection and necrosis can avoid surgical treatment. In the author’s opinion, the advantages of the PCD technique are: (1) it can relieve the patient’s general condition and reduce the risk of surgery; (2) it can serve as a “guiding light” for later surgical treatment and provide a basis for the selection of surgical access; (3) it can reduce the patient’s treatment trauma and have a certain objective cure rate. However, the disadvantage of this technique is also obvious, that is, it cannot effectively remove large pieces of pancreatic necrotic tissue. It has also been suggested that early indwelling abdominal drainage tubes may be one of the reasons for aggravating the secondary abdominal infection in SAP. In addition, this technique requires high imaging-assisted diagnostic skills and high operational skill requirements, which cannot be widely carried out and applied in hospitals at all levels yet. The application of multi-modality measures in the treatment of SAP The etiology and condition of SAP patients are often complex and often cannot be relieved or cured by a single treatment modality. In patients with biliary pancreatitis, for example, gallbladder stones combined with bile duct stones, after ERCP, if the diameter of gallbladder stones is small, after simple endoscopic treatment, there is a possibility that the small stones in the gallbladder may be dislodged again and induce the recurrence of SAP. For such cases, a combination of ERCP combined with laparoscopic cholecystectomy (LC) is generally used to achieve a more desirable treatment outcome. In other more complicated cases, the combined treatment of SAP patients by multiple means should also be considered to obtain good therapeutic results. V. Continuous arterial regional infusion therapy (CRAI) CRAI is a common interventional treatment for SAP, which requires a Seldinger method of puncture through the right femoral artery under X-ray fluoroscopic guidance. During the operation, a pancreatic angiogram is first performed so as to determine the site and extent of pancreatic necrosis. The advantages of CRAI include: (1) regional perfusion of pancreatic vessels significantly improves the degree of pancreatic microcirculatory disorders; (2) direct perfusion of antibiotics or growth inhibitors into the pancreatic lesion area increases local perfusion and improves the blood supply to the pancreas, while also increasing the blood concentration in the area. Navalho et al. showed that secondary infection caused by intestinal bacterial translocation is the main cause of death in SAP, and continuous infusion of antibiotics and other drugs through the superior mesenteric artery can prevent small intestinal mucosal damage and bacterial translocation, thus effectively improving patient prognosis. CRAI as an invasive operation has the following disadvantages: (1) the catheter needs to be left in place for a long time after the operation and the limb on the traumatized side is braked, and it is easy to form lower limb deep vein thrombosis and secondary embolism and other complications, and the patient suffers more; (2) the puncture site is easy to form local hematoma; (3) it is easy to develop systemic infection of medical origin; (4) the local high concentration of drug administration is more likely to produce drug resistance. Nowadays, minimally invasive is not only a clinical technique, but also a treatment concept and direction throughout all stages of SAP treatment. In recent years, medical technology has been developing, but the cure rate of SAP has not been significantly improved. In the author’s opinion, traditional surgical treatment not only fails to provide effective treatment for some patients, but also leads to aggravation of the patient’s condition and even death due to greater trauma. The continuous development of minimally invasive technology is considered to be an effective way to change this situation, and “minimally invasive surgery” is promoting the overall development of minimally invasive surgery. It is foreseeable that with the continuous in-depth research on the pathogenesis of SAP, its minimally invasive treatment will enter a new era. On the other hand, we should be aware of the limitations of minimally invasive treatment, and should not exaggerate the effectiveness of minimally invasive treatment, but “choose the best one”. We should understand the relationship between minimally invasive treatment and traditional surgery, and implement individualized treatment plans based on an accurate grasp of SAP, so as to choose the most suitable treatment for the patient, thus effectively increasing the cure rate of SAP and significantly improving its prognosis.