Liver malignant tumors are relatively common malignant tumors in China, and the current principle of liver cancer treatment is a comprehensive treatment mainly based on surgery, supplemented by interventional therapy and biotherapy. In recent years, new research results, new concepts and new technologies have emerged in the field of minimally invasive surgical diagnosis and treatment of liver malignant tumors. Liver resection from irregular local resection to regular hepatic lobectomy to anatomical hepatic segmental resection, its comprehensive surgical technology is more and more mature and complete. It can be said that the minimally invasive surgical treatment of liver tumors is mainly reflected in how to delicately and accurately resect the tumor and maximally preserve the normal liver from damage. Preoperative evaluation Preoperative evaluation of liver tumor resection should consider and solve 3 basic questions, i.e., can it be operated? How to operate? How much should be resected? The assessment is based on: (1) the location of the tumor, the size of the tumor body, whether there is hepatic sclerosis in the liver and the degree of sclerosis, the main intrahepatic blood vessels and bile ducts adjacent to the tumor and their relationship with extrahepatic vital organs and blood vessels, and whether there is metastasis, etc.; and (2) the overall functional status of the liver, the reserve capacity of the liver, and the hepatic excretory test, if necessary, as suggested by the laboratory tests. Combine the above two points to determine the amount of liver resectable under the premise of tumor resection, and at the same time initially judge the feasibility of the surgery and choose the most appropriate surgical plan. Reasonable hepatic resection Application of instruments All hepatic resection techniques require reasonable and standardized use of surgical instruments, and non-invasive or minimally invasive instrumentation is a prerequisite for minimally invasive surgical operation. Generally, electric knife, argon gas knife, ultrasonic suction knife and bipolar electrocoagulation are used in alternating and comprehensive application to carry out dissections of liver parenchyma. In the process of dissections, according to the different thicknesses of blood vessels and bile ducts being handled, silk ligature or suture dissections, titanium clamps for closure of the dissections after the clamping, localized bipolar electrocoagulation clamping, and cautery hemostasis are used, which can control the bleeding of the sectioned surfaces very well. Application of hepatic portal blocking technique Reasonable application of hepatic portal blocking technique during liver resection is crucial to the success of the operation. Reasonable regional blocking of hepatic blood flow is conducive to the reduction of hepatic traumatic hemorrhage and the control of hemorrhage in the case of accidental hemorrhage, and hemostasis can be operated under direct vision, avoiding blind operation in a pool of blood, which is also the principle that should be followed in minimally invasive surgery. It is worth mentioning that, when implementing hepatic blood flow blockade, the time and position of hepatic portal blockade should be judged according to the patient’s preoperative hepatic function reserve, the operator’s experience and technical level, the expected operation time, the location and size of the lesion and whether it infringes on the vasculature, etc., and adjusted anytime during the operation if necessary, and strive to find the hepatocytes instantly between the low damage caused by the regional hepatic portal blockade and low risk caused by the total hepatic blood flow blockade “We strive to find the optimal balance between the immediate damage of hepatocytes due to blood loss and oxygen deprivation and the subsequent damage due to ischemia and reperfusion, so as to avoid postoperative liver failure due to ischemia and reperfusion injury in the reserved liver. Application of intraoperative ultrasound In order to ensure clean tumor resection and minimize the blow to the remaining liver, and to achieve precision, minimally invasive and low injury of tumor resection, intraoperative ultrasound technology can be applied. The organic combination of ultrasound imaging and surgical exploration has unique advantages in intraoperative tumor localization, correction of preoperatively designed resection access, and re-determination after resection. Specifically, intraoperative ultrasound enables surgeons to achieve accurate intraoperative judgment, resection in place, clean surgical area, and safeguard postoperative liver surplus, etc. Therefore, this method is also a specific application in precise liver tumor treatment guided by the concept of minimally invasive. The author’s center uses intraoperative ultrasound detection almost exclusively when performing liver tumor resection, which achieves good results, shortens anesthesia and operation time, ensures that the remaining liver function is not excessively impaired, and the patient’s postoperative liver function recovers quickly, and the clinical effect is obvious. It is worth mentioning that the application of ultrasonography in the interventional therapy of hepatocellular carcinoma is also very wide. The key to the success of interventional therapy is to destroy the tumor comprehensively, otherwise, even if the local treatment is very successful, recurrence is still inevitable. Laparoscopic hepatectomy should be carried out reasonably. Laparoscopic hepatectomy must follow the radical principle of open surgery, including: ① Emphasizing on complete resection of the tumor and surrounding tissues; ② “non-contact” principle of tumor manipulation; ③ sufficient margins of incision; ④ thorough lymph node dissection. Compared with gastrointestinal surgery, laparoscopic hepatectomy has certain advantages because most liver malignant tumors do not require routine lymph node dissection, and there is no reconstruction after resection, no laparoscopic suturing and knotting and other complicated operation steps, so most scholars believe that it is a more desirable way of treating liver malignant tumors. In view of the above principles, the “tumor-free operation” protocol of laparoscopic hepatic resection of malignant tumors includes: ① intraoperative laparoscopic ultrasound for tumor localization, guiding the tumor resection; ② cut off the blood flow to and from the tumor as much as possible before resection, so as to achieve vascular isolation; ③ specimen into a disposable bag for removal, to avoid contamination of the incision; ④ examination of the specimen, to determine that the cutting edge is at least 1 cm away from the tumor, and the incision edge is at least 1 cm away from the tumor. ④ check the specimen to make sure the cutting edge is at least 1 cm away from the tumor, and perform intraoperative freezing examination if necessary; ⑤ avoid missing lesions by postoperative laparoscopic ultrasonography. Because of the lack of hand palpation in laparoscopy, it is difficult to localize the tumor by intraoperative palpation when the tumor is located deep in the liver parenchyma as in open surgery. The literature reports that negative or sufficiently safe margins cannot be obtained in approximately 10% of laparoscopic liver resections. Preoperative enhanced CT or magnetic resonance imaging (MRI) is very important, and thin-layer scanning and three-dimensional reconstruction are feasible when necessary to further show the exact location of the tumor and its important relationship with the vasculature, which is a good guide for surgical planning. Intraoperative laparoscopic ultrasonography should be used to guide the surgical procedure while avoiding squeezing the tumor with instruments. Advances in other non-surgical minimally invasive treatments Advances in minimally invasive non-surgical treatments for liver tumors are mainly reflected in various fields, such as transcatheter hepatic artery chemoembolization (TACE), radiofrequency ablation (RFA), percutaneous anhydrous ethanol injection (PEI), biologic therapies, targeted therapies, and so on. In recent years, these fields have also presented new characteristics, and the relevant progress in several fields with more concentrated research is now briefly described. TACE TACE is based on the fact that the blood supply of liver cancer tumors is mainly borne by hepatic arteries, and with the help of interventional techniques, the blood supply of tumors can be blocked so that the tumors can atrophy and necrosis due to ischemia. It should be noted that 80% of patients can only achieve the effect of tumor reduction and survival after TACE treatment, which is only a palliative treatment for the tumor. However, after combining with chemotherapeutic drugs, TACE can play the dual roles of embolization of the tumor blood supply and local chemotherapy, which is more certain of the therapeutic effect, and it has become the first choice for the advanced hepatocellular carcinoma that is difficult to be treated by surgery. Meta-analyses have further demonstrated that TACE can significantly improve the 3-year survival rate of patients with advanced hepatocellular carcinoma, and combined chemoembolization of the hepatic artery and portal vein can further improve the efficacy and tumor-free survival rate. In recent years, TACE has shifted from single use in the past to the use of novel embolizing agents and combined chemotherapeutic agents, and some of the results are promising. Local ablation therapy This method is a powerful measure for local minimally invasive treatment of hepatocellular carcinoma, which once replaced PEI, and it includes high-intensity focused ultrasound, microwave coagulation therapy (MCT), laser thermal ablation (LTA), RFA and other methods, among which RFA has the most affirmed efficacy.RFA therapy has the advantages of precise efficacy, less trauma, less pain to the patients, no definite serious complications, can be repeated for many times, and is suitable for RFA is a more effective minimally invasive treatment for hepatocellular carcinoma with the advantages of precise efficacy, less trauma, no clear and serious complications for patients, repeatable application, suitable for detection by various imaging techniques and dynamic evaluation. At present, RFA can be used as a palliative treatment for patients with inoperable liver cancer, mainly for malignant tumors ≤3 cm in diameter, and it can achieve 90% necrosis effect.RFA is an important tool for the treatment of early-stage, solitary, complicated location and difficult to surgically resect small or end-stage hepatocellular carcinoma. At present, the combined and sequential application of many minimally invasive interventions is increasing year by year in clinical development, and the effect has obvious advantages over single application. Comment In traditional concepts, the treatment of malignant tumors of hepatobiliary system is still inclined to direct surgical treatment, and minimally invasive interventions and other therapeutic measures are mostly carried out in the case of patients with late tumor staging, poor status, and complications that make it difficult to carry out surgical treatment. With the advancement of science and technology, the updating of concepts and the emergence of conclusive evidence-based medical evidence, minimally invasive therapies such as clinical laparoscopy, TACE, RFA, PEI, microwave therapy, cryotherapy, laser ablation and other minimally invasive therapies are growing in popularity, and the scope of their application is expanding and their therapeutic efficacy is improving, which has become a good supplement to the surgical treatment of clinical hepatobiliary tumors and broadened the space of choices in the development of medical treatment plans; and more importantly. More importantly, with the development of medical science, the rise of humanistic medicine, the evolution of medical model and the widespread promotion and recognition of the concept of evidence-based medicine, the continuation of the traditional concept of surgical concepts is undergoing a new change, the minimally invasive surgical concept of “minimal trauma to win optimal recovery” has been promoted by the contemporary surgical, upholding, and the new concept is driving the traditional empirical surgical model to the modern precision surgical model, and the new concept is driving the development of a modern precision surgical model. The new concept is driving the transformation of the traditional empirical surgical model to the modern precision surgical model. The traditional biomedical model of disease-centered, technology-focused medicine is gradually being replaced by patient-centered, evidence-based decision-making and minimally invasive treatments that emphasize the improvement of overall health and intrinsic quality of life, and are in line with modern humanistic medicine, reflecting the new direction of development of modern surgery.