I. Development of laparoscopic techniques in liver surgery In 1987, French surgeon Mouret completed the world’s first modern laparoscopic cholecystectomy. Subsequently, laparoscopic surgical techniques have been rapidly promoted in various surgical fields. The use of laparoscopy in liver surgery started later. In 1991, Reich et al. discovered a marginal occupying lesion in the liver during gynecologic laparoscopy and performed laparoscopic resection of liver tumors, completing the world’s first laparoscopic hepatectomy. With the advancement of laparoscopic display equipment and surgical instruments, the technique of laparoscopic hepatic surgery developed rapidly. 1991-2001, only 200 cases of laparoscopic liver resection were reported worldwide; 2001-2004, about 500 cases of laparoscopic lobectomy were reported worldwide; after 2004, the indications for laparoscopic hepatectomy were gradually expanded. In 2007, Koffron reported 300 cases of laparoscopic hepatectomy, which is the largest series of single-center cases reported internationally, including 20 cases of right hepatic graft resection. 2009, Nguyen summarized 2804 cases of laparoscopic hepatectomy worldwide. 2009 to present, laparoscopic techniques in liver surgery have flourished, and the number of reported laparoscopic right hemicolectomy and special liver segment resection centers are gradually increasing. Second, the development of the concept of precision liver resection and the connotation of minimally invasive treatment in modern liver surgery In recent years, with the rapid development of diagnostic imaging technology, surgical techniques and instruments, liver surgery has also been flourishing. Liver resection surgery has entered the era of precise liver resection. Precise liver resection advocates a concept of surgical resection, which does not refer to some high-end surgical technique, but rather a combination of modern liver surgical examination and treatment. It includes preoperative three-dimensional localization of the lesion under high-resolution imaging conditions, simulated assessment of the resection plan using computerized 3D reconstruction, calculation of the tumor and remaining liver volume, and accurate resection of the diseased liver using modern liver resection instruments according to the preoperative simulation plan. The exact meaning of precise hepatectomy refers to the complete and thorough resection of the liver lesion with maximum preservation of the remaining liver tissue structure and function. It has the advantages of not blocking the blood flow to the liver at all during the operation, less bleeding, less impact on the patient’s liver function, and quick recovery after the operation. Minimally invasive surgery means that the surgical operation brings minimal trauma to the patient and the patient recovers quickly after surgery. It generally refers to the use of medical equipment such as laparoscopy to perform the surgery, leaving only tiny scars after the operation. Minimally invasive in the strictest sense refers not only to the smallness of the surgical incision, but should also include the reduction of trauma to the surgical site organs. Laparoscopic hepatectomy can protect the intact abdominal wall structure and the traffic branches of the portal vein system to the greatest extent possible, thus helping to avoid elevated portal vein pressure due to surgery. Open surgery. The use of ultrasonic knife and other modern liver cutting instruments can achieve anatomical liver segment resection, which is in line with the modern surgical concept of precise liver resection in liver surgery and is truly minimally invasive treatment. Third, minimally invasive surgery currently common methods of dissection of liver parenchyma At present, the main liver cutting instruments commonly used in minimally invasive surgery are ultrasonicscapel, Tissue Link, ultrasonic emulsion suction knife (CUSA), ligation speed vascular closure system (LigaSure), endoscopic cutting closure device (Endo GIA), microwave knife ( microwave tissue coagulator), and the endoscopic multifunctional surgical dissector (PMOD). Each of these instruments has its own advantages and disadvantages. At present, the ultrasonic scapel is widely used for lumpectomy: it uses the function of high-energy ultrasound to cut and coagulate tissues to destroy and crush them, with a radius of 1-2 mm, and can safely coagulate arteries, veins and bile ducts below 3 mm in diameter, and even blood vessels of 5 mm in diameter. The advantage of ultrasonic knife is the precision of resection. The advantages of ultrasonic knife are precise resection, good coagulation effect, only a small amount of body fluid vaporization mist, which does not affect the field observation, this mist can carry small tissue fragments, but does not contain live cells, and the amount of tissue fragments produced is similar to the electric knife. There is no conductive tissue damage, so separation can be performed in the vicinity of important organs. However, it is important to note that the ultrasonic knife should not clamp too much tissue at a time when removing tissue, in order to avoid affecting the coagulation effect. When there are large vessels, it is still necessary to use vascular clamps before cutting to prevent intraoperative and postoperative hemorrhage. Endo GIA: Similar to the principle of linear cutting closure used in open surgery, it can cut and staple the tissue at the same time. It is generally used in laparoscopic hepatectomy for the severance of important vessels and bile ducts. Because of the potential risk of accidental injury to deep vital ducts during insertion of liver tissue, it is recommended that it be used under direct vision after adequate dissection, which is safer. Ultrasonic emulsion suction knife (CUSA): It works by using the cavitation tissue effect, another effect produced by ultrasound energy, and has tissue selectivity, and higher energy is required to fragment tissues with low water content (such as collagen-rich vessels and nerves) than to fragment tissues with higher water content (such as liver, tumor, spleen). Its tissue damage is limited to the 1-2 mm range near the tip, and coagulation is less effective. Ligation speed vascular closure system (LigaSure): It has a higher cutting and closing ability, but the cutting speed is slower and not as convenient to use as ultrasonic knife in patients with less severe cirrhosis. Its advantage is that it can close larger diameter (>3mm) ductal structures. IV. Update on the scope of indications for surgery Previously, the scope of indications for the application of laparoscopic hepatectomy generally required benign disease and lesions located in segments II, III, IV a, V of the liver. The location was relatively superficial, with a certain distance from the inferior vena cava and the large vessels and bile ducts of the liver, with a diameter of ≤5 cm, preferably without a history of surgery for hepatobiliary diseases, and without serious organic lesions in other organs. With the update of surgical equipment and instruments in recent years, the indications for laparoscopic hepatectomy have been gradually expanded to include benign and malignant tumors. Experienced laparoscopic hepatobiliary surgeons are now able to safely perform standard hemihepatectomies, live donor liver resections, and even specific liver segmental lesions (e.g., segments I, IVb, VII, and VIII occupancies) that were previously contraindicated for laparoscopy. It has been well documented that regular hemihepatectomy, extended hemihepatectomy, and special segmental hepatectomy can be safely performed laparoscopically without increased surgical risk. Therefore, the real contraindications for laparoscopic hepatectomy are: tumor invasion of the first or second hepatic hilar vessels that cannot be dissected, unclear tumor borders, combined large-vessel thrombosis or distant metastases, severe adhesions due to a history of upper abdominal surgery, Child-pugh grade C liver function, and other combined systemic diseases that cannot tolerate the procedure. The 21st century is the era of minimally invasive surgery. With the progress of surgical concept and surgical equipment, the application of minimally invasive surgery in liver surgery is gradually widening. At present, scholars have proposed that laparoscopic left outer lobe resection of the liver will gradually become the gold standard for left outer lobe resection. In combination with the modern surgical concept of precise and minimally invasive liver surgery, laparoscopic liver surgery will rapidly become an important part of liver surgery with its own unique advantages. Currently, laparoscopic liver surgery is gradually evolving from traditional multi-port surgery to less invasive single-port laparoscopic surgery, and the emergence of multi-port single-port devices has greatly eased the difficulty of performing single-port laparoscopic surgery using traditional instruments. On the other hand, laparoscopic surgery has shifted from the previous 2D planar image to a 3D image view. The da Vinci Surgical Robot technology, which has been successfully used in many clinical procedures, represents the most cutting-edge technology in laparoscopic surgery, and all these technologies will help patients to operate more safely, further reduce their surgical trauma and shorten their recovery time.