As people’s living standards improve, the incidence of hemorrhoids is gradually increasing and tends to be younger. Young patients have a high level of knowledge, pay attention to their own health, and tend to overcome the disease at high speed with high technology, so “minimally invasive” in the field of hemorrhoid treatment is becoming a common goal for doctors and patients. Minimally invasive is a combination of minimally invasive concept and minimally invasive technology, a concept, not a surgical method. Some people have high hopes that minimally invasive treatment of hemorrhoids is a panacea for “no surgery, no incision, no hospitalization, no pain, and treatment on the go”, but they often have many questions and problems after receiving the treatment. The concept of minimally invasive has trauma in it, which means it is surgery, and surgery is an invasive treatment, an operation that destroys the integrity of the tissue (incision) or restores the damaged tissue (suturing), which explains that minimally invasive can have various risks like other surgeries, such as infection, bleeding, and sequelae. The minimally invasive techniques developed in recent years for the treatment of hemorrhoids are for internal hemorrhoids. Some methods of treating internal hemorrhoids can be used to lift back some of the external hemorrhoids due to the lifting of the anal cushion, but for external hemorrhoids that cannot be eliminated, they still need to be combined with manual excision, requiring the doctor to have a minimally invasive concept and minimally invasive techniques. The following are a few of the commonly used minimally invasive methods of hemorrhoid treatment. A. DG-HAL hemorrhoid artery ligation This method combines ultrasonic exploration and suture surgery into one, and the essential point of the procedure is to ligate the artery supplying the hemorrhoid accurately as well as selectively at a high level. The unique anoscope is equipped with a side-viewing Doppler ultrasound probe, and through the Doppler ultrasound guidance, the submucosal arteries from above the anus near the anal canal are identified and sutured or ligated through a window located above the Doppler ultrasound probe. The entire procedure is judged by the arterial Doppler ultrasound display, and since no venous return is compromised, the inflow/outflow ratio will be reduced at the same time. As a result, the hemorrhoid will dislodge, and the bleeding and pain will disappear. As the tension decreases, the connective tissue will also regenerate, thus promoting shrinkage and shedding of the hemorrhoid. The procedure is a minimally invasive surgical procedure that is safe and effective for ultra-low damage without the use of a knife, minimal discomfort, no removal of hemorrhoidal tissue, no trauma, no postoperative complications, and no impact on anal function. It is suitable for stage I-II internal hemorrhoids, and the long-term efficacy is yet to be observed. This method is developed from traditional Chinese medicine ligation therapy. This method is to apply a rubber ring to the base of the hemorrhoid or mucosa on the hemorrhoid through a special automatic hemorrhoid ligature at an appropriate position 1.5-3cm above the dentate line, blocking the blood supply to the hemorrhoid or reducing venous backflow through the tightening and strangulation of the rubber ring, reducing the hypertrophy of the hemorrhoid or blood flow stasis, causing ischemia, atrophy and necrosis. The ligature tissue gradually falls off, and the traumatic tissue is repaired and healed. Shenyang Anorectal Hospital, Department of Anal Surgery, Liu Bin, after ligation, the local inflammatory reaction causes the mucosa, submucosa and superficial muscle layer to adhere, the mucosa wrinkles, the anal cushion is lifted and fixed in a higher position, partially blocking the blood supply to the hemorrhoid or reducing venous backflow, reducing the congestion and hypertrophy of the hemorrhoid or stagnant blood flow, causing the hemorrhoid to atrophy; direct ligation of the base of the hemorrhoid can stop the bleeding immediately. The whole process of lancing is automated, time-saving, labor-saving, practical and easy; the pain is mild and complications are rare. It is suitable for all stages of internal hemorrhoids (stage I-III has the best effect); the internal hemorrhoid part of mixed hemorrhoids; RPH can be used as supplementary treatment for those who have incomplete retraction of hemorrhoid mass or anal cushion after PPH or other therapies; focal lesions of rectum, such as rectal polyps, rectal hemangioma or vascular malformation, etc. It cannot be used for the treatment of simple external hemorrhoids, external part of mixed hemorrhoids, anal papillary hypertrophy and rectal polyps with suspected malignant changes. The PPH technique is an anastomotic hemorrhoid circumcision, suitable for patients with severe circumferential internal hemorrhoids and partial rectal mucosal prolapse. It is also called “supra-hemorrhoidal mucosal circumcision”, which is a new technique based on the theory of anal cushion lesions. This is a new technique based on the theory of anal cushion lesions. A special instrument called “PPH anastomosis” is used to circumferentially excise the mucosa and submucosa of the lower rectal wall, and anastomosis is performed at the same time of excision to lift the prolapsed anal cushion and restore the normal anatomical position of the cushion, which acts as a “suspension”. At the same time, the arterial blood branches supplying the hemorrhoid nucleus are cut off, which plays the role of “cutting off the flow”. Since the rectal mucosa above the dentate line is innervated by the visceral nerves, the patient has almost no pain after the surgery; and since the surgery not only removes the prolapsed rectal mucosa, but also blocks the terminal anastomotic branch of the terminal rectal artery, eliminating the root cause of hemorrhoids, and it is a non-open wound, the lifting effect after the removal of the anastomosis can reduce the size of some external hemorrhoids, which has the characteristics of quick effect, quick recovery and no pain after the surgery. It is suitable for patients with internal hemorrhoids, mixed hemorrhoids, and internal prolapse of rectal mucosa. However, the long-term efficacy remains to be observed, and complications exist, such as postoperative hemorrhage and anastomotic infection, etc. Serious complications have also been reported, including intestinal fistula, rectovaginal fistula, pelvic infection leading to sepsis, etc. TST (Tissue-selectingTherapystapler) minimally invasive surgery, also known as selective supra-hemorrhoidal mucosal resection anastomosis, is known as the safest minimally invasive anorectal technique, which is designed in accordance with the formation mechanism of human hemorrhoids and the physiopathological structure of hemorrhoids, and is based on the theory of “segmental tooth ligation” in Chinese medicine. “The TST minimally invasive technique uses a special anorectal mirror to form different open-loop windows, uses an anastomosis probe to lock the hemorrhoid nucleus and adjusts the scope of hemorrhoid mucosa removal according to the size and number of hemorrhoid nuclei, which maximally protects the normal function of the anus. It aims to correct the pathophysiological changes of hemorrhoids, rather than removing the anal cushion altogether, preserving the normal anal cushion and mucosal bridges, which can reduce surgical trauma, maximize the maintenance of fine anal sensation and contractile function, minimize postoperative anal discomfort, shorten treatment time, and make hemorrhoid surgery more minimally invasive. tst technique is mainly suitable for patients with stage III and IV hemorrhoids with mainly non-circular prolapse. tst technique plays its The TST technique is a useful combination of traditional Chinese medicine and modern medicine in the field of minimally invasive treatment of hemorrhoids in anorectal surgery, with the advantages of reasonable preservation of the site and number of skin bridges and mucosal bridges, and a tooth-shaped distribution of the ligature area, combined with the PPH procedure using the anastomosis to remove the mucosa and submucosa above the submucosal pad. The small number of titanium staples implanted reduces postoperative discomfort in the anus caused by titanium staples. In addition, there are a variety of widely advertised high-tech painless and minimally invasive treatments for hemorrhoids, such as high frequency, microwave, laser, plasma, freezing, infrared, radiofrequency, copper ion, etc., which ultimately achieve therapeutic results due to protein denaturation. Some improper treatments can seriously damage the patient’s internal and external skin mucosa of the anal canal, resulting in extensive skin mucosa necrosis and narrowing of the anal canal. It is internationally recognized to be effective only for initial bleeding internal hemorrhoids. All treatment methods have indications and risks. Hemorrhoid treatment follows the principle of individualized treatment, treating symptomatic hemorrhoids to minimize infection, bleeding, pain, recurrence, and sequelae, which is the patient’s requirement and the goal of the practitioner.