No-invasive surgery is the ultimate in surgical excellence, but unfortunately, even in another 100 years, the likelihood that surgery will achieve this goal is slim to none. Since the history of surgery, medical trauma has been as inseparable as the twin brother of surgery. Throughout history, according to the principle of “choosing the lesser of two evils”, the primary purpose of surgery is to radically remove the lesion, followed by the preservation and reconstruction of function. In the history of the development of surgery, limited by the conditions and cognitive ability at that time, the predecessors in the fight for lesion removal at the same time, for the medical trauma have no time to care, or even helpless, on the preservation of function and reconstruction of the lack of attention, these need to be put into the historical conditions of the time to consider, and the present generation should not be arbitrarily difficult. However, after all, surgery has its own development law and trend, with the optical, electrical, anatomical, physiological and other related fields of progress and the development of manufacturing processes, as well as the patient’s medical knowledge and quality of health care services to improve the requirements of modern surgery in the fight for the fundamental resection of the lesion under the premise of the more and more required and more and more conditioned to reduce the medical side injuries, the operation is minimally invasive direction of the development of the operation. This point is not difficult to understand, which patient does not hope that the operation is easier, faster recovery, functional preservation is more ideal? Throughout the history of the development of modern otolaryngology, whether it is from the evolution of radical mastoidectomy to improved mastoidectomy, or from total laryngectomy to partial laryngectomy, radical neck contouring surgery to functional neck contouring surgery, which all hide the main line, either explicitly or implicitly, that is, the concept of functional surgery or minimally invasive surgery. Academician Huang Zhiqiang recently wrote: “Minimally invasive should be the concept of surgical development, and minimally invasive surgery should be the pursuit of every surgeon”. Therefore, if one fails to grasp this trend in the development of surgery or is ambiguous about the concept of minimally invasive surgery, the result will inevitably be marginalized by the relentless era. Minimally invasive surgery is a new concept that began to be proposed in the 1980s, the core of which is to minimize the collateral damage of the surgery itself on the basis of complete removal of the lesion. The life of surgery is the exposure of the lesion, the deeper the site of the lesion, the greater the medical trauma accompanying the exposure, and a good surgical field is the basis for achieving precise resection of the lesion and obtaining the minimum trauma, which involves improved illumination and line of sight. Because light travels in a straight line, surgery requires that there be no obstruction between the light source, the surgical field, and the eye. Historically, the invention of the shadowless light essentially eliminated the barrier between the first two, and the successful elimination of the obstruction between the surgical field and the eye has been the cornerstone of modern minimally invasive surgery. The means to realize minimally invasive surgery mainly include three aspects: first, the magnification of the field of view, such as microsurgery, through the magnifying effect of the microscope to carry out delicate operations to completely remove the lesion, reduce the accompanying damage, but still need to remove a lot of tissue on the surface; the second is the field of view of the indirect display, such as vascular interventions with the help of X-ray imaging and stereotactic therapy, the shortcoming is that the field of view is not direct enough; the last way is the field of view of optical display; the last way is the field of view of optical display. The last way is the optical conversion of the field of view, that is, endoscopic-assisted surgery, referred to as endoscopic surgery, with the help of light-guiding fibers and camera systems operated under the guidance of monitors, to change the optical transmission of the “straightness”, the relative impact on the surgical approach to the tissues is relatively small and well exposed, is the most ideal mode of minimally invasive, and is basically the synonym of minimally invasive surgery at present. It is the most ideal minimally invasive mode and is now basically synonymous with minimally invasive surgery. However, it must be clear that minimally invasive surgery is not equivalent to endoscopic surgery, endoscopy only plays an auxiliary role, endoscopic surgery is not always minimally invasive surgery, endoscopic surgery does not comply with the principle of minimally invasive can also bring unnecessary trauma. Many domestic scholars do not understand this, endoscopic surgery and minimally invasive surgery, and even due to the dominant position of abdominal surgery in surgery, laparoscopic surgery is simply called minimally invasive surgery, this confuse the concept of arbitrarily expanding and narrowing the connotation of minimally invasive surgery is simply mind-boggling. The connotation of minimally invasive surgery, simple but complex, is generally considered to include the following aspects: (a), the most complete resection of the lesion and the minimum damage to the target tissue; (b), gentle manipulation of all tissues in the surgical access; (c), the appropriateness of the choice of surgical methods, i.e., keyhole (Keyhole) technology. In the understanding of the connotation of minimally invasive surgery, some scholars equate keyhole with small incision, which is actually a misunderstanding. The so-called keyhole technique refers to the choice of surgical method for the resection of lesions as appropriate as a key to open a lock, rather than referring to a simple small incision, otherwise why not call it a small hole (Smallhole) technique? Therefore, the inappropriate use of a small or even non-invasive approach to a lesion that does not allow for adequate and optimal management of the lesion cannot be considered minimally invasive surgery. It must be clear that the so-called minimally invasive surgery, there is not an absolute standard, minimally invasive is always a relative, comparative concept, its connotation with the development and progress of society is still deepening. Therefore, some surgeries that we regard as “minimally invasive” today may have been examples of minimally invasive surgeries in the past, while some surgeries that we regard as minimally invasive today may be discarded as “minimally invasive” surgeries in the future. Otorhinolaryngology is a branch of the broader science of surgery, and as such, its development has followed the same or even more advanced trends in surgery. Just as middle ear surgery was once the forerunner of microsurgery, sinus surgery has historically been at the forefront of endoscopic surgical development. in the early 1970s, Messerklinger, a scholar at the University of Graz, Austria, began to explore nasal sinus endoscopic surgery on the basis of the study of nasal physiology and in 1973 reported the endoscopic surgery of the whole sieve sinus and the whole sinus open surgery. In 1984, American scholar Kennedy went to Graz to study nasal endoscopic surgery with Prof. Messerklinger’s student Stammberger, and in 1986, he proposed the concept of “Functional Endoscopic Sinus Surgery”. The concept of “Functional Endoscopic Sinus Surgery” was introduced in 1986, and nasal endoscopic surgery has been widely spread in the world since then, while the first documented case of laparoscopic surgery in the world appeared in 1987. In China, Professor Zhao Choran of Tianjin Huanhu Hospital reported nasal endoscopic leptomeningeal resection in 1990, and Professor Xu Geng reported nasal endoscopic sieve sinus and total sinus surgery in 1991, while the first laparoscopic cholecystectomy on the mainland of China was not independently accomplished by Dr. Xun Zuwu of the Second People’s Hospital of Qujing City, Yunnan Province, until 1992. This history, revisited, fully illustrates the contribution of otolaryngologists in the development of surgery. But on the other hand, the development of otolaryngology must also be actively integrated into the general trend of minimally invasive surgery. Because of the history of Kennedy’s “functional endoscopic sinus surgery (Functional Endoscopic Sinus Surgery)” in the “functional” is actually a very narrow concept, specifically refers to the endoscopic nasal surgery. The concept of “functional” in “Functional Endoscopic Sinus Surgery” is actually a very narrow concept, specifically referring to the surgical operations performed under nasal endoscopy with the goal of unblocking the sinonasal complex, which obviously limits the connotation of functionality too much and is prone to misunderstandings and disputes, and it is not a one-size-fits-all concept, therefore, despite the milestone significance of the concept of “Functional Endoscopic Sinus Surgery” in the development of nasal endoscopic surgery, it has been widely recognized as the most important concept of endoscopic surgery. Therefore, although the concept of “functional endoscopic sinus surgery” is a milestone in the development of nasal endoscopic surgery, it is inevitable that it will be gradually replaced by minimally invasive nasal endoscopic surgery. The content of modern endoscopic surgery has been described in detail in this article and will not be repeated here. From a broad perspective, all surgical efforts to maintain or rebuild normal physiological functions of the body can be regarded as functional surgery, only to a different extent, and functional surgery is the direction of minimally invasive surgery. Clearly, we can understand that as long as the basic concept of minimally invasive surgery is grasped, nasal endoscopy of the anterior group of sieve sinus, the posterior group of sieve sinus surgery is not fundamentally different. Although minimally invasive surgery has always been an abstract, comparative level of concepts, and in the continuous deepening of the naso-endoscopic surgery should be followed by a certain operating principles, our experience in the clinical work is that: (a), minimally invasive concepts should be carried through in the operation of the naso-endoscopy of each procedure, including examination, anesthesia, surgery and the operation of the nasal endoscopy. (a), the concept of minimally invasive should be carried out in every procedure of nasal endoscopy, including examination, anesthesia, surgery, filling, filling, changing, rinsing, etc.; (b), endoscopy and instruments in and out of the operative cavity to avoid inserting injuries to the mucous membrane, in particular the anterior and lateral margins of the middle turbinate, which is the most common and the most fundamental cause of postoperative sinus cavity adhesion atresia; (c), in addition to affecting the nasal cavity, sinus ventilation and drainage of lesions should be completely removed, as far as possible, the preservation of inflammatory lesions, and to promote their recovery through comprehensive treatment; (d), in addition to affecting nasal cavity, sinus drainage, inflammation should be retained through comprehensive treatment. (D), the removal of lesions and sinus opening as much as possible using sharp instruments such as sinus knife, mucosal forceps and cutting drill, to avoid tearing, so as not to accidentally injure the normal mucosa; (E), prohibit the direct attraction, scratching the normal nasal cavity, sinus mucosa; (F), try to avoid direct exposure of the nasal cavity sinus bone wall in the operation, the mucosa should be reset to avoid inflammatory bone hyperplasia; (VII), sinus opening should be moderate, not the bigger the better. (G), the opening of the sinus opening should be moderate, not the bigger the better. Especially the maxillary sinus, in addition to fungal infections, do not have to completely open; (h), the selection of cases to follow the basic principles of diagnosis and treatment, and due to the operator’s ability to vary, do not in order to carry out endoscopic surgery and a failure of nasal endoscopic surgery.