Minimally invasive concept and minimally invasive techniques are one of the most important elements of modern surgery, which require “the least possible or smallest possible trauma” to achieve and maintain the best stable state of internal environment and “the least possible cost to the patient” [1] while achieving the same good results. How to apply minimally invasive concepts and techniques to anorectal surgery is an issue that is actively explored by anorectal surgeons, and is also the direction and goal of future development of anorectal surgery. The Guide to Clinical Treatment of Hemorrhoids (2006 Edition) points out that asymptomatic hemorrhoids do not need to be treated; the aim of treatment is to eliminate and reduce symptoms; and it is more meaningful to relieve symptoms than to change the size of the hemorrhoid body. Under the guidance of this principle, the traditional concept of “treating hemorrhoids as soon as you see them” should be abandoned, and basic treatment such as diet, sitz baths, and conservative treatment such as medication should be emphasized. MIPH). At present, the clinical application of hemorrhoid treatment methods is still a wide range of names, each method has its advantages and disadvantages, anorectal medical personnel also combined with clinical practice to make improvements to various methods, while the introduction of minimally invasive technology and the application of modern high technology also make the treatment of hemorrhoids fully reflect the minimally invasive concept. 1.Injection therapy Injection therapy has long been the preferred method for treating Ⅰ to Ⅱ degree internal hemorrhoids. Since the initial use of the necrotizing agent withered hemorrhoid liquid to the most widely used sclerosing agent eliminating hemorrhoid spirit, and then the corresponding sclerosing agent improvement, the improvement of drugs on the one hand to reduce the harmfulness of the drug itself to the human body, but also to reduce the postoperative pain and the corresponding complications. 2.Ligature therapy Ligature therapy evolved from the ligature method of internal hemorrhoids, initially using silk or intestinal thread, and then gradually evolved into the rubber ring ligature (RBL), and now the clinic mostly uses automatic hemorrhoid ligature (RPH), which uses a special ligature device to ligature the rubber ring to the base of the hemorrhoid, through the elastic contraction of the rubber ring to partially block the blood supply of the hemorrhoid, so that the hemorrhoid body atrophy, fall off and achieve the purpose of treatment. The ligature therapy is a safe, effective, inexpensive and convenient method to treat internal hemorrhoids of degree II and III, and was once called the Minimally Invasive Technique for treating internal hemorrhoids by European and American scholars. 3.Copper ion electrochemical therapy The copper ion is fed into the internal hemorrhoid body through electrodes and combines with substances in the blood to form a copper complex, which slows and coagulates the blood flow of microvessels in the tissue, edematizes the epithelial cells of the blood vessel wall, produces sterile inflammation, necrosis, and mechanization, reduces the number of capillaries in the hemorrhoid body, reduces the amount of stagnant blood, and atrophies the hemorrhoid body to a smaller size for the purpose of treatment. This method is a safe, effective, minimally invasive and convenient way to treat bleeding and prolapsed internal hemorrhoids of degree II. 4.Hemorrhoid artery ligation (HAL) HAL can make the hemorrhoid body atrophy by blocking the blood supply of hemorrhoid, so that the internal pressure of the venous plexus of hemorrhoid body decreases. At the same time, the ligation effect can make the rectal mucosa and submucosal tissue adhesion fixed and prevent the anal cushion from moving down, so as to eliminate the symptoms of hemorrhoid prolapse. Doppler-guided hemorrhoid artery ligation (DG HAL) uses a special Doppler probe to detect the artery above the hemorrhoid at 2-3 cm above the tooth line for direct ligation treatment, making the clinical operation more precise and easy. A large number of clinical applications by domestic and foreign scholars have also confirmed that it is a minimally invasive method for the treatment of internal hemorrhoids of degree II and III. This technique is an emerging technique for the treatment of prolapsed internal hemorrhoids based on the theory of inferior displacement of anal cushion established by Italian scholar Longo. The mucosa and submucosa of the lower rectal wall are resected circumferentially above the prolapsed internal hemorrhoid by means of a specially designed anastomosis, and the distal and proximal mucosa are anastomosed at the same time as the resection, thus achieving the purpose of lifting, repositioning, cutting off the flow and reducing the body of the prolapsed internal hemorrhoid. Since its application, it has been rapidly and widely used in domestic and foreign clinics, and has the advantages of easy operation, less damage, less pain and quick recovery for the treatment of III and IV degree internal hemorrhoids, especially annular prolapsed internal hemorrhoids. 6.Minimally invasive techniques in external peeling and internal ligation surgery External peeling and internal ligation (Milligan?Morgan surgery) is still the mainstream procedure for anorectal surgeons to treat mixed hemorrhoids, especially severe hemorrhoids. Since its application in 1937, the majority of clinicians have made a lot of improvements to this procedure in the pursuit of minimally invasive aesthetics, which are summarized in three aspects. 6.1 Preservation of the anal cushion In 1975 Thomson proposed the doctrine of inferior displacement of the anal cushion of hemorrhoids, which was considered to be formed by pathological hypertrophy and displacement of the anal cushion and siltation of the perianal subcutaneous vascular plexus. It was gradually recognized that the primary site of hemorrhoids is the ATZ (anal transitional zone) epithelium, i.e. the migrating epithelium of the rectum and anal canal, which belongs to the functional normal tissue in the anal cushion area. It has a certain endocrine and immune function and is distributed with highly specialized sensory nerve tissue with a fine sense of discrimination, which induces the anal reflex to maintain normal bowel self-control. Under the guidance of this doctrine, the majority of scholars at home and abroad have timely updated the concept and improved the operation, preserving the normal anal cushion as much as possible and reducing the damage, which has achieved satisfactory clinical results. 6.2 Preservation of the dentate line The dentate line area is a highly specialized zone of sensory nerve terminal tissue, which is the evoked zone of defecation movement. The clinical research on the correspondingly derived completely preserved dentition or minimizing the damage to the dentition has confirmed that preserving the dentition can effectively protect the anal function and reduce the occurrence of postoperative complications. 6.3 Preservation of skin bridge and anal appearance plastic surgery For cricoid mixed hemorrhoid surgery, too much skin damage will lead to perianal skin defect and increased scarring, which will affect anal function and prolong healing time to some extent, and can lead to anal stenosis in serious cases, so minimally invasive techniques should be used clinically as much as possible to achieve the purpose of skin preservation, and external hemorrhoid treatment gradually evolves from excision at the beginning to peeling, along the perianal skin pattern alignment and Minimally invasive incisions are designed along the shape of the perianal skin pattern and the shape of the external hemorrhoid, striving to preserve more of the perianal skin and the skin bridge between each incision, while using such as winged incisions or auxiliary incisions to ensure the overall appearance of the anus is as flat as possible and even achieve cosmetic results. There are numerous hemorrhoid treatment methods, and there is no single treatment method that is a perfect cure for hemorrhoids. The clinical choice of various methods should follow the principle of individualized treatment guided by the concept of minimally invasive, while taking into account factors such as health economics. No method or even any sophisticated instrument or apparatus can be called minimally invasive in the true sense of the word. Minimally invasive must be reflected in the entire treatment process of hemorrhoids and in every detail facing the hemorrhoid patient, while the depth of basic research on the pathogenesis of hemorrhoids will also influence the progress of the concept of hemorrhoid treatment and minimally invasive treatment.