The title seems a bit funny, the key to minimally invasive treatment of varicose veins must be “minimally invasive”, what else would it be? Yes, the main idea of minimally invasive treatment of varicose veins in lower extremities is to achieve equal or better results than traditional surgery with less or minimal trauma, reduce perioperative discomfort, speed up postoperative recovery, and reduce the impact of surgery on daily life; the minimization of surgical wound or no wound at the same time brings better cosmetic results. But I think the key to minimally invasive treatment is not minimally invasive, but what is it, of course, “treatment”! No matter how the treatment is carried out, the treatment effect is the ultimate goal. By emphasizing minimally invasive treatment and leaving the root of “treatment”, patients may end up not benefiting from new technology and new methods, but becoming victims. I would like to say that minimally invasive treatment is in the interest of the patient, but we should not forget the conditions that must be in place to balance the relationship between minimally invasive and effective treatment. During surgical treatment, from the surgeon’s point of view, the ease of surgery is generally directly related to the inadequate exposure of the lesion site. Good lesion exposure can greatly reduce the difficulty of surgery and reduce the incidence of complications. However, good lesion exposure cannot be achieved without an adequate skin incision, which is contradictory to minimally invasive treatment. The contradiction between the two can be balanced or compatible in some procedures, but in others, the two are irreconcilable. Specifically for varicose vein surgery, there are strict conditions for implementation in order to achieve minimally invasive treatment. This condition is the preoperative imaging (ultrasound) directly involved or performed by the surgeon and the strict intraoperative imaging-guided treatment. The target of varicose vein treatment is the superficial veins of the lower extremities, including the great saphenous vein, the small saphenous vein, the basal branch veins, or the collateral veins, or the variant veins, or the penetrating veins. Anatomically, the venous network is extensive, complex, and variable, and without imaging guidance, primarily ultrasound, the process of minimally invasive treatment is very blind, and sometimes it may be impossible to determine whether minimally invasive treatment tools (including sclerotherapy, radiofrequency catheters, laser guidewires, etc.) have actually acted accurately on the target vein. Blind treatment simply does not guarantee the effectiveness of the treatment and can easily lead to accidental injury to the tissues surrounding the vein, including the skin, nerves, etc. Unfortunately, not only is it difficult for patients to recognize this in their quest for care, wrongly believing that minimally invasive surgery is necessarily better than classical surgery; many doctors themselves, when performing minimally invasive surgery, put most of their efforts into pure minimization, ignoring the imaging guidance techniques that are also necessary to ensure the effectiveness of the treatment. In this sense, as far as varicose veins are concerned, if there is no precise ultrasound guidance during surgery, minimally invasive treatment may be frivolous, blind, and may become a gimmick; and there is certainly no guarantee that minimally invasive treatment will be accompanied by equivalent or better results. Therefore, the key word for minimally invasive treatment of varicose veins in lower extremities is not “minimally invasive” but “treatment”, which is “intraoperative precise positioning treatment under ultrasound guidance”.