Hepatic hemangioma is the most common benign tumor of the liver. If the tumor is small and has no obvious symptoms, it can be followed up and observed; if the hemangioma is large (≥5 cm) and has a significant growth trend or/and produces obvious clinical symptoms, it needs to be treated aggressively. Open hepatectomy is the traditional treatment for hepatic hemangioma, but it is highly invasive, has many complications, and has a long hospital stay. Clinicians performing open surgery for hepatic hemangioma often assume greater psychological stress and thus attempt to use more minimally invasive treatments. As laparoscopic techniques continue to improve, surgeons are experimenting with laparoscopic hepatectomy for hepatic hemangiomas. However, laparoscopic hepatectomy for hepatic hemangioma is technically difficult, and controlling intraoperative bleeding is the difficulty and key to the procedure. The main sources of intraoperative bleeding are extrahepatic vascular bleeding during dissection of the hepatic hilum and vascular bleeding during hepatic dissection, and the management measures include reducing central venous pressure, Pringle method to block the first hepatic hilum, and Ligasure to treat vessels <3 mm in diameter. The learning curve time of these methods is long, and coupled with the rich blood supply of hepatic hemangioma, a slight improper intraoperative operation may cause uncontrollable hemorrhage. Therefore, the rate of open abdomen is still high. In recent years, radiofrequency ablation (RFA) has been increasingly used in the clinical treatment of hepatic hemangiomas, showing the advantages of clear efficacy, minimally invasive, safety and good application prospects. . However, the treatment of large hepatic hemangiomas (≥10 cm) by RFA is controversial, mainly because of the large size of hepatic hemangiomas, the long ablation time, and the susceptibility to ablation-related complications. The authors' team combined laparoscopic hepatic resection and RFA technique and successfully completed laparoscopic RFA-assisted intratumoral resection of giant hepatic hemangioma. This procedure reduced the difficulty of surgery and avoided ablation-related complications. The advantages of this procedure are three as follows: 1. The pre-cut line is 1.0 cm from normal liver tissue for hepatic hemangioma tissue, and the ablation and resection targets are hepatic hemangioma tissue without dealing with large vessels and bile ducts in liver tissue, which can avoid the risk of intrahepatic vessel and bile duct injury. The pre-cutting lines of RFA ablation-assisted hepatectomy reported in the literature are all normal liver tissues adjacent to the liver tumor. 2.After the pre-cut line of hepatic hemangioma is treated by RFA, coagulation, carbonization and atrophy collapse are obvious, forming a longitudinal depressed ablation zone. The application of ultrasonic knife along the ablation zone can achieve bloodless hepatic hemangioma resection, reduce the difficulty of surgery and shorten the operation time. Compared with simple RFA treatment of hepatic hemangioma, this procedure only ablates the pre-cut line without ablating the whole tumor, which significantly reduces the ablation time and avoids ablation-related complications. In conclusion, laparoscopic RFA-assisted resection of giant hepatic hemangiomas within the tumor reduces the difficulty of surgical resection and avoids complications related to intrahepatic biliary tract injury caused by ablation. Our preliminary experience aims to provide new ideas for the minimally invasive treatment of giant hepatic hemangiomas. At present, it seems that this procedure is suitable for the treatment of exophytic, borderline giant hepatic hemangiomas, and whether it is equally applicable to the treatment of hepatic hemangiomas in other sites remains to be further explored. (A) Enhanced CT of the abdomen shows a single giant hemangioma in the left lateral lobe of the liver with a maximum diameter of 12.0 cm; (B) Ablation of pre-cut line hemangioma; (C) Hepatic hemangioma was completely resected; (D) Repeat enhanced CT of the abdomen: complete resection of hemangioma in the left lateral lobe of the liver with no hepatic hemangioma remaining. (A) Enhanced abdominal CT shows a giant hemangioma in the right lobe of the liver with a maximum diameter of 13.1 cm; (B) Ablation of pre-cut line hemangioma; (C) Intraoperative ultrasound guidance to determine the boundary of hepatic hemangioma in the liver parenchyma (arrow points to the boundary of hepatic hemangioma, white arrow points to the ablated hepatic hemangioma tissue, red arrow points to the unablated hepatic hemangioma) (D) Repeat enhanced abdominal CT: right lobe of liver The hemangioma was completely resected, and no hepatic hemangioma remained.