The basic concept of minimally invasive surgery is to perform surgery with minimal damage to the body, removing the disease while focusing on preserving the original function. Well-known procedures, such as laparoscopic surgery, cardiovascular catheterization and stenting, and laser surgery, are all minimally invasive surgeries. From the patient’s point of view, these surgical techniques leave only tiny wounds on the surface of the body; from the surgeon’s point of view, these surgical techniques reduce bleeding and interference or damage to the tissues in the operated area (blood vessels, nerves, muscles and other tissues), removing diseased tissues without affecting the original function of the body. Daoxing Zhang, Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital of Capital Medical University As a sensory reconstructive surgery, cochlear implantation has gained popularity in clinical practice in the last 20 years, with nearly 200,000 patients undergoing the procedure worldwide. The routine steps of cochlear implant surgery include: incision and flap manipulation, opening of the mastoid process, opening of the facial socket, opening of the inner ear, grinding of the implant bone bed, implant fixation, implantation of the electrode into the inner ear, and closure of the surgical cavity. The trauma that may be generated by the surgery itself during the above process consists of two aspects: macro-trauma (Macro-trauma) and micro-trauma (Micro-trauma). Macro-trauma includes interruption of blood vessels, nerves and muscle fibers caused by surgical cutting instruments, charring of tissues caused by electrocoagulation, and excessive grinding of bone tissues, etc. The prevention and treatment of macro-trauma, in contrast, has not been given enough attention by doctors in the clinic, and for cochlear implantation surgeries, many medical staffs do not pay too much attention to the prevention and treatment of macro-trauma; and it is also believed that the small-incision technique is more of an aesthetic requirement for the patients. It is also believed that the small incision technique is more of a response to the aesthetic requirements of patients, and does not have practical significance from the clinical point of view. In fact, small incisions are an important step in minimally invasive surgery in order to minimize macroscopic trauma during cochlear implantation. I have performed more than three thousand cochlear implant surgeries with small incisions and have received very good results. I believe that reducing macro trauma includes the following three aspects: 1. Small incision: the size of the incision is the most direct manifestation of the size of the macro trauma. Larger incisions can easily expose the surgical area, giving the instruments enough operating space, but may interfere too much with the integrity of the blood supply system of the tissues in the surgical area (may not be conducive to postoperative wound healing), and in the postoperative legacy of obvious scarring. The size of the surgical incision is usually determined by the following factors: the maximum transverse diameter of the cochlear implant; the size and location of the implant bone bed; the manner in which the surgeon grinds the implant bone bed; and the surgeon’s familiarity with open mastoid surgery. Of these four factors, if future cochlear implants provide a new fixation pattern that eliminates the need to grind the bone bed, then the size of the surgical incision will be largely determined by the size of the implant’s maximum transverse diameter alone-meaning that the definition of a small incision could be narrowed even further, from the current 3 centimeters, to 2.5 centimeters. This means that the definition of a small incision could be further reduced from the current 3 cm to 2.5 cm. Current cochlear implant manufacturers are making these attempts to eliminate the need for grinding of the implant bone bed in order to make the small incision technique even more minimally invasive. 2. Improved flap treatment: Currently, a two-layer flap design is used in clinical practice, i.e., a C-shaped incision behind the ear to incise the skin and subcutaneous tissues, followed by a U-shaped or Y-shaped incision to incise the musculoskeletal flap. In fact, the second layer of U-shaped or Y-shaped incision is also mainly to facilitate the grinding of the implant bone bed. If future cochlear implants no longer require grinding of the implant bone bed, then the second layer of the flap can be shaped in a slightly staggered direction from the first layer of the flap, reducing the need for a C-shaped or straight incision to the muscle fiber group – obviously, a C-shaped or straight incision can be shaped more in the direction of the temporal muscle fibers, which reduces the risk of damage to the muscle and blood vessels. Adequate mastoid opening: adequate mastoid opening facilitates field exposure and instrumentation, but excessive bone grinding is essentially medical trauma. Therefore, the range of mastoid opening should be appropriate to facilitate the opening and operation of the facial socket, and unnecessary grinding of the mastoid bone should be avoided during the operation. Micro-trauma is the trauma to the internal structure of the cochlea caused by electrode insertion. As an auditory reconstruction surgery, electrode trauma to the internal structure of the cochlea may lead to hearing loss in cases, therefore micro-trauma in cochlear implantation surgery has received general attention from surgeons, and corresponding concepts and techniques to reduce micro-trauma have also been applied in surgery: the concept of “soft surgery”, the round window implantation technique, non-invasive electrode preparation, and the “soft surgery” concept. The concept of “soft surgery”, round-window implantation, the preparation of noninvasive electrodes, and the use of perioperative hormones have also been applied in surgery. The avoidance or reduction of intraoperative trauma by the above concepts and techniques has been demonstrated theoretically and practically, and has been accepted and applied by clinical surgeons. As mentioned above, in cochlear implantation surgery, techniques to reduce and avoid microtrauma with an eye to preservation of the original sensory function (hearing) have been generally accepted and applied in the clinic, but techniques and concepts to reduce macro-trauma have yet to be accepted on a wider scale. At the same time, the progress of clinical technology depends on the updating of medical concepts and improvement of surgical instruments – in the near future, small incision techniques should be able to have greater operational feasibility in cochlear implantation surgery.