Laparoscopic techniques applied to liver surgery are still in the exploratory stage, especially laparoscopic hepatectomy can only be performed in a few medical centers, and most of them are small non-anatomical hepatectomies. The main reason for this phenomenon is because of the difficulty of controlling traumatic bleeding during hepatectomy. The main method of controlling traumatic bleeding during hepatectomy is hepatic flow blockade. If total hepatic portal flow blockade is used in laparoscopic hepatectomy, it will reduce intraoperative traumatic bleeding, but it will cause adverse effects such as ischemia-reperfusion injury to the residual liver and gastrointestinal stasis, which brings new trauma to the body while reducing bleeding and is contrary to the purpose of minimally invasive laparoscopic surgery. In addition, the clear and effective exposure of the section pipeline during hepatectomy is another key to control traumatic bleeding, but the hepatectomy instruments usually used at home and abroad, such as ultrasonic knife, Ligasure, argon coagulator, microwave knife, etc., are inadequate and potentially dangerous, and cannot perform extensive hepatectomy well. I. Laparoscopic regional hepatic blood flow block technique In order to control bleeding from the trauma during hepatectomy, total hilar blood flow block is applied to laparoscopic hepatectomy. Although this method can reduce intraoperative trauma bleeding, the whole body systemic hemodynamics is significantly changed after hepatic hilar blockade, and the whole liver is in ischemic state for a longer period of time, and the gastrointestinal blood return is obstructed, resulting in ischemia-reperfusion injury to the liver and gastrointestinal stasis, which makes the surgical trauma significantly increased. One of the objectives of carrying out laparoscopic hepatectomy is to reduce surgical trauma, and obviously the whole liver blood flow blocking technique is not in line with the concept of minimally invasive laparoscopic surgery and is not the best method of liver blood flow blocking. We propose a laparoscopic regional hepatic blood flow block technique, which is mainly applied in laparoscopic hemihepatectomy. This technique controls intraoperative bleeding similarly to whole liver hemorrhage block without affecting the blood supply to the preserved side of the liver and has little to no effect on systemic hemodynamics. Performing laparoscopic regional hepatic flow block is a simple procedure, but it is difficult and risky to implement, the main risk being bleeding due to injury to the vessels or their branches during the operation, which makes the operation intermediate to open. Therefore, blunt dissection must be used when performing regional hepatic blood flow block dissection of the hepatic hilar ducts in order to protect the ductal structures in the hilar region. We performed the operation using the punch-suction blunt dissection method. When performing blunt dissection with a punch suction device or laparoscopic multifunctional surgical dissector, the hepatoduodenal ligament is first opened and the anterior fatty tissue of the hepatic duct is pushed and suctioned with the punch suction device until the anterior wall of the common hepatic duct is revealed; blunt dissection continues to the left to dissect out the intrinsic hepatic artery and continues up the intrinsic hepatic artery to reveal the right and left hepatic arteries and their bifurcations, at which point the corresponding hepatic arteries can be treated as needed. The portal vein is located behind the hepatoduodenal ligament, and the bifurcation site of the left and right portal veins is very high, which makes dissection more difficult. After cutting off the corresponding hepatic artery branches, the severed end of the distal hepatic artery branches must be lifted, and the bifurcation part of the portal vein and the corresponding branches are separated by blunt dissection, and the corresponding portal veins are clamped with absorbable clips. At this point, the regional hepatic blood flow blockage (inlet blood flow) is completed, and at the same time, one side of the liver can be seen on the surface of the liver showing obvious ischemic changes. Theoretically, regional hepatic blood flow blockade includes both inlet flow blockade and outlet flow (hepatic vein) blockade, and we believe that outlet flow (hepatic vein) blockade is not very important and necessary. Many literatures are very concerned about treating the hepatic veins before hepatectomy, and the main reason is that they cannot separate the hepatic veins for targeted treatment during hepatectomy, and often use Endo-GIA for treatment, which is somewhat blind and may clamp some of the hepatic veins, leading to hepatic vein hemorrhage and air embolism, or even endangering the patient’s life. Therefore, these authors tend to deliberately go to the second hepatic hilar before liver resection in an attempt to isolate the hepatic vein for management. This has little chance of success, and the dissection process of separation can easily cause bleeding from the inferior vena cava or hepatic vein, which once it occurs requires intermediate open abdominal treatment to stop the bleeding, but bleeding from these areas is difficult to manage even under open conditions. Therefore, we do not recommend deliberately dissecting the second hepatic hilar and blocking the hepatic vein before hepatectomy; we also do not advocate dealing with the hepatic vein by blindly lancing it with large needles before hepatectomy. The advantages of laparoscopic regional hepatic flow blocking technique are: (1) the control of hemihepatic inflow requiring surgical treatment is similar to that of total hepatic portal inflow blocking, which can significantly reduce intraoperative hepatic trauma bleeding; (2) there is almost no effect on systemic hemodynamics, and gastrointestinal blood flow can flow back into the body circulation through the contralateral liver, avoiding gastrointestinal blood flow stagnation, intestinal bacteria and endotoxin displacement, intestinal mucosal damage (3) After hemihepatic flow blockade, the blood supply of the preserved hemihepatic side is not affected, avoiding the occurrence of ischemia-reperfusion injury, fully reflecting the purpose of minimally invasive laparoscopic surgery, especially for those with underlying diseases such as cirrhosis, which can reduce the incidence of postoperative complications and morbidity and mortality; (4) regional hepatic flow blockade has no time limit, which is conducive to comfortable intraoperative operation, avoiding the rapid operation due to the time limit of hepatic hilar blood flow (4) the regional hepatic blood flow block is not time-limited, which is conducive to comfortable intraoperative operation and avoids accidental damage to adjacent tissues such as blood vessels caused by rapid hepatic resection due to time limitation of hepatic flow block. Because of the large size of the liver, there are many intrahepatic ducts and their distribution in the liver parenchyma is not regular, and there are no signs on the surface of the liver to indicate the ducts in the parenchyma, so how to reveal the irregularly distributed ducts in the liver parenchyma one by one and deal with them accordingly in the process of liver dissection is another key to the success of laparoscopic hepatectomy. The liver dissection tools commonly used at home and abroad are inadequate, potentially dangerous, and expensive. At present, the main instruments used for laparoscopic liver resection are as follows. 1, microwave knife: it is used to coagulate the liver parenchyma on the tangent line of the liver, and to cut the liver after the coagulation of the liver tissue and some ducts on the tangent line. However, some large ducts on the tangent line cannot be coagulated by microwave; and if the time required for coagulation is long, the coagulated liver tissue is thick, and too much necrotic tissue is left after the operation, it is easy to cause secondary infection and the formation of liver abscess. In addition, there is a risk of haemorrhage caused by stabbing deep large blood vessels when the microwave probe is pierced into the liver parenchyma. 2.Argon coagulator: It uses the high-energy beam of argon laser to form a 3 mm thick crust on the liver section to stop bleeding, but it does not have the function of dissection itself. 3.Ligasure vascular closure system: It uses high-frequency electrical energy, combined with the pressure of the vascular jaws, to make the human tissue collagen and fibrin dissolve and denature, and the vessel wall dissolve to form a transparent band, producing permanent lumen closure.Ligasure can only deal with the separated pipeline, but it does not have the function of dissecting the separated pipeline itself. 4.Ultrasound knife: It is the only tool with anatomical function among all liver cutting tools at present. It ruptures the hepatocytes through the principle of ultrasonic oscillation, leaving a tough and dense duct structure, and then treats the ducts accordingly according to their thickness. However, for patients with cirrhosis, its dissection speed is very slow and the required operation time is long, while most patients with liver diseases in China are accompanied by cirrhosis, so the clinical application is limited. 5. Endoscopic linear cutting closure: It can cut the closed buried ducts in the liver parenchyma while cutting the liver tissue, and theoretically it can effectively control intraoperative bleeding. However, there are two problems in practice: firstly, the linear cutting closure can only be used to cut thin layers of liver tissue, while for hypertrophic liver, it is necessary to cut in layers, and the process of cutting closure into the liver parenchyma is relatively blind when cutting in layers, and there is a risk of damaging the intrahepatic ducts; secondly, the length of the endoscopic linear cutting closure is limited each time the liver tissue is cut and closed, and the ducts located at the distal end of the liver parenchyma may be partially cut in one cut, resulting in hemorrhage. may be partially severed, causing hemorrhage. 6.Laparoscopic multifunctional surgical dissector: In response to the limitations and shortcomings of the above-mentioned liver dissection tools, we designed a laparoscopic multifunctional surgical dissector to perform liver dissection. Its biggest advantage is that it can separate and dissect each tiny duct in the liver section in a short time and treat it accordingly. A layer of scorch is formed after electrocoagulation of the wound surface, which can effectively control the bleeding and small vessels, and the bleeding can be controlled in a timely manner by coagulation while cutting. The thicker vessels are dissected after clamping with titanium clips or absorbable clips, and there is almost no bleeding during the whole process of liver dissection, and air embolism caused by air entering the circulatory system from the dissected end of the vein under pneumoperitoneum conditions can be avoided. We believe that the laparoscopic multifunctional surgical dissector is currently a more ideal tool for laparoscopic liver dissection.