Minimally invasive concept and minimally invasive techniques are one of the most important elements of modern surgery, which “require the least possible or small trauma” to achieve and maintain the best stable state of internal environment for patients, and “the patient pays as little as possible” to achieve the same good results. How to apply minimally invasive concepts and techniques to anorectal surgery is a problem that anorectal surgeons are actively exploring, and it is also the direction and goal of the future development of anorectal surgery. When talking about minimally invasive treatment of hemorrhoids, we must first understand what hemorrhoids are? There are two views: one view is that hemorrhoids are bulging venous masses formed by tortuous and dilated terminal veins in the lower rectum or anal canal. This view was once widely accepted and is a more traditional understanding. Another view is that in normal people, there is a special tissue structure called “anal cushion” under the mucous membrane at the end of the anal canal and rectum, which is formed in the fetus and its function is to assist in the normal closure of the anus and to control defecation, just like the role of a faucet washer. This view has been shared by more scholars in recent years. After the formation of hemorrhoids, not everyone will have symptoms, and symptomatic hemorrhoids are called hemorrhoids. Hemorrhoids are divided into internal, external, and mixed hemorrhoids depending on where they occur. It should be said that common anorectal disease is not a big disease, and appropriate treatment can fully achieve satisfactory results, but a variety of treatment methods may be nothing to start with, “Hemorrhoid clinical diagnosis and treatment guidelines” pointed out: asymptomatic hemorrhoids do not need treatment, the purpose of treatment is to eliminate, reduce the symptoms, the relief of symptoms is more meaningful than changing the size of the hemorrhoid body. Generally speaking, asymptomatic hemorrhoids do not require treatment. It is important not to administer unnecessary or incorrect treatment to the patient, as it will not only waste the patient’s money, but also cause unnecessary harm to the patient, some of which may even have sequelae. Most of the general treatment for stage 1 and 2 patients can be effective. General treatment includes avoiding irritating foods, drinking more water, eating more dietary fiber, keeping the bowels open, using local suppositories and creams, or taking sitz baths and physical therapy. Microwave, radiofrequency, collar ligation, and HCPT (high frequency capacitive field) therapy can be applied to stage 1 and 2 internal hemorrhoids as appropriate, but care should be taken to prevent complications. Thrombosed external hemorrhoids can be completely cured through clothing if extracorporeal radiofrequency is applied early, and our department has basically stopped doing this type of surgery since the introduction of this equipment, achieving complete non-invasiveness. For stage 3 and 4 internal hemorrhoids and mixed hemorrhoids, most of them require surgery. Ligation therapy and its derivative procedures are still the most valuable methods recognized for hemorrhoid treatment at home and abroad, especially external peeling and internal ligation therapy, which has been applied since 1937, and these mainstream procedures have become increasingly mature. The concept of “minimally invasive” can be achieved depending on the patient’s condition. A large number of clinicians have made a lot of improvements to the procedure in the pursuit of minimally invasive aesthetics, summarized in three aspects: Preserve the anal cushion as much as possible during surgery, in line with the anal cushion doctrine; 2. Preserve the dentate line as much as possible, which can effectively protect anal function and reduce the occurrence of postoperative complications; 3. Preservation of the skin bridge and anal appearance shaping, for cricoid mixed hemorrhoids, too much skin damage can lead to perianal skin defects and increased scarring. The treatment of external hemorrhoids is gradually evolving from excision to peeling, designing minimally invasive incisions along the perianal skin pattern and the shape of external hemorrhoids, striving to preserve more perianal skin and the skin bridge between the incisions, while using such as winged incisions or auxiliary incisions, etc. The overall appearance of the anus is made as flat as possible, and even cosmetic effects are achieved. How to choose in the face of various advertised treatments? From the early laser, microwave and injection treatments to the HCPT ablation treatment and PPH treatment that are being promoted all over the world, all of them are labeled as “minimally invasive treatment”, which may be a process of continuous elimination and improvement, but the concept of minimally invasive is unbelievable in terms of various types of anorectal diseases. These treatments have complications such as bleeding, infection, and anal canal stenosis that patients may fear. These methods should only be used as a supplement to the anorectal treatment system, and not as a substitute for the traditional ligation surgery that has evolved over a dozen procedures. If someone says that so-and-so method can solve all your worries, it is not scientific. As a medical center specialized in anorectal in Nanyang area, the Department of Anorectal has been perfected in recent years with specialist various diagnostic and treatment equipment. And also equipped with HCPT ablation instrument and PPH anastomosis. The knowledge that should be popularized is that HCPT, or high frequency capacitive field, is just a method of removing hemorrhoids by thermal cautery. It is not an original and irreplaceable brand new treatment, tens of thousands of dollars of equipment is not a huge investment, not to mention high-tech, as invasive treatment, the essence is still the surgical method – the removal of hemorrhoids with the help of instruments, the healing time after this operation, the patient does not feel statistically improved. So unless the patient’s hemorrhoids themselves are particularly small, it is impossible to talk about “minimally invasive” and “painless”. The specialist’s choice of case is unquestionable, but it is consistent with the risks of all invasive treatments. The most common are post-operative hemorrhoids, epithelial defects of the anal canal, anal or rectal stenosis, sore infections, and long-term failure to heal, all of which require secondary surgery to resolve the problem. Other cases such as high perianal abscess and complex anal fistula repeatedly do not heal are even more numerous. For PPH surgery, the theory is based on the theory of inferior displacement of the anal cushion, using a device called “PPH anastomosis” to make a circular excision of the prolapsed rectal mucosa above the hemorrhoid, which can be effective for selective cases of internal hemorrhoid prolapse. However, for patients with large external hemorrhoids, external hemorrhoid removal must be performed at the same time. Again, because of the limited indications, it is only a supplement and is far from being able to overturn traditional hemorrhoid surgery, and is expensive, with complications and long-term results still to be seen. There is a wide range of hemorrhoid treatment methods, and no single treatment method is yet a perfect one. The clinical choice of various methods should follow the principle of individualized treatment guided by a minimally invasive concept, 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 and other factors will also influence the concept of hemorrhoid treatment and the progress of minimally invasive treatment.