Surgery has a long history as one of the means of treating disease. Due to the lack of anesthetic techniques and appropriate instruments, early surgical procedures were not only painful but also significantly traumatic. With the development of anesthesia and drug preparation, surgery became painless and relatively safe; with the improvement of surgical instrumentation and surgical concepts, the concept of “minimally invasive surgery” entered the realm of modern surgery. The basic concept of minimally invasive surgery is to perform surgery with minimal damage to the body and to preserve the original function while removing the disease. The familiar lumpectomy, cardiovascular catheterization and stenting, and laser surgery lights are all minimally invasive procedures. From the patient’s point of view, these surgical techniques leave only tiny wounds on the surface of the torso; from the surgeon’s point of view, these surgical techniques reduce bleeding during surgery and disturbance or destruction of tissues (blood vessels, nerves, muscles and other tissues) in the operating area, and remove diseased tissues without affecting the original functions of the torso. As a reconstructive sensory surgery, cochlear implants have gained clinical popularity in the last 20 years, with nearly 200,000 patients worldwide undergoing the procedure. The routine steps of cochlear implant surgery include incision and flap manipulation, mastoid opening, facial crypt opening, inner ear opening, grinding of the implant bone bed, implant fixation, electrode implantation into the inner ear and closure of the surgical cavity. Macro-trauma, including the disruption of blood vessels, nerves and muscle fibers by surgical cutting instruments, charring of tissue by electrocoagulation, and excessive grinding of bone tissue, and micro-trauma, mainly the trauma to the internal structures of the cochlea caused by electrode insertion, are two aspects of the procedure. Therefore, micro-trauma in cochlear implantation surgery has been widely recognized by surgeons, and concepts and techniques to reduce micro-trauma have been applied: the “soft surgery” concept, round window implantation, non-invasive electrode preparation and technique. techniques, non-invasive electrode preparation and the use of perioperative hormones. These concepts and techniques have been proven in theory and practice to avoid or reduce intraoperative trauma, and are accepted and applied by clinical surgeons. In contrast, the prevention and management of macroscopic trauma have not received sufficient attention from surgeons in clinical practice. For cochlear implant surgery, many medical staff equate the prevention and management of macroscopic trauma with the application of small incision techniques, and believe that small incision techniques are more a response to the aesthetic requirements of the patient, and therefore do not have practical significance from a clinical medical perspective. In fact, minimally invasive techniques applied to reduce macroscopic trauma in cochlear implantation surgery should involve the following aspects: 1. Small incision: The size of the incision is the most direct manifestation of the size of macroscopic trauma. A larger incision can easily expose the operative area and give the instruments enough space to operate, but it has the potential to interfere excessively with the integrity of the tissue blood supply system in the operative area (potentially detrimental to postoperative wound healing, especially in cases of secondary and multiple cochlear implantation) and leave significant scarring in the postoperative period. 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 bed; the way the surgeon grinds the implant bed; and the surgeon’s familiarity with mastoid opening. Of these four factors, if future cochlear implants offer new fixation patterns that eliminate the need to grind the bone bed, then the size of the surgical incision will depend largely on the size of the maximum transverse diameter of the implant – meaning that the definition of a small incision can be further reduced from the current 3 cm to 2.5 cm. This means that the definition of a small incision can be further reduced from the current 3 cm to 2.5 cm. These attempts are being made to eliminate the need to grind the bone bed of the implant and to make the small incision technique even more minimally invasive. 2. Improved flap treatment: At present, the clinical practice mostly adopts a double-layer flap design, i.e., a C-shaped incision behind the ear to cut the skin and subcutaneous tissue, followed by a U- or Y-shaped incision to cut the musculocutaneous flap. In fact, the second layer of U- or Y-shaped incision is also used mainly to facilitate the grinding of the bone bed of the implant. If future cochlear implants no longer require grinding of the implant bed, then the second flap can be shaped in a slightly staggered alignment from the first flap, reducing the C-shaped or straight incision to the muscle fiber group – obviously, the C-shaped or straight incision can be shaped more in the direction of the temporalis muscle fibers, reducing the damage to the muscle and blood vessels . 3.Appropriate papillary opening range: Adequate papillary opening facilitates surgical field exposure and instrumentation, but too much bone grinding is also essentially medical trauma. Therefore, the extent of mastoid opening should be such that the facial saphenous fossa can be easily opened and operated, and unnecessary mastoid bone grinding should be avoided during surgery. As mentioned above, the technique of reducing and avoiding micro trauma in cochlear implantation surgery with an eye to the preservation of the original sensory function (hearing) has been commonly recognized and applied in clinical practice, but the technique and concept of reducing macro trauma has yet to be recognized on a larger scale. At the same time, the advancement of clinical technology depends on the updating of medical concepts and the improvement of surgical instruments – in the near future, the small incision technique should have greater operational feasibility in cochlear implantation.