Background and Aims Anatomic hepatectomy (AH) is a type of liver resection targeting the tumor-bearing portal territory. It conforms to precise hepatectomy and has gradually become the mainstream laparoscopic hepatectomy for patients with hepatocellular carcinoma (HCC). However, for a long time, the academic community has debated whether AH is superior to non-anatomic hepatectomy (NAH) in terms of oncological benefits for patients with HCC. This controversy may be due to the anatomical deviation of the traditional segmentation method (Couinaud's system) from the patient's actual liver vascular anatomy, which may fail to remove all tumor-bearing portal territory completely. The popularization of three-dimensional (3D) visualization technology can help surgeons more intuitively and fully understand the patient's intrahepatic vascular course and variations before surgery, make the most realistic analysis of the tumor-bearing portal territory, and guide the development of individualized and accurate AH. In this article, the authors discuss the above problems based on clinical experience and describe the procedural steps and experience of implementing AH under laparoscopy.Methods The clinical data of 2 patients with HCC treated in the Department of Liver Surgery, Xiangya Hospital, Central South University in 2022 were retrospectively analyzed. Both patients had single tumor lesions involving two adjacent liver segments. The 3D imaging analysis of the liver and mass was carried out by professional software before surgery. The tumor-bearing portal territory was set as the resection range while taking into account that the surgical specimen to meet the minimum safe margin (1 cm), otherwise it was necessary to include the adjacent 1-2 portal tributaries and their territories to expand the resection range to achieve the safe margin appropriately. During the operation, 3D laparoscopy was used. The liver membrane structure was entirely used to help dissect the tumor-bearing hepatic pedicle under low central venous pressure and temporary total hepatic blood inflow blockade (if necessary, liver parenchyma was split to facilitate the exposure of the liver pedicle). Then the liver blood inflow was restored. The ischemia/resection range was marked on the liver surface. After that, the resection range and the distance between the resection margin and the mass were determined again by intraoperative ultrasound to confirm whether the resection margin was consistent with the preoperative plan.Results Both patients had successful operations, and after the target liver pedicles were dissected and ligated, the scope of the ischemia area was in line with the preoperative plan, which was confirmed by laparoscopic ultrasound. Postoperative specimen autopsy revealed that the distance between the resection margin and the mass was at least 1 cm. Pathological examination confirmed that both patients had well-differentiated HCC and no tumor microvascular invasion. There was no tumor recurrence during 6-8 months of postoperative follow-up, and their quality of life was satisfactory.Conclusion 3D visualization combined with tumor-bearing portal territory analysis can help clinicians clarify the range of AH in HCC patients before surgery. Meanwhile, considering the safety margin of at least 1 cm, the minimum range of AH that is clinically acceptable can be achieved. This approach is particularly useful when a single mass simultaneously involves 2 adjacent liver segments. However, if the mass is close to large intrahepatic vessels (e.g., the middle or right hepatic vein), a wider range of AH may provide better oncological benefits.