Background and Aims The utilization of laser ablation (LA) has improved the precision of liver tumor ablation, thereby reducing the possibility of complications, and has become an important clinical treatment method for malignant liver tumors. However, there are few reports on the application of three-dimensional (3D) reconstruction-assisted laparoscopic ultrasound-guided LA in the treatment of malignant liver tumors. Therefore, this study was performed to evaluate the clinical efficacy and application value of 3D reconstruction-assisted laparoscopic ultrasound-guided LA in the treatment of malignant liver tumors.Methods The clinical data of patients with malignant liver tumors who underwent 3D reconstruction-assisted laparoscopic ultrasound-guided LA from September 2020 to March 2022 were retrospectively collected. The completion of the surgery, operative time, intraoperative blood loss, occurrence of postoperative complications, changes in liver function parameters and tumor markers before and after surgery, as well as the tumor overall response rate (ORR) and recurrence rate during the postoperative follow-up period, were analyzed.Results A total of 35 patients who met the inclusion criteria were included, including 25 cases of primary liver cancer, 6 cases of colorectal cancer liver metastasis, 2 cases of pancreatic cancer liver metastasis, and 2 cases of lung cancer liver metastasis. All patients successfully completed the surgery, with an operative time of (66.3±2.8) min and an intraoperative blood loss of (15.9±12.4) mL. Three patients experienced mild postoperative complications, including 1 case of pleural effusion and 2 cases of postoperative fever, without severe perioperative complications or deaths. The patients showed elevated transaminase and total bilirubin levels after surgery, but after routine liver protection treatment, the levels returned to preoperative levels within one month. In the 25 cases of primary liver cancer, the postoperative AFP level was significantly lower than the preoperative level at 3 months (8.2 ng/mL vs. 5.3 ng/mL, Z=-3.269, P=0.001). All patients underwent contrast-enhanced CT at 3 months postoperatively, showing a ORR of 100%. At 6 months postoperatively, a repeat contrast-enhanced CT scan revealed that 2 out of 53 treated lesions showed local recurrence, resulting in a local recurrence rate of 3.8% (2/53). These lesions were subsequently treated with repeat LA.Conclusion Selective use of 3D reconstruction-assisted laparoscopic ultrasound-guided LA for malignant liver tumors has the advantages of precise treatment, minimal invasiveness, and satisfactory efficacy. In particular, for small lesions in the liver that are difficult to locate, those near important structures, and other complex situations, choosing this treatment method is beneficial for patients.