Objective: This study evaluated the efficacy and safety of laparoscopic microwave ablation for treating focal nodular hyperplasia (FNH) of the liver. Methods: A retrospective analysis was conducted on the medical records of FNH patients treated at our center from November 2019 to March 2024. The subjects included 43 patients who underwent laparoscopic microwave ablation and 65 patients who received surgical resection. Key indicators such as operative duration, intraoperative blood loss, postoperative hospital stay, costs, and complications were analyzed. Results: The ablation procedures were successfully completed in all patients, with an average operative time of 1.1 ± 0.6 hours, average intraoperative blood loss of 35.8 ± 6.7 ml, average postoperative hospital stay of 2.9 ± 1.5 days, and average hospitalization cost of approximately 21,257.5 ± 3,059.2 RMB. These indicators were significantly better than those in the resection group. Postoperative complications included fever (4 cases, 9.3%), hematuria (1 case, 2.3%), and renal insufficiency (1 case with a serum creatinine level of 236 umol/L, 2.3%). The incidence of postoperative complications showed no significant statistical difference compared to the resection group. Follow-up results indicated that all lesions were completely ablated, with no enlargement or recurrence observed during a one-year follow-up period. Conclusion: Laparoscopic microwave ablation for FNH is safe, effective, and cost-efficient, warranting further promotion and application in clinical practice.