Objective：To evaluate the efficacy and safety of laparoscopic microwave ablation for treating focal nodular hyperplasia （FNH）of the liver. Methods：A retrospective analysis was conducted on FNH patients treated at our center from November 2019 to March 2024. The subjects included 43 patients underwent laparoscopic microwave ablation（ablation group）and 65 patients received surgical resection（resection group）. Key indicators such as operation duration，intraoperative blood loss，postoperative hospital stay， costs，and postoperative complications were compared between the two groups. Results：All procedures in the ablation group were successfully completed，with an average operation duration of（1.1 ± 0.6）h，average intraoperative blood loss of（35.8 ± 6.7）mL， average postoperative hospital stay of（2.9 ± 1.5）d，and average hospitalization costs of（21 257.5 ± 3 059.2）yuan. These indicators were significantly better than those of 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 μmol/L，2.3%）. The incidence of postoperative complications showed no significant difference compared to the resection group. Follow - up results indicated that all lesions were completely ablated，with no lesion enlargement or recurrence observed within one -year follow - up period. Conclusion：Laparoscopic microwave ablation for FNH is safe，effective，and economical，and it merits clinical promotion and application.