Liver surgery includes a huge and complex variety of resections, often requiring precise planning and execution to achieve successful outcomes. The positioning of the patient and the choice of the access play a pivotal role in the safety and effectiveness of liver surgery. Factors such as the patient’s anatomy, the location of the liver lesion, and the surgical technique to be employed all influence the choice of patient positioning and the type of access. This relevance can be highlighted in all the different approaches, from the standard open hepatectomies to the minimally invasive hepatectomies, with specific tips according to the planned surgery. This chapter aims to provide a comprehensive overview of the various possible options for patient positioning, the types of access approaches, and their use in relation to the type of liver surgery. It will discuss the advantages and disadvantages of the different settings, emphasizing their importance in patient safety, optimal exposure, and surgical practicality.