Surgical microwave ablation (MWA) surgery has recently emerged as a first-line treatment option for variety of benign and malignant liver tumors. As majority of patients have some type of underline chronic liver disease (steatosis, NASH, cirrhosis) and limited functional reserve, minimally invasive ablation techniques have proven efficacy in tumor destruction with preservation of liver parenchyma and synthetic function. Modern microwave technology utilizes high frequency electromagnetic waves that allows for more active heating with production of higher tissue temperatures in a shorter period of time and generate more predictable ablation zones with less susceptibility to heat-sink effect. Intraoperative ultrasound (IOUS) guidance allows for precise visualization, targeting and minimization of periprocedural complications. Surgical approach provides opportunity to concomitantly perform proper oncological staging or other surgical procedures. Recent data supports comparable short- and long-term oncological outcomes of MWA treatment of hepatic tumors and minimally invasive surgical approaches, making it an attractive locoregional treatment modality of choice.