Objective This study aimed to investigate the feasibility, safety, and clinical effect of No Touch liver pedicle microwave ablation (NTLP-MWA). Methods The outcomes of 118 patients diagnosed with hepatocellular carcinoma (HCC) between 2014 and 2015 were retrospectively analyzed. Patients were divided into three groups. In group A, 35 patients underwent ultrasound-guided NTLP-MWA, 27 in Group B were treated with routine microwave ablation (RMWA), and 56 in group C underwent anatomic hepatectomy (AH). The preoperative basic data, intraoperative data, and postoperative data were analyzed among the three groups. Results The treatment time, intraoperative blood loss, and postoperative liver function (alanine transaminase) in the NTLP-MWA and RMWA groups were significantly different from those in the AH group (all P < 0.005). There was no difference in the complete elimination rate and local recurrence within 1 year among the three groups. Treatment was not an independent risk factor for early postoperative recurrence. There was no significant difference in the 5-year overall survival rates among the three groups. Conclusion NTLP-MWA is safe and reliable, in accordance with the principles of oncology treatment, and worth further promotion in clinical practice.