Objective To compare the effects of simulated surgical planning (based on preoperative CT three-dimensional reconstruction) combined with multimodal navigation (intraoperative ICG fluorescence and LUS) versus simulated surgical planning alone on liver function preservation and short-term outcomes during laparoscopic precise hepatectomy for primary liver cancer. Methods Clinical data of 82 consecutive patients with primary liver cancer admitted to the First Hospital of Jiaxing City between March 2021 and February 2024 were retrospectively analyzed. According to the period of technology application, patients were divided into a multimodal navigation group, 38 patients who received preoperative CT three-dimensional reconstruction combined with intraoperative indocyanine green fluorescence and laparoscopic ultrasound (LUS) guidance between September 2022 and February 2024, and a planning-only group, 44 patients who received only preoperative CT three-dimensional reconstruction guidance between March 2021 and August 2022. Liver function parameters (before surgery, on postoperative day 1 and day 7), operative time, blood loss, and complications were compared between the two groups. Results No statistically significant differences were found in baseline characteristics between the two groups (P>0.05). Before surgery, there were no significant differences in total bilirubin, alanine aminotransferase, aspartate aminotransferase, and albumin levels between the two groups (P>0.05); on postoperative day 7, albumin levels also showed no significant difference (P>0.05). Compared with patients in the planning-only group, patients in the multimodal navigation group had significantly lower levels of total bilirubin, alanine aminotransferase, and aspartate aminotransferase on postoperative day 1 and day 7, and significantly higher albumin level on postoperative day 1 (P<0.05). Patients in the multimodal navigation group also had significantly shorter operative time, duration of drain retention, and postoperative hospital stay, less intraoperative blood loss, and a lower rate of blood transfusion than those in the planning-only group (P<0.05). The overall postoperative complication rates were 13.2% in the multimodal navigation group and 31.8% in the planning-only group, with the multimodal navigation group showing a significantly lower rate (P<0.05). Conclusion Compared with laparoscopic hepatectomy guided by simulated surgical planning alone, simulated surgical planning combined with multimodal intraoperative navigation is a more effective treatment for primary liver cancer, which enables precise resection while better preserving hepatic function.