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Background Laparoscopic liver biopsy (LLB) is a critical complementary diagnostic modality for complex liver diseases, addressing unmet clinical needs when percutaneous/transjugular biopsy approaches are unfeasible. However, the lack of international standardized guidelines has led to highly heterogeneous clinical practices, limiting the safe and rational implementation of LLB. This study aimed to develop an international multidisciplinary consensus to standardize LLB clinical practice.Methods A panel of 45 multidisciplinary experts from 6 continents was recruited. A modified Delphi process with three rounds of anonymous survey was conducted, with a pre-defined consensus threshold of ≥78% expert agreement. All statements were thematically organized into 6 core domains of LLB practice.Results All 46 proposed statements achieved consensus, with 25/46 receiving unanimous (100%) agreement, 20/46 with 90–99% agreement, and 1/46 with 78–89% agreement. The consensus covered clinical application scenarios, high-risk patient management, preoperative preparation, surgical procedures, complication prevention, and discharge/quality management. The Delphi process flowchart in Figure 1 ( IDDF2026-ABS-0365 Figure 1. Flowchart of the Delphi procedure adopted for developing a consensus statement on LLB).Conclusions This international consensus provides a unified, evidence-based framework for LLB practice, which will significantly enhance procedural safety, diagnostic accuracy, and rational clinical implementation, supporting the appropriate use of LLB in complex liver disease diagnosis globally.Abstract IDDF2026-ABS-0365 Figure 1