Objective To investigate the short-term efficacy and safety of AccuTarget cryoablation in the treatment of early primary hepatocellular carcinoma. Methods A total of 23 patients with early primary hepatocellular carcinoma who underwent CT-guided AccuTarget cryoablation in the Department of Oncology of Longhua Hospital, Shanghai University of Traditional Chinese Medicine from Jan. 1, 2017 to Jun. 30, 2019 were recruited. The imaging information during cryoablation, adverse reactions, postoperative recurrence, and deaths were recorded to evaluate the ablation, postoperative complications, progression-free survival and 1-year overall survival rate of the early primary hepatocellular carcinoma treated with AccuTarget cryoablation. Results Among the 23 patients, 21 achieved the ice hockey complete coverage of the tumor during AccuTarget cryoablation, 2 cases had incomplete coverage, and the complete ablation rate was 91.3% (21/23). The progression-free survival was 12.0 (7.0, 12.0) months, and the 1-year overall survival rate was 95.7% (22/23). Kaplan-Meier survival analysis showed that the sum of tumor diameter and postoperative complications were related to the progression-free survival after AccuTarget cryoablation (both P=0.028). Multivariate Cox regression analysis showed that the sum of tumor diameter and postoperative complications were independent factors of the progression-free survival after AccuTarget cryoablation (both P<0.05). No obvious abnormality of the liver function was found in the 23 patients, 3 patients had a small amount of ascites, 2 patients had a small amount of hemoptysis, and no serious complications occurred. Conclusion AccuTarget cryoablation is safe and effective in the treatment of early primary hepatocellular carcinoma.