One night last November, I received a call from a lady who said she was coming to my house for a visit. I asked her what it was about and she said that I had operated on her for gallstones 2 weeks ago. I told her not to come, but she ended up coming to my house anyway. Knocked on the door and came in, along with a very spirited old man who looked very well and was very studious. It turned out that the old man was a professor at Guangzhou University of Traditional Chinese Medicine and the lady was his wife. They carried some things in their hands, saying that their son had just gotten married, and brought some wedding candy. After entering the door and chatting, I realized that the old man was the patient I had treated. There was a misunderstanding because two patients with gallbladder stones and common bile duct stones had combined duodenoscopy and laparoscopy in those two weeks. They told me that they must come to see me because my help enabled them to go home and organize their son’s wedding! It turned out that the TCM professor had a history of gallbladder stones for more than 10 years, and usually only had some symptoms of upper abdominal discomfort or fullness, so he had been prescribing some Chinese herbs for his own treatment, which was not a big problem. In recent years, I often had pain in the upper abdomen, but since it was not very severe, I thought it was caused by gallbladder stones and did not pay much attention to it. However, a week before the onset of this illness, I felt very severe pain in my upper abdomen and my eyes and skin had turned yellow. After examination in their affiliated hospital of Chinese medicine school, it was found that the gallbladder stones were larger than 2cm, and there were also multiple stones in the common bile duct, the largest being about 1.2cm, and the common bile duct was also significantly dilated. So, he went to our Minimally Invasive Center of the First Affiliated Hospital of Guangzhou Medical College to see Prof. Liu Yanmin for treatment. Professor Liu is one of the first experts in China to do cholecystectomy by laparoscopy, and is very famous in the line. Moreover, Prof. Liu and them can also cut the common bile duct open under laparoscopy and remove the common bile duct stones with a choledochoscope. The surgeries are all done very well. However, since the common bile duct is cut open, a T-tube needs to be placed in the common bile duct to drain it after the surgery, and it takes 1-2 weeks to remove the T-tube if it goes well. The cost of the operation was not much higher and the risk was lower, which was generally acceptable to the patients. However, at that time, our TCM professor was faced with the problem that his son was scheduled to get married next week and he could not possibly attend the wedding with a T-tube. Therefore, Prof. Liu approached me and wanted us to use a combined duodenoscopic and laparoscopic approach to remove the gallbladder at once with the laparoscope, while using retrograde cholangiopancreatography (ERCP) with the duodenoscope to remove the common bile duct stones retrograde from the intestine through the opening of the common bile duct with a reticulocyan. This will eliminate the need to incise the common bile duct during surgery and to leave a T-tube in the common bile duct, and if it goes well, the patient can be discharged on the third postoperative day. The combined duodenoscopic and laparoscopic treatment of gallbladder stones and common bile duct stones is not new and can be performed in many hospitals in China. However, since it is performed during laparoscopic gallbladder removal, the patient is lying down under anesthesia, while usually ERCP patients are in the left side, if ERCP choledocholithiasis is performed simultaneously with duodenoscopy, the requirements for the ERCP surgeon to enter the mirror are higher. But it is because the patient is under anesthesia when doing ERCP lithotripsy at the same time as laparoscopy, so the patient will not have any pain when doing duodenoscopic ERCP lithotripsy at this time. In fact, in the usual surgical options, the general recommendation is for the patient to have ERCP lithotripsy first and then laparoscopic gallbladder removal a few days later; the second option is also to have laparoscopic gallbladder removal first and then duodenoscopic ERCP choledocholithotripsy a few days later. Both of these options are quite normal and in line with medical routine. However, by doing so, the patient will endure the pain twice and the cost will increase. Dual-scope combination therapy would have obvious advantages. Since the combination of two scopes is beneficial for patients with gallbladder stones and common bile duct stones, why do doctors generally not choose to do so? This is because laparoscopy is usually performed by surgeons, while minimally invasive procedures such as duodenoscopic ERCP choledocholithiasis are usually performed by gastroenterologists. Doctors in the hospital have their own daily work schedule, and an operation like ERCP, for a gastroenterologist, may be scheduled at a certain time of the week and done with a few patients in an operating room with a radiology machine. The purpose of the radiology machine is to perform a cholangiogram during the ERCP to see how the common bile duct is doing and if the stones have been removed. It is not very easy to coordinate the time of the doctors of both departments if the two departments go together. It is not easy to coordinate the time of the doctors in both departments, and for the ERCP doctors in the gastroenterology department, it is obviously less efficient. Moreover, for this one patient, the nurse needs to push the endoscopy machine into the operating room, then set up the surgical endoscopy table, and move the radiology machine over, which is very troublesome, while the charge is still the same, no extra charge. Another point is that since all the imported disposable materials are used when doing ERCP, the cost of the procedure will increase (but the overall medical cost should be less), and some patients are not willing to choose this procedure for cost reasons, but will choose laparoscopic choledochotomy for stone extraction. As a doctor, you should choose a better treatment option for your patient. However, sometimes, due to various constraints, the choice is not the best one for the patient. This requires some effective reforms in the medical system, such as the endoscopy centers in foreign countries, where there are various endoscopes and medical surgeons are scheduled together to do these minimally invasive procedures. In terms of medical costs, the state should encourage doctors to give patients the choice of less invasive treatments at the expense of the state, and so on. These kinds of problems are not something that can be solved by us small doctors worrying about them. All we can provide is the best possible quality medical care within our capacity.