Sanlu milk powder made the whole nation experience the horror of kidney stones once. In fact, kidney stones are a very old disease, and the procedure of lithotripsy has been recorded since the time of Hippocrates. The term “lithotomy position”, which is commonly used in clinical practice, is derived from the ancient Greek position for intercepting urinary stones. For large kidney stones, conservative treatment is not effective. In the past, most of them were removed by open surgery, but the surgery caused more trauma to the patient, especially some complex kidney stones, which are not easy to be removed at one time, and the recurrence rate is high, and repeated stone removal is difficult, and there is even a risk of kidney failure and kidney loss. Due to the widespread development of endovenous urology and extracorporeal shock wave lithotripsy (ESWL) technology, most upper urinary tract stones no longer require open surgery. In recent years, with the development of minimally invasive techniques, percutaneous nephrolithotomy (PCNL) has become the first treatment for many complex kidney stones (deerstalker, cast) in clinical practice because of its many advantages such as less trauma, faster time, safety, high efficiency, quick recovery, and wide indications. Minimally invasive technology has greatly reduced the public’s fear of surgery. PCNL is performed through a fine needle puncture in the lumbar back directly to the renal calyces or the renal hilum, dilates and establishes a channel from the skin to the kidney, inserts a minimally invasive nephroscope, and removes or fragments the stone under direct vision. For larger stones that cannot be removed directly, the stone should be crushed. Currently applied lithotripsy devices include ballistic lithotripsy, holmium laser, ballistic plus ultrasound, dual-catheter ultrasound, dual-frequency dual-pulse, and liquid electricity. Due to the complex stone distribution and anatomical variation of the renal pelvis (disjointed halls and rooms, small halls and large rooms, large halls and small rooms), multichannel puncture is sometimes required to remove stones. The puncture site can be selected from the upper, middle and lower channels, and the surgical position is divided into prone and lateral, each as desired. Intraoperative precautions: puncture should be superficial rather than deep, stopping the operation if thick fluid comes out, not too much perfusion pressure, not too long perfusion time, and avoiding channel loss as much as possible. Surgical complications: pneumothorax (closed drainage), large vessel injury of visceral intestine (timely detection and treatment), bleeding (DSA embolization if necessary), urogenital sepsis (preoperative routine urine culture), etc. PCNL is in line with the development direction of modern minimally invasive urology and is an important tool in modern surgical treatment of stones. With strict training, high attention to intra-operative and post-operative complications, timely detection and correct treatment, the operation is generally safe and reliable and will be popularized in minimally invasive surgery. P.S. Specially introduce Holmium laser: comprehensive and practical lithotripsy tool; ureteral rigid and flexible scopes as well as percutaneous nephroscopy, laparoscopy, choledochoscopy and duodenoscopy are applicable; unique comprehensive performance (adequate lithotripsy, cutting soft tissue, coagulation and hemostasis). The Department of Urology of Shanghai Renji Hospital is the first one to carry out this technology in Shanghai area, and has already recovered thousands of cases with good results.