With the advances in laparoscopic surgery technology and improved instrumentation in recent years, there are almost no gallbladders that cannot be removed laparoscopically anymore. However, there are some cases in which laparoscopic operation of the gallbladder is more difficult and still requires a more specialized surgeon. The first condition is patients with portal hypertension, such patients have cirrhosis and portal hypertension, and their risk factor is varices around the common bile duct, which may lead to hemorrhage if one is not careful, so the general location of the cut of the bile duct in such patients should be close to the abdomen of the gallbladder jug, and the structure should be divided during surgery. The second condition is patients with internal fistula, usually recurrent patients, where the gallbladder will produce internal channels with the common bile duct, stomach, duodenum, and colon. In such patients, care should be taken to avoid damaging the corresponding tissues during surgery, and the common bile duct or gastrointestinal tract should be securely sutured after removal of the gallbladder. The third condition is patients with severe intra-abdominal adhesions. These patients often have a history of upper abdominal surgery, especially those with poor recovery from surgery, fistulas or infections, and special care should be taken to avoid damaging the adherent intestinal tissues. The fourth case is patients with residual gallbladder. Generally, the first time the gallbladder is not removed from the pot belly indicates that the inflammation was very severe, so these patients should have very localized adhesions on the liver surface, and special care should be taken not to damage the structures within the hepatoduodenal ligament. The fifth case is patients with atrophic cholecystitis, which is generally not too difficult to operate on, but it is common to see scarring at the gallbladder triangle, which is locally dense, so beware of damaging the common bile duct. The sixth condition is acute cholecystitis, when the emergency attacks, often local inflammation is heavy, in fact, the surgery is not very difficult because the structure is still relatively clear after edema. However, in some patients, because of long-term chronic inflammation, the local fibrous tissue is dense, so we have to beware of damage, and also at this time the gallbladder is congested and prone to blood loss, so we need to operate step by step and slowly. Of course, there are still a very few patients who cannot be removed by laparoscopy, and then open surgery is still needed.