The “new” biliary stone extraction procedure is based on the introduction of choledochoscopy. The previous cholecystectomy procedure was only to remove the stones and preserve the gallbladder ducts, and the recurrence rate of stones was higher after surgery. The “new” biliary lithotomy emphasizes the need to remove the stones and preserve the functional gallbladder, and has extremely strict surgical indications. Traditional cholecystectomy is one of the main methods to treat gallbladder stones, and the introduction of laparoscopic cholecystectomy has won the crown of “gold standard” of gallbladder stone treatment. More and more well-functioning gallbladders are disappearing from the human body at the instigation of laparoscopic surgeons, who offer painless, less invasive and faster recovery. What follows is a long history of indigestion, abdominal pain, bloating, diarrhea, and other digestive symptoms, for which surgeons and outpatient surgeons are often at their wits’ end, giving patients explanations that do not make sense. It is also believed that cholecystectomy not only exposes the patient to the possibility of bile duct damage but also increases the incidence of postoperative chronic colitis and colon cancer. This is also true in the Chinese population, where hypertonicity of the sphincter of Oddi can also predispose to the development of gallbladder stones. The above has led more and more doctors to question the “gold standard” of cholecystectomy as a treatment for gallbladder stones. However, the Langenbuch theory, which has ruled surgeons for more than 100 years, is deeply rooted: “Gallbladder removal is not due to the presence of stones in the gallbladder, but to the production of stones in the gallbladder itself” has influenced several generations of surgeons. In the late last century, along with the rapid development of modern high technology and the introduction of various medical biliary scopes, the disadvantages of gallbladder removal were put in front of the doctors. Surgeons are no longer satisfied with just a doctor who can remove the organs, but also emphasize the establishment of the concept of functional surgery. So the new thinking of “remove the stones and preserve the function of gallbladder” is accepted by more and more surgeons and patients. The difference between “new” biliary stone extraction and old biliary stone extraction “new” biliary stone extraction and old biliary stone extraction have essential differences. The “new” biliary lithotripsy emphasizes the preservation of a functional gallbladder based on the removal of stones. In 1867, Bobbos performed the first case of gallbladder dissection to remove stones, which started the prelude of the old biliary stone extraction, but it was abandoned by surgeons due to the high recurrence rate of stones after surgery, as well as the high rate of trauma, complicated surgery and infection. The “new” biliary stone extraction is done with the help of high-tech products such as fiberoptic choledochoscope, biliary rigidoscope and other related equipment, a small incision of 2~3cm is made under the right rib to enter the abdominal cavity, and the gallbladder stones are removed under the direct view of the choledochoscope with a high extraction rate, little trauma and fast recovery, which preserves the gallbladder and removes the stones. In 2009, someone reported that the recurrence rate of gallbladder stones was 0.49% at 1 year, 4.39% at 2 years, 5.83% at 3 years, 6.60% at 5 years, 7.21% at 7 years, 8.38% at 9 years, and 8.38% at 10 and 15 years after the operation. The 10-year and 15-year recurrence rates were both 10.11%. It is believed that the “new” biliary stone extraction has good therapeutic effect on patients with functional gallbladder stones, avoids the defects of “blind stone extraction” of the old biliary stone extraction, reduces the recurrence rate of postoperative stones, preserves the functional gallbladder, and improves the survival quality of patients. In recent years, the successful use of laparoscopy in the “new” biliary stone retrieval has given the new concept of minimally invasive and safe operation. How to determine whether the gallbladder is functional or not Whether the gallbladder is functional or not is the first problem faced by the “new” biliary stone extraction. To determine whether the gallbladder is functional or not, ultrasound, ECT and gallbladder contraction rate should be performed. Generally speaking, ultrasound indicates that the wall thickness of the gallbladder is >4mm, ECT examination shows a good image of the gallbladder, and the measurement of the contraction rate of the gallbladder is 20-30%, which indicates that the gallbladder has contraction and concentration function. Measurement of gallbladder contraction rate: The gallbladder volume was calculated according to the following formula: gallbladder volume = p/6×L×W×D (L: long diameter of gallbladder; W: transverse diameter; D: anterior and posterior diameter) after fasting and 30, 60, 90 and 120 min after a fatty meal (2 fried eggs). The maximum contraction rate of the gallbladder (%) = (1 – residual volume of the gallbladder / fasting volume) × 100%, which is the contraction rate of the gallbladder (E). e ≥ 30%, is an important indicator to determine the contractile function of the gallbladder. The laparoscopic assessment of the physiological status of the gallbladder is a good way to determine the contractile function of the gallbladder from the morphological point of view. Indications and contraindications of “new” gallbladder stone removal The main purpose of “new” gallbladder stone removal is to remove the stones and preserve the functional gallbladder, but not all gallbladder stones can be preserved. Removal of the functional gallbladder is not in accordance with the modern view of functional surgery. Proper selection of surgical indications can significantly reduce postoperative complications, especially the recurrence rate of stones. Inappropriate selection of cases and blind pursuit of gallbladder stone preservation will make the treatment of gallbladder stones not work as desired. Therefore, the indications and contraindications for surgery should be strictly controlled. Similarly, there are strict indications and contraindications for laparoscopic-assisted choledochoscopic biliary stone extraction. Indications: (1) Under 50 years of age, with a diagnosis of gallbladder stones confirmed by ultrasound or other imaging studies, without combined bile duct stones. (2) Negative gallbladder fat meal test, normal gallbladder function (gallbladder wall thickness << span="">4 mm, good gallbladder visualization by ECT, gallbladder E ≥ 30%) or good gallbladder physiological status under laparoscopy. (3) Those who are asymptomatic or have mild symptoms. (4)Those who have strong intention to preserve gallbladder and refuse cholecystectomy. (5)Those who can tolerate anesthesia and surgery without serious medical diseases. (6) Those who do not have serious impairment of liver function and coagulation dysfunction. Among them, (2) is a necessary condition for biliary stone extraction. Contraindications: (1)Gallbladder atrophy, significant thickening of the gallbladder wall >5mm or disappearance of the gallbladder cavity. (2) Gallbladder stones induced acute cholecystitis, gallbladder gangrene, acute pancreatitis or other serious complications. (3) Gallbladder stones complicated by polyp augmentation-like changes or suspected gallbladder cancer. (4) Malfunction of gallbladder contraction. (5) Complete obstruction of the gallbladder duct. (6) Intrahepatic gallbladder cannot be raised intraoperatively. (7) Gallbladder stones with bile duct stones. (1) Repeated clamping and traction of the gallbladder should not be used during surgery to avoid damage to the gallbladder wall, which may affect the recovery of gallbladder function after surgery and even induce acute cholecystitis, and moderate force should be used when tracting the gallbladder to avoid tearing the gallbladder bed and causing bleeding. (2) Two traction lines need to be sutured symmetrically at both ends of the incision at the bottom of the gallbladder. Do not use violence when adjusting the position of the gallbladder in the traction line to prevent the leads from tearing off the gallbladder wall, retracting the gallbladder, and bile flowing into the abdominal cavity, causing cholestatic peritonitis. (3) The lithotripsy process is only allowed to use fiberoptic choledochoscopic lithotripsy mesh to remove stones and adsorbers to aspirate them, without using surgical instruments to enter the gallbladder to retrieve stones or cooperate with lithotripsy, and after the stones are removed, the bile must be observed to gush into the gallbladder at the opening of the cystic duct. (4) If biliary mud is found on the mucosal surface of the gallbladder, the gallbladder wall can be cleaned with saline after brushing with a choledochoscope cytoscope. (5) No fistula is left in the gallbladder, and the gallbladder incision is closed with absorbable thread in one stage. (6) If any accidental damage to the gallbladder occurs during the intraoperative operation, immediate intermediate transfer for LC or OC is required.