Gallbladder stones are a common and frequent disease that affects human health. The traditional treatment is to remove the gallbladder. However, medical science has facilitated many changes in treatment techniques and concepts over the centuries. As far as the concept of surgical treatment is concerned, we have gone from Resection, Repairment, to the recent era of Replacement. With the progress of basic medical research, it is expected that the concept of surgical treatment in the 21st century will shift to the fourth “R”, i.e., preservation of organs (Reserve). After unremitting efforts, our surgical scientists have come up with new techniques and theories of minimally invasive bile preservation. This innovation has brought good news to many gallbladder stone patients. Since the First National Endoscopic Gallstone Retrieval Symposium held in December 2007 in Guangzhou, minimally invasive gallstone retrieval with preservation of the gallbladder, as a new thinking and a new choice, has been favored by patients and gradually recognized by fellow biliary surgeons. After more than a decade of clinical research, minimally invasive biliary stone extraction is changing the traditional way of gallbladder removal for gallstones. In our clinical practice of minimally invasive biliary therapy for gallstone disease, we have also found more questions to ponder. Here we combine our own experience in minimally invasive cholecystectomy with the experience of our colleagues to discuss the relevant issues and perspectives. 1. Whether cholecystectomy is the gold standard for the treatment of gallstone disease 1.1: Reconsideration of cholecystectomy for gallstones in the light of medical progress and history of cholecystectomy: In 1882, German surgeon Langenbuch first performed open cholecystectomy for the treatment of cholecystitis caused by gallstones. In the 1980s, laparoscopy was introduced and used for the diagnosis of intra-abdominal diseases, and in 1987, Phillpe Mouret, an obstetrician and gynecologist in Lyon, France, performed the world’s first laparoscopic cholecystectomy. Since then, laparoscopic cholecystectomy (LC) has become the gold standard for the treatment of gallstone disease because it is less invasive, less painful, faster recovery and better aesthetic effect, and is accepted by the majority of patients. Since February 1991, laparoscopic cholecystectomy has been carried out in China, and laparoscopic cholecystectomy for gallbladder stones has become very common. Meanwhile, laparoscopic surgeons in China are constantly innovating to further optimize laparoscopic cholecystectomy. In terms of technique, LC has been reduced from four holes to three holes, two holes, or even a single hole for gallbladder removal. The combination of laparoscopy with choledochoscopy and duodenoscopy has expanded the surgeons’ treatment of gallbladder and bile duct stones, further developing the practical application of minimally invasive in the treatment of gallstone disease. Although minimally invasive techniques have greatly improved the quality of life of patients, the treatment concept is still the earliest “resection”. As with open cholecystectomy, laparoscopic cholecystectomy inevitably results in complications such as biliary tract injury. There are five major complications after cholecystectomy: 1) dyspepsia and reflux gastritis; as far as is known, the gallbladder has at least a storage, concentration and contraction function. It also has, of course, complex chemical and immunological functions. The gallbladder concentrates dilute hepatic bile 30 times, stores it in the gallbladder, and drains it into the intestine to participate in digestion when a high-fat diet is consumed. If the gallbladder is removed, the patient will no longer have high quality bile to help when eating a high-fat diet, and the body will often suffer from indigestion, bloating, and diarrhea. However, this symptom is often ignored by surgeons and pushed to the gastroenterology department, becoming a “persistent disease” difficult to treat in internal medicine. In addition, there are many reports on duodenogastric reflux (DGR) and gastric reflux after cholecystectomy in recent years. Clinical studies have found that all markers after cholecystectomy reflux toward the gastroesophagus and are accompanied by a significant decrease in lower esophageal sphincter tone, while DGR may be caused by the loss of bile reserve function after cholecystectomy, resulting in a continuous drainage of bile into the duodenum from intermittent excretion caused by feeding. Since bile is retained in the duodenal bulb for 24h, it is easy to flow back into the stomach to produce DGR. (2) The problem of bile duct injury caused by cholecystectomy; it is known that cholecystectomy has a certain rate of bile duct injury (0.18%-2.3%) and a certain rate of death, which is 5%-8% in the early stage and still 0.17% at present. Surgical injuries include: bile duct injury, hepatic duct injury, vascular injury, gastrointestinal injury, etc. Among the bile duct injury cases, 75% are caused by cholecystectomy. Since cholecystectomy is one of the most common surgical procedures, it is estimated that thousands of bile duct injuries will occur worldwide each year. Bile duct injuries have a certain mortality rate, so the risks associated with cholecystectomy are carefully calculated. Bile duct injury is not only a source of despair and suffering for patients, but also a “constant pain” for biliary surgeons. As surgeons, it is our duty to study the countermeasures. 3) The incidence of common bile duct stones increases after cholecystectomy; after cholecystectomy, the gallbladder loses its buffering effect on the fluid pressure in the common bile duct, resulting in higher pressure in the common bile duct, causing compensatory dilation, and thus the bile flow in the common bile duct swirls or eddies, which may be an important mechanism for the formation of common bile duct stones after cholecystectomy. 4) Gallbladder The effect of cholecystectomy on the incidence of colon cancer; clinical studies have found a phenomenon of association between colon cancer and cholecystectomy. Although the mechanism of this phenomenon is not clear, it is worth paying attention to whether the large increase in secondary bile acids after cholecystectomy has an effect on the colonic mucosa. 5) Post-cholecystectomy syndrome; cholecystectomy may lead to inflammation and dyskinesia of the sphincter of Oddi resulting in the so-called “post-operative syndrome”. This condition is very difficult to treat clinically. The above complications indicate that cholecystectomy should also be selected in order to avoid unnecessary side effects or complications. In other words, with the development of modern medicine and the emphasis on quality of life of patients, we should rethink the historical criteria of cholecystectomy for gallstones. In contrast, the conditions and realities of medical history 100 years ago were often such that patients only went to the hospital with gallbladder stones complicated by acute cholecystitis, or gallbladder cancer. It goes without saying that these conditions do necessitate the removal of the gallbladder to this day. However, medicine has made great progress in more than 130 years. In the case of gallstone disease, this is mainly reflected in advances in surgical techniques, early detection rates of gallstone disease, advances in health insurance and advances in the value patients place on their health. These advances have inevitably prompted us to revisit the gold standard of gallbladder removal for gallstones for more than 130 years. Whether and how asymptomatic gallbladder stones need to be treated is also a question worth pondering. There are two facts that we need to take seriously:1 Gallbladder stones may be asymptomatic or have only nonspecific epigastric discomfort when found on physical examination, but because they are impossible to eliminate, a significant proportion of patients will develop complications over time and with disease, such as cholangitis of biliary origin, acute cholecystitis, or even gallbladder cancer. We must then address head-on the simple question of whether, when and how to treat the patient. Must we not treat until complications occur? Must the gallbladder be removed even if there are asymptomatic gallbladder stones, or after there are complications? According to our experience and the results of the National Gallbladder Preservation Collaborative Group, the vast majority of patients (more than 90%) with asymptomatic gallbladder stones recover normal gallbladder function and remove the psychological burden of having stones after minimally invasive gallbladder stone extraction and appropriate preventive measures.2 Although a portion of gallbladder stones are asymptomatic, most patients are treated with long-term medication and follow-up observation and examination. The result is that gallbladder stones are not removed, but only much medical cost is consumed. From the point of view of health economics, the superiority of early minimally invasive gallbladder stone removal appears to be particularly obvious. Do these facts allow us to revisit the one-size-fits-all gallbladder stone treatment by cholecystectomy? 1.2. Reconsideration of cholecystectomy for gallstones from the progress of research on the causes of gallstones: It was previously believed that “cholecystectomy is not because the gallbladder contains stones, but because the gallbladder can grow stones”, which is the theory later called the hotbed doctrine, from which the theory was proposed that ” cholecystectomy should be performed for the treatment of gallbladder stones and polyps”. This gold standard surgical method has been followed for more than 100 years and seems to have an unshakable academic status. Mechanistic studies on the cause of gallstones have been confirmed, and the hotbed theory needs to be refined. As is well known, gallstones can be divided into three main categories according to their main components: cholesterol stones, biliary pigment stones and rare types of stones with mainly other components. With the improvement of living standard in China, cholesterol-based stones are the majority of gallbladder stones. And the main cause of gallbladder cholesterol stones is metabolic factors. We can consider that metabolic factors cause gallstones first of all by an alteration of the bile composition. This alteration is of hepatic origin and is sometimes referred to as hepatogenic stones. In other words, with such stones, the gallbladder is not a hotbed for stone growth, but a victim of metabolic abnormalities. Naturally, using the hotbed doctrine as a theoretical basis, removal of the gallbladder for treatment of such stones would be challenged. In normal gallbladder bile, bile salts, lecithin and cholesterol coexist in proportion to each other in a stable colloidal ionophore. In general, the ratio of cholesterol to bile salts is between 1:20 and 1:30. The precipitated cholesterol initiates the pathological process of nucleation, which eventually leads to the formation of stones visible to the naked eye. This nucleation mechanism is not fully understood. In late pregnancy and the elderly, cholesterol levels in the blood are significantly higher, making multiple pregnancies and the elderly susceptible to this disease. This is the reason for the high incidence of gallbladder cholesterol stones in individuals with metabolic syndrome. In addition, individuals with impaired liver function have a reduced secretion of bile acids and are prone to stone formation. Patients with congenital hemolysis can develop biliary stones due to the long-term destruction of a large number of red blood cells. In the treatment of gallbladder stones resulting from changes in the composition of bile secretion by the liver, we should consider whether they are different from stones caused by gallbladder factors. It is worth discussing whether it is worthwhile to remove the gallbladder to treat gallstones without removing the original factors. Biliary infection is an important factor in the formation of gallbladder stones, especially more than 100 years ago, which is truly consistent with the doctrine that the gallbladder is a hotbed of stone production. It is well documented that S. typhi, Streptococcus, Bacillus Weiss, Actinomyces, H. pylori, and even viruses have been cultured from the gallstone core. In addition to causing gallbladder inflammation, bacterial infections such as colonies and shed epithelial cells can become the core of stones, and the protein component of inflammatory exudate in the gallbladder can become the scaffold of stones. Likewise, even if the so-called “hotbed” of gallbladder is removed, the common bile duct stones may be inevitable after cholecystectomy if the infectious factors are not removed. Stagnation of bile, low bile pH, and vitamin A deficiency are also causes of stone formation. The dissolved components of bile become non-soluble due to some of the above mentioned reasons and form crystals or precipitate to precipitate and form stones. Therefore, we must analyze the causes of gallbladder stones comprehensively, treat them differently and provide individualized treatment, and not completely blame gallbladder stones on the gallbladder and leave everything alone. 1.3. Implications of cholecystectomy for patients with unresectable gallstones In the early years, in the process of cholecystectomy for gallbladder stones and cholecystitis, some patients used percutaneous cholecystectomy for stone drainage to relieve their condition because their systemic condition did not allow it, or the risk of surgical injury was too great due to unclear anatomical structures caused by gallbladder inflammation. Although there is a recurrence rate of up to 30% of stones, still about 70% of patients do not require further treatment. This indicates that the removal of gallbladder stones can treat a portion of the gallbladder stone disease. More than ten years ago, Zhang Baoshan was the first to propose the concept of minimally invasive gallbladder stone preservation treatment in the field, that is, to remove the stones and preserve the gallbladder, changing the traditional concept of gallbladder stone removal. The concept of gallbladder preservation is based on the development of laparoscopic and endoscopic technology, which is different from the traditional stone extraction method, and is operated under the direct vision of endoscope, with strong controllability and high stone extraction rate. According to the information of the National Gallbladder Preservation Collaborative Group, the effect of minimally invasive gallbladder stone extraction for gallbladder stones is excellent under the premise of stone extraction. 2.The problem of minimally invasive biliary stone extraction for gallbladder stones and individualized thinking: Biliary stone extraction for gallbladder stones has been favored by more and more surgeons. Huang Zhiqiang and Qiu Fazu, the senior members of our foreign scientific community, have given high praise to the concept of biliary stone extraction. Academician Huang Zhiqiang pointed out that “the new thinking of endoscopic biliary technology is a great event in the 21st century and a great event in China”. Qiu Fazu has clearly stated: “To protect the gallbladder”. Professor Ran Ruitu pointed out that “gallbladder stones originate from the liver, and the indications for cholecystectomy should be modified”. These views unified everyone’s thinking at an early stage and gave strong support for gallbladder stone extraction; at the same time, the patient’s strong desire to preserve the organ also provided the basis for gallbladder stone extraction. These objective and subjective factors have contributed to the rapid development of biliary lithotripsy. With the accumulation of experience and improvement of minimally invasive biliary preservation scholars for more than 10 years, the debate on biliary preservation and biliary excision has basically ended, and we are not going to repeat it here. Generally speaking, minimally invasive biliary preservation is safe and effective in the treatment of gallstone disease. For the time being, everyone recognizes biliary preservation as an option for the treatment of gallbladder disease. However, in the course of treating gallstones, near-term such as bile leakage, stone residuals, distant stone recurrence, and the development of gallbladder mucosal lesions are still affecting the effectiveness of biliary preservation and inevitably cause non-controversy among traditional surgeons. The mutual discussion of bile preservation and cholecystectomy really aims to face these problems head-on and thus improve the theory and practice of minimally invasive bile preservation for gallstone disease. As scholars who wish to carry out minimally invasive biliary preservation for the treatment of cholelithiasis, they should correctly understand the possible problems and seriously consider the indications for biliary preservation, the basic conditions for biliary preservation, and the technical points of biliary preservation. In order to better minimally invasive bile preservation work well, we should think about how to standardize the development. 2.1. The problem of surgical standardization One of the keys affecting the success of minimally invasive biliary preservation is the removal of net stones. For this reason, the necessary technical training is essential. According to our experience, standardized minimally invasive biliary preservation should include the following points: the hospital should have hardware equipment for condition laparoscopy and cholangioscopy. Surgeons should have the skills to use laparoscopy and cholangioscopy skillfully for diagnosis and treatment. In fact, there are still quite a few doctors who use the old-fashioned method of stone extraction, i.e., opening the gallbladder, removing the stones with tongs, and using hand touch to determine whether the stones are removed, which results in a higher recurrence rate of stones. In some hospitals, the level of personnel operating laparoscopy and cholangioscopy varies, resulting in inconsistent surgical results and affecting the treatment of biliary stone extraction. In order to protect the health of the majority of patients, the health department is currently developing guidelines to address these issues, including: ( 1) studying the admission mechanism, assessing and evaluating the conditions and personnel of each hospital that performs biliary surgery, and setting standards. Those who meet the criteria will be granted access; ( 2 ) Establishing technical requirements with consensus and establishing a training mechanism. Biliary preservation surgery requires that the operator must have the ability to perform open resection of the gallbladder, laparoscopic resection of the gallbladder and laparoscopic suturing, and be able to operate the choledochoscope skillfully. Training can be done in three steps: simulation box training, animal practice, and then clinical practice under the supervision of a supervising surgeon. The simulation box is so realistic that it is equivalent to the operating room operation, and the operation is gentle and accurate. The physical animal practice can make beginners aware of intraoperative bleeding and biliary fistula, train the operator’s clinical decision-making and response ability, and truly master the methods of handling them. Finally, through clinical training, the operator’s self-confidence in completing the surgery is enhanced, and the operator is familiar with the surgical steps to perform the surgery well. 2.2. Grasp of surgical indications As described above, not all gallbladders can be treated by biliary preservation methods. In order to minimize complications and recurrence rate, we have to think about what kind of patients are suitable for minimally invasive biliary preservation. It is generally accepted that the indications for biliary stone extraction are as follows: (1) good gallbladder function; (2) no or mild right upper abdominal pain and mild inflammation; (3) no more than 3 single or multiple stones. The reason for this is that the functional gallbladder can be preserved to concentrate the bile, and the gallbladder can contract after eating. For patients with more than 3 stones, the possibility of stone retention increases, so biliary preservation is not recommended for patients with multiple stones. However, with years of practice, the indications are expanding. Many surgeons, who are skilled in surgery, have started biliary preservation surgery for patients with multiple stones or filled stones with good results. Some authors have reported that 87 stones can be removed in a single operation with good postoperative gallbladder contraction. In patients with gallbladder stones complicated by common bile duct stones, preoperative ERCP followed by laparoscopic biliary preservation can be performed. With the growing popularity of hybrid operation theater, it will become a trend to use the combination of laparoscopy, choledochoscopy and gastroscopy to treat gallbladder stones and common bile duct stones. In patients with gallbladder duct obstruction due to embedded stones, some scholars have used lithotripter to remove the stones after lithotripsy, and successfully removed the stones to preserve the gallbladder. For gallbladder stones with poorly contracted gallbladder, biliary preservation therapy is controversial and is considered contraindicated in the absence of practical experience. However, Professor Liu Jingshan of Peking University has successfully treated some patients with dyskinetic gallbladder by intraoperative laparoscopic exploration, with bile flowing out of the gallbladder duct after removing the stones by releasing the adhesions, provided that the inflammation of the gallbladder is not severe. The indications for minimally invasive cholelithiasis treatment should also be based on the experience of the operator and the surgical conditions. Recently, the author successfully performed biliary preservation surgery on a patient with gallbladder stones combined with acute cholecystitis attack because the gallbladder edema was mild and there was no obvious chronic inflammatory hyperplasia. However, we believe that surgeons who perform minimally invasive biliary preservation in the early stage should still strictly control the indications to ensure the success rate and reduce the recurrence rate. In any case, there are several points that should always be grasped: extraction of stones, recovery of inflammatory lesions of the gallbladder, preservation of the functional gallbladder, non-neglect of contraindications, and proper postoperative prevention of stone recurrence. Only in this way can we bring benefits to the patient to a large extent. The third issue in the development of surgical techniques and methods is the issue of surgical methods, which includes two aspects: one is the surgical approach, and the other is the rational use of flexible and rigid mirrors. At present, the commonly used surgical methods are: ( 1 ) small incision, that is, a small incision of about 3-4 cm at the projection of the gallbladder body, the gallbladder is put out of the body, a small incision is made at the bottom of the gallbladder, a biliary mirror is put in, the stones are removed, the gallbladder is closed with absorbable sutures, and the abdomen is closed; ( 2 ) laparoscopic method, that is, the biliary preservation method under laparoscopic operation. We use laparoscopic minimally invasive biliary preservation method; ( 3 ) laparoscopic plus rigid choledochoscopic biliary stone extraction method. All three surgical approaches are minimally invasive procedures. There are advantages and disadvantages in the use of soft and rigid mirrors. The soft mirror is more curved and has a wider field of view, but is less effective for interstitial stones; the rigid mirror is more effective for interstitial stones, but cannot be folded back and has a limited field of view. If the two are used together, it will be more convenient for the operation. With the above mentioned points in mind, the surgeon can choose a procedure that suits his or her condition according to the conditions and techniques. In addition, most of the causes of bile leakage after minimally invasive bile preservation are technical. The most important one is due to poor laparoscopic suturing. In some cases, the main blood vessels supplying the incision are injured during the gallbladder incision or suturing, blocking the blood supply and causing poor healing of the gallbladder, resulting in bile leakage. It is best to avoid the transverse part of the gallbladder during cholecystotomy because the gallbladder artery can easily be misplaced during suturing, resulting in gallbladder necrosis. If bile leak is detected the gallbladder should be removed immediately by reoperation. Therefore, the standardization of technique will greatly reduce the complication rate. 3.Thinking about recurrence after bile stone extraction and countermeasures Recurrence of gallstone has been a major obstacle to the development of bile stone extraction. The recurrence rate of gallstones is 30% to 50% with the old method of biliary lithotripsy, while Zhang Baoshan et al. reported in 2009 that the recurrence rate was 3. 9% at 15 years in 577 cases of biliary surgery. It has been proved that the recurrence rate can be reduced to less than 10% after strict control of the indications and precise surgical operation. It has been shown that there are three main causes of recurrence of gallstones: first, missed stones due to incomplete removal of stones or interstitial stones; second, recurrence of gallbladder stones due to inability to preserve the gallbladder; and third, natural recurrence, i.e., recurrence in the true sense of the word after many years. As mentioned above, reducing recurrence is also one of the tasks that our minimally invasive bile preservation surgeons must face. First of all, we must carefully remove the stones intraoperatively and carefully master the indications for minimally invasive biliary preservation. For gallbladder stones that have led to irreversible chronic proliferative inflammation, we should carefully preserve the gallbladder so as to ensure the quality of minimally invasive biliary preservation. Regarding the issue of natural recurrence, we should have sufficient knowledge and deep understanding of the mechanism of gallstone genesis so that we can do a better job of stone prevention after minimally invasive biliary preservation. Please be sure to note that gallstone prevention education is one of the tasks of our cholelithiasis surgeons. Patients after gallstone preservation should pay attention to changes in lifestyle habits, such as changing the habit of skipping breakfast and eating a proper light diet. Postoperative treatment should be supplemented with cholestatic drugs and cholesterol-lowering drugs to reduce the recurrence rate to a greater extent. In cases of recurrence of gallstones after failure of the above countermeasures, we should carefully analyze the causes of recurrence in terms of the mechanism of gallstone genesis. Only on the basis of removing the causes of recurrence can we minimize the recurrence after minimally invasive bile preservation surgery. Among the many causes of recurrence, we should focus on recognizing the two most common causes, namely metabolic syndrome, and biliary outflow tract lesions. Epidemiological studies at Zhejiang University in China confirmed that patients with metabolic syndrome are five times more likely to develop gallstones than normal people, indicating that when treating metabolic syndrome combined with gallstones, measures to treat metabolic syndrome and prevent recurrence of gallstones must be given simultaneously after removing the stones. At the same time, when treating metabolic syndrome, if a large amount of lipids are excreted from the bile in a short period of time may change the composition of the bile and secondary gallstones may occur. Therefore, we must think about these issues in an integrated manner so as to maximize the prevention of gallstones or their recurrence. In the clinical practice of minimally invasive bile preservation, we also found that some of the stone recurrence is due to the abnormal alteration of the biliary fluid mechanics and does not lift. The clinical study by Professor Yang Yulong of Zhongshan Hospital of Dalian University in China found that many patients with refractory or recurrent gallstones were treated with ERCP examination with the presence of biliary outflow tract abnormalities. The main manifestation is inflammation or abnormality in the papillae, which causes stenosis and leads to a persistent increase in bile duct pressure to the extent that the pressure in the gallbladder increases secondary to poor bile excretion and stone formation. Their experience proves that this recurrence is not a failure of minimally invasive biliary preservation, but because the primary cause was not relieved. In such cases, the recurrence was able to be eliminated by ERCP treatment of the papillary lesion. These experiences prove from another side that recurrence of gallstones after minimally invasive biliary preservation cannot be blamed on the error of minimally invasive biliary preservation treatment strategy, but rather, the causes should be analyzed and thought about in terms of the mechanism of gallstone genesis to release the factors of recurrence. To sum up, practitioners of minimally invasive biliary preservation must carefully understand the mechanism of gallstone genesis and do a good job of comprehensive gallstone prevention and treatment along with minimally invasive biliary preservation. Only in this way can we greatly improve the success rate of minimally invasive biliary preservation and bring maximum benefits to the patients. 4. Prospect of minimally invasive biliary therapy for gallbladder diseases 4.1. Multicenter research on minimally invasive biliary therapy for gallstone disease: Over the past decade or so, China has made promising achievements in clinical research on minimally invasive biliary therapy for gallstone disease. As far as the current data are concerned, although the strategy of minimally invasive biliary therapy for gallstone disease has been recognized and agreed in terms of feasibility, effectiveness and risk, the research results are all single-center reports, and there is a lack of multicenter, prospective controlled studies with long-term follow-up. For this reason, it is difficult to publish papers on minimally invasive biliary therapy for gallstone disease in China in peer-reviewed, high-quality SCI journals. Therefore, in order to obtain convincing statistics from our world peers, we should carefully organize and design multicenter clinical studies on minimally invasive biliary therapy for cholelithiasis in accordance with international practice. We believe that in the near future, we will have experts leading such studies to promote the concept of minimally invasive biliary preservation for gallstone disease to the world. 4.2. Minimally invasive cholecystic polyp removal (Laparoscopic cholecystic polypectomy) for gallbladder polypoid lesions: There are at least three types of gallbladder polyps, namely pseudopolyps (usually cholesterol polyps), inflammatory polyps and true polyps. There is a consensus about the treatment of gallbladder polyps, which is determined by the size of the polyps. And the treatment is cholecystectomy. For the treatment of gallbladder polyps, we should likewise think about the treatment options according to its regression. Pseudopolyps and inflammatory polyps may initially just complain of right upper abdominal discomfort, but inflammation or polyp detachment leads to gallbladder stone formation before eventually giving birth to complications. True polyps naturally have the potential to become cancerous. Therefore, polypoid lesions of the gallbladder need to be treated. It is just a matter of thinking about when and how to treat them. The leader of our team, Prof. Hai Hu, advocated and carried out a clinical study on minimally invasive biliary polyp removal for gallbladder polyps. The preliminary results are very satisfactory. A more extensive clinical study is currently being done. Obviously, today, when minimally invasive biliary polyps removal i