The Hepatobiliary Department of Transplantation Center successfully treated a patient with cystic dilatation of intra- and extra-hepatic bile ducts combined with cholangitis and bile duct stones by using percutaneous transhepatic choledochoscopic plasma lithotripsy technology. This is the first case of treating intrahepatic bile duct stones with percutaneous transhepatic cholangioscopy technology in 309 Hospital, achieving a breakthrough of “zero” in percutaneous transhepatic cholangioscopy technology in our hospital. The patient was a 44-year-old male patient from the famous ancient city of Xingcheng, Liaoning. The patient was diagnosed with “congenital cystic dilatation of intra- and extra-hepatic bile ducts, acute cholangitis, and bile duct stones” in January 2000, with a large area of extremely dilated intrahepatic bile ducts with “braid-like” changes and multiple stones. Later, he underwent “bile-intestinal anastomosis” and recovered well. However, after discharge from the hospital, he still had intermittent right upper abdominal pain, often accompanied by chills, high fever, abdominal distension, nausea and other symptoms, and required hospitalization once or twice a month. The patient was extremely thin, with a height of 180 cm and a weight of only 52 kg. He was depressed and his quality of life was significantly reduced. For further treatment, the patient was admitted to our department as “congenital cystic dilatation of intra- and extra-hepatic bile ducts, post-biliary-intestinal anastomosis”. The imaging data showed that the patient had multiple cystic dilatation of the left and right hepatic ducts near the hepatoportal and distal parts, with a diameter of 26 mm (normal 3 mm or less), and a large number of stones, with a diameter of 23 mm and significant abnormal liver function and portal hypertension. Director Li Hucheng organized doctors Huang Hui, Wu Tiantian, Wang Ruiguan and Zhang Wei to carefully analyze the examination data and concluded that conventional biliary surgery could no longer effectively achieve the purpose of “relieving obstruction, removing lesions and unobstructed drainage”, and there was no point in operating again. The patient had a strong indication for liver transplantation, but due to the family’s financial constraints, the patient refused to undergo liver transplantation. If left to develop, it would inevitably lead to biliary tract infection and liver failure, ultimately taking the patient’s young life. How to find out a treatment plan that is less invasive, less expensive and repeatable for this patient’s specific situation, while not giving up the treatment, is a difficult problem in front of all the medical and nursing staff of the Third Department of Hepatobiliary Surgery. After thorough discussion and brewing, a new, bold treatment plan was created. It was a new technology that had never been applied in the history of 309 years – percutaneous transhepatic choledochoscopic plasma lithotripsy. Percutaneous transhepatic choledochoscopy is a minimally invasive endoscopic surgical technique that involves entering the intrahepatic bile duct through the skin and liver, similar to creating a tunnel between the mountains; then, after multiple dilation, the drainage opening is enlarged to 18F and a thick drainage tube is placed, similar to building a bridge between the intrahepatic bile duct and the outside world. Through this “tunnel” and “bridge”, the cholangioscope can enter and exit the intrahepatic bile duct freely and repeatedly, and then use the plasma generator to break up the stones and remove them through the sinusoidal or bile-intestinal drainage port. Due to its complexity, high technical content, high risk and susceptibility to complications, only a few large medical centers in the country have performed this technique. On April 13, 2011, the patient recovered well, with no abdominal pain, chills or fever, and no obvious stone residue on imaging, and was discharged with a tube in preparation for the next examination and treatment. The patient praised our minimally invasive technology and expressed her deep gratitude to the nursing team led by Nurse Manager Wang Liqin, and once again built up her confidence to overcome the disease. On August 13, 2011, the patient returned to our hospital for a follow-up examination, and no obvious stone remained on the imaging examination. During the patient’s discharge, he did not have any more symptoms such as abdominal pain, chills and fever, and basically returned to normal life. At this point, the first case of using percutaneous transhepatic biliary cholangioscopy technology to treat multiple bile duct stones in the liver in our hospital was a complete success. This marks that the Third Department of Hepatobiliary Medicine has mastered a new weapon and opened up a new way for inoperable complex hepatobiliary stones. The sequential treatment plan of percutaneous transhepatic puncture biliary drainage – percutaneous transhepatic biliary drainage sinusoidal dilatation – trans-sinusoidal choledochoscopic endobiliary lithotripsy and stone extraction is less invasive, less costly, easier to repeat and more effective, which is more acceptable to patients and makes valuable exploration and innovation in the clinical treatment of this disease.