In foreign countries, cholecystectomy occupies a dominant position, and biliary stone retrieval surgery is not recognized because of the high recurrence rate after surgery. With the development of endoscopic biliary stone extraction technology, more and more hospitals in China are carrying out biliary surgery. With the improvement and maturity of biliary surgery technology, the application will become more and more widespread, and new minimally invasive biliary research will gain the support of many doctors and patients, but there are still several issues that deserve in-depth consideration. The feasibility of biliary preservation for stone extraction is highly controversial domestically, but it is generally agreed that the indications should be strictly controlled and abuse should be avoided in order for patients to benefit. Most of the reports seen in China have not been followed for a long time, and the number of cases counted is not enough. The results of clinical randomized grouped controlled trials with multicenter bulk cases and clinical research results with strict follow-up of 5 to 10 years or longer are urgently needed to provide more adequate clinical evidence and operational guidelines for the feasibility of biliary stone removal. Rationale for gallbladder removal: 1. The hotbed doctrine: “Gallbladder removal is necessary not only because it contains stones, but also because it can grow stones. 2. Gallbladders with previous stones, polyps, or inflammation have the potential for cancer, although the rate of cancer is low. 3. Limited techniques for gallbladder preservation and extraction, and high recurrence rates after surgery. Reasons for gallbladder preservation surgery: 1. Treating gallbladder disease while preserving organs and functions is the ultimate goal of biliary surgical treatment and is the common desire of doctors and patients. 2. There is a fundamental difference between the new style and the old style of gallbladder preservation and stone extraction. The endoscope allows direct visualization of the entire mucosa in the gallbladder cavity and the use of lithotripsy instruments to remove stones and polyps, reducing the residual rate.3. Strictly grasp the indications for biliary preservation surgery, with good long-term results. The advantages of gallbladder removal: 1. the gallbladder stones or polyp-like lesions are removed; 2. the hotbed of gallbladder is removed and no more gallbladder stones or polyps will grow; 3. the problem is solved once and for all, i.e., the problem is solved once and there is no worry of gallbladder cancer in the future. The advantages of gallbladder preservation surgery are: 1. the importance of the function of the gallbladder, the role of the gallbladder, and the preservation of the gallbladder’s existence; 2. the new type of gallbladder removal surgery, with a significantly lower recurrence rate 5 years after surgery; 3. the maintenance of normal physiological balance, restoring a true level of health (rather than subhealth). The disadvantages of gallbladder removal are: 1. the problem of medical bile duct injury has not been completely avoided; 2. changes in enterohepatic circulation of bile and lipid metabolism; and 3. the possibility of postoperative dyspepsia. The disadvantages of gallbladder preservation surgery are: 1. The old biliary lithotripsy cannot see the whole situation in the gallbladder, and the stones are removed with a lithotripter, so it is not guaranteed to be complete, resulting in a recurrence rate of 30% to 40% in 5 years. 2. At present, there are problems with gallbladder preservation: 1. The traditional concept that the gallbladder is a dispensable organ, ignoring the important functions of the gallbladder in digestion, metabolism and immunity. 2. “3. The indications for cholecystectomy have been expanded. In cases of filled gallbladder stones, Mirriz syndrome, gallbladder atrophy, gallbladder tumor polyp and suspected cancer, there are still reports of active biliary surgery applications. 4. The cause of gallstones is not clear, the prevention effect is poor, and the preserved gallbladder, like the normal gallbladder, still has the possibility of growing gallstones and polyps, i.e., distant recurrence. Because the short-term recurrence rate of gallbladder stones in traditional gallbladder stone extraction surgery is as high as 30%-50%, and even up to 70% has been reported, so it is not accepted. At present, with the improvement of biliary stone retrieval technology, the recurrence rate of gallbladder stones after endoscopic minimally invasive biliary stone retrieval has been significantly reduced. The recurrence rate of stones has been reported to be reduced to 1.99%-2.95% after 8-10 years of follow-up. Currently, the feasibility of biliary stone extraction is highly controversial. It is generally accepted that strict indications are needed for biliary stone extraction. The indications for biliary stone extraction are: (1) the morphology and function of the gallbladder are similar to those of normal subjects as confirmed by ultrasound or CT, the thickness of the gallbladder wall does not exceed 2 mm, the fasting volume of the gallbladder does not increase, and the gallbladder shrinks ≥ 30% after a fatty meal; (2) the fasting and postprandial plasma CCK levels are similar to those of normal subjects; (3) the intraoperative choledochoscopy shows that the cystic duct is patent, and there are no obvious adhesions around the gallbladder on laparoscopic examination; (4) childhood gallbladder stones; (5) patients with poor general condition who cannot tolerate cholecystectomy. Contraindications for biliary stone extraction: (1) loss of functional atrophy of the gallbladder, excessive thickening of the gallbladder wall, and loss of the gallbladder luminal space (filled stones); (2) stones in the gallbladder duct that cannot be removed; (3) obstruction confirmed by intraoperative imaging of the gallbladder duct; (4) combined with common bile duct stones; (5) severe adhesions around the gallbladder; (6) gallbladder perforation; (7) malignant tendency of the gallbladder. However, the most controversial issue is whether this group of patients suitable for bile stone extraction really needs surgery.