Gallbladder stones are a common disease. Since the introduction of laparoscopic cholecystectomy, it has gradually replaced all other treatment methods and is considered the gold standard for gallbladder stone treatment because of its minimally invasive nature, few complications, broad indications, clear efficacy and absence of gallbladder stone recurrence, but is the gallbladder really all that can be done? 1.The problems brought by gallbladder removal According to the statistics of large number of cases, the rate of vascular injury in laparoscopic cholecystectomy is 0.2%, the incidence of bile duct injury is 0.2%~0.8%, and the incidence of intestinal duct injury is 0.07%~0.87%. In addition, after cholecystectomy, patients lose the function of concentrating, storing and discharging bile from the gallbladder, resulting in the inability of the body to provide sufficient bile when eating high-fat and high-protein foods, which increases the incidence of dyspepsia, bloating and diarrhea, and the incidence of common bile duct stones. Therefore, laparoscopic cholecystectomy becomes the gold standard of gallbladder stone treatment only relatively, and is by no means the only method applicable to all patients. 2. The aging population affects the decision to treat gallbladder stones. But as the population ages, people are living longer and the chances of developing the disease have increased. We have found that many patients with asymptomatic gallbladder stones, which are often considered untreatable, develop them at an advanced age, when they are often life-threatening because most of them have comorbidities such as hypertension, coronary heart disease, cerebrovascular disease, and diabetes. This requires early intervention and secondary prevention of gallbladder stones, i.e., effective management of asymptomatic gallbladder stones to prevent complications or further stone enlargement. In other words, we need to expand the indications and scope of surgical intervention for gallbladder stones. 3.Biliary excision or gallbladder preservation? One thing is certain: the gallbladder is not a dispensable object, and there should be a place for gallbladder preservation and stone extraction. Who is suitable for gallbladder preservation? Gallbladder stones with normal gallbladder function, asymptomatic or mildly symptomatic gallbladder stones can be eliminated without removing the gallbladder. The occurrence of gallbladder stones in childhood is mostly related to congenital metabolic diseases, blood diseases and other factors, and has little to do with the gallbladder itself, so gallbladder preservation surgery should be preferred. Fourthly, in elderly patients, because of the decline of systemic organ function and more coexisting diseases, the risk of surgery is high, so minimally invasive biliary stone extraction should be adopted as much as possible. 4. The new type of biliary lithotripsy is less traumatic and more thorough. Traditional biliary lithotripsy is to open the gallbladder and remove the stones blindly with lithotripters, which may also fragment the stones or damage the gallbladder wall. As a result, it is difficult to remove the stones in this procedure, and the stones may remain and be mistaken for recurrent stones. This procedure is called blind stone extraction, which is like a blind man feeling an elephant. Nowadays, laparoscopic combined with endoscopic minimally invasive choledocholithotomy is called the new type of choledocholithotomy. The combination of laparoscopy and cholangioscopy in biliary lithotripsy surgery is a perfect match. The combination of laparoscopy and cholangioscopy in biliary lithotripsy is a perfect combination of the advantages of biliary lithotripsy and bile duct extraction. In recent years, we have completed dozens of cases of biliary lithotripsy and biliary polypectomy using this combined technique without bile leakage, stone residue and intraoperative and postoperative complications. 5.Biliary preservation and biliary excision are not challenges but complementary. At present, the reason for the debate on whether to treat gallbladder stones with bile preservation or gallbladder removal is that neither side can produce newer, high-quality evidence-based medical evidence. Studies on the complications of cholecystectomy surgery are often limited to recent surgical complications such as bleeding, bile leak, bile duct injury and intestinal injury, while epidemiological surveys of the post-cholecystectomy population are lacking to clarify the incidence of, for example, common bile duct stones, reflux esophagitis and colon cancer to determine whether and how harmful the removal of the gallbladder really is. The efficacy of endoscopic biliary lithotripsy lacks the corroboration of high-quality randomized controlled trials. However, we should focus more on the perfect combination of preserving gallbladder function and treating gallbladder stones in our treatment selection. We should neither use data from more than 10 years ago to argue against today’s view of newer biliary stone preservation supported by minimally invasive endoscopic technical conditions, nor use retrospective studies to prove the superiority of biliary stone preservation. We need to conduct in-depth studies on the mechanisms of gallbladder stone formation, especially the role of the gallbladder in gallbladder stone formation. We oppose the blind removal of a functioning gallbladder and the blind gallbladder preservation for stone extraction regardless of the circumstances. The two are not competing challenges, but rather a golden combination that complements each other in the staged treatment of different diseases, which doctors and patients can explore carefully to find a more personalized and scientifically rational treatment plan.