A 64-year-old mother-in-law was found to have “gallbladder stones” during a medical checkup at a local hospital a month ago. The old woman usually had intermittent abdominal pain, with vague or distending pain in the upper abdomen, which was not too serious and did not affect her daily work and life much. The abdominal pain was diffuse, without nausea and vomiting, without chills and fever, without panic and chest tightness, without diarrhea. After the pain attack, it often relieves on its own, so she usually did not do any examination or treatment at home. The physician told her that “you have large gallstones and need to have surgery in time”! My mother-in-law also felt that it was not a good thing to have abdominal pain all the time, and it would be good to solve the problem early, so she discussed it with her family, who also supported it. If we delay further, we will be older and the risk of surgery will be higher. After some preparation, the mother-in-law was admitted to the hospital. A CT examination was done and this gallbladder stone was indeed quite large. Figure 1: The image in the red marked area is a gallbladder stone As shown in Figure 1, perhaps this stone has been there for so long and grown for so long that it has grown into the exact same shape as the gallbladder, or rather, it has slowly filled up the entire gallbladder! And it has also enlarged the gallbladder, this gallbladder is more than twice the size of a normal gallbladder. So, can this gallstone be operated laparoscopically and minimally invasive? During the regular preoperative discussion within the department, everyone discussed fully and expressed their own opinions. Some thought that the stones were too large and might not be removed successfully, while others thought that there was still a chance to complete the surgery successfully. The final opinion was that the patient’s needs were the driving force behind our pursuit of technical heights! The decision was made to perform a laparoscopic cholecystectomy. The operation started as scheduled. During the operation, the operating team overcame one technical problem after another and finally removed the gallbladder stones intact without any problems. Figure 3: Comparison of the stone removed by laparoscopic surgery Figure 2 shows this gallstone with a 22 cm length vascular clamp. The surface of the stone was ground smooth and shiny. The incidence of gallbladder stones is not low in the general population. Usually, some people have symptoms and some people have no symptoms. Many people are found when they have a physical examination. Laparoscopic cholecystectomy is the gold standard for surgical treatment of gallbladder stones, but not all gallbladder stones are suitable for minimally invasive laparoscopic surgery. Not if the stones are too large, not if the stones are too small; not if there have been multiple abdominal surgeries, not if the gallbladder is atrophied, not if the gallbladder is acutely inflamed and gangrenous, not if the gallstone has formed an internal fistula, etc. Therefore, if you have gallbladder stones, whether you can do laparoscopic minimally invasive surgery or not, you should listen carefully to the specialist’s advice, evaluate accurately and standardize the treatment.