Percutaneous nephrolithotomy (PCNL) is a procedure that uses advanced imaging, intracavitary techniques and various lithotripsy devices to treat upper urinary tract stones, and has replaced open surgery as the procedure of choice for larger, complex kidney stones and upper ureteral stones with high removal rates and rapid postoperative recovery. The technique of puncture and channel establishment is crucial, as traditional puncture requires multiple channel expansions, which can easily cause bleeding and channel loss. Based on the summary of previous techniques, our department innovatively proposed the one-step dilatation method to establish the surgical channel, which greatly shortens the operation time and related complications, and the related techniques are being promoted to other units. After the successful establishment of the channel, we have a variety of lithotripsy means, such as pneumatic ballistic lithotripsy, ultrasonic lithotripsy, laser lithotripsy, etc., which fully ensure the efficiency of lithotripsy and improve the safety of lithotripsy. We also combine ultrasound and intraoperative X-ray to improve stone removal rate. The common complications of PCNL are: intraoperative and postoperative bleeding, postoperative infection or even infectious shock, and stone residue, so avoiding these complications to the maximum extent possible is the key to the success of the operation. In the next article I will talk to you about stone prevention.