Cheng is 80 years old and has been operated on four times in the past 16 years for severe pancreatitis, abdominal abscess, gallbladder stones and bile duct stones, with multiple incision scars in the abdomen, and the last operation 4 years ago took more than 3 hours due to severe abdominal adhesions. Cheng has high blood pressure, coronary heart disease, diabetes and other diseases. Bile duct stones were found again a year ago, and acute cholangitis occurred intermittently seven times over the past year. He was admitted to our hospital a week ago with chills, fever, and yellow sclera of the skin again. In consideration of the patient’s general and abdominal conditions, it was decided to treat him with PTCS protocol, firstly, percutaneous hepatic puncture bile duct placement under X-ray fluoroscopy, and then choledochoscopic stone extraction after dilation. Percutaneoustranshepatic cholangioscopy, PTCS for short, is a minimally invasive procedure for intrahepatic cholangiolithiasis, especially for postoperative residual and recurrent intrahepatic cholangiolithiasis, complex cholangiolithiasis, and their associated biliary strictures and obstructive jaundice. PTCS is a parabolic procedure that allows for multiple treatment objectives of stone removal, bile duct drainage, and biliary stricture relief under direct choledochoscopic vision. A percutaneous transhepatic choledochotomy and drainage (PTCD) is first performed under ultrasound guidance or x-ray fluoroscopy, and the sinus tract is gradually dilated in stages, and the stone is retrieved through this sinus tract using a choledochoscope. Since this method does not require opening the abdomen, is less invasive and easily tolerated by the patient, and the procedure is based only on PTCD to dilate the sinusoids (usually the left hepatic puncture is chosen) and has less impact on respiratory movements, it has a high success rate and few comorbidities. Except for intrahepatic branches that are too angled or biliary tracts that are too narrow for the bile ductoscope to pass through, left and right hepatic duct stones can be removed through this route. Bile duct stones larger than the sinusoidal aperture can also be fragmented and then removed by extracorporeal shock wave lithotripsy, liquid electrolysis, laser lithotripsy and mechanical lithotripsy. The advantage of the PTCS technique is that it allows for the creation of a manual access to the biliary tract to complete the diagnosis and treatment when natural access (transoral) or surgical access (intraoperative or postoperative) to the biliary system is not possible.