1. The logic of bile cutting The historical roots of the logic of bile cutting go back to the pre-Langenbuch era. Due to poor diagnostic techniques, gallbladder stones were only detected when they caused complications and were often fatal, with a very high mortality rate. Without efficient antimicrobial drugs and without the technology and conditions to deal with secondary endo-environmental disturbances, the removal of the diseased gallbladder was clearly the only possible effective means to save the patient’s life. It was against this background that Dr. Langenbuch in Germany invented the cholecystectomy, which was a landmark in the history of surgery. Although death still occurred under the conditions of the time, it was clearly a huge improvement over the previous practice of sitting on the sidelines, and later, as overall medicine continued to advance, the procedure was refined and its results improved, and it naturally became the “gold standard” for the treatment of gallbladder stones. The logic of treating gallbladder stones at this time was simple: because the gallbladder produced stones, which in turn destroyed the gallbladder and endangered lives, removal was the only option. Later, with the advent of technology, new diagnostic tools, especially B-mode ultrasound instruments, made it possible for doctors to detect stones at or before the onset of clinical symptoms of gallbladder stones. This method of detection offers the possibility of analyzing the epidemiology and natural evolution of gallbladder stone disease because it is accurate, rapid, non-invasive, simple to perform and repeated many times. The results of a 15-year follow-up found that only 20% of patients with gallbladder stones were symptomatic and 80% could be asymptomatic for life [1]. Therefore, the idea that asymptomatic stones do not require treatment has been proposed and accepted by a very large majority of scholars. However, for symptomatic stones, gallbladder removal is still advocated because there is no proven non-surgical treatment. The logic at this point is that the gallbladder should be removed not only because of the stones in the gallbladder, but because the gallbladder is the “soil” where the stones are produced. This is the “hotbed doctrine” pointed out by the famous scholar Prof. Zhang Baoshan. 2, the error of the logic of cutting gallbladder The logic of cutting gallbladder is based on the following premises: (1) the gallbladder is dispensable or has no value for short-term existence; (2) the gallbladder must be cut; (3) it is absolutely safe to remove the gallbladder; (4) gallbladder stones are bound to recur after removal. The first one is obviously wrong, humans have not “revolutionized” the gallbladder after tens of thousands of years of evolution, which naturally indicates its existence value. With the development of modern medical science and technology, there is a better understanding of the gallbladder as an important digestive organ, which is a complex organ with chemical and immunological functions, in addition to the role of concentration, contraction and regulation of buffering bile duct pressure. The second rule only holds if the gallbladder is suspected to be cancerous or has become cancerous, the gallbladder has lost function, and complications have occurred, so most gallbladder stones do not have to be cut. Cholecystectomy is not absolutely safe. Injury to the common bile duct in laparoscopic cholecystectomy is a very serious complication, amounting to 1% .In 1992 Morgensten et al. reported a mortality rate of 1.8% for caesarean cholecystectomy, all in patients older than 66 years of age. When choledochotomy is necessary, the mortality rate increases threefold. The situation is similar with laparoscopic cholecystectomy. Stone recurrence after stone extraction is not inevitable. The recurrence rate of stones at 15-year follow-up has been shown to be 2-7% with the newer biliary stone extraction method. If, gallbladder stones = gallbladder + stones; then, gallbladder stones – stones = gallbladder. But the logic of the blind gallbladder cutter is: if, gallbladder stones = gallbladder + stones; then, gallbladder stones – stones = gallbladder stones, in other words, once the gallbladder has stones, even if the stones are removed, the stones are bound to recur. In other words, once the gallbladder has stones, even if the stones are removed, they are bound to recur, unless they are guaranteed never to recur. There is no doubt that this is an extremely wrong viewpoint. Even if one considers a person as a machine and the gallbladder as a component, if something goes wrong, it should be repaired, even though it cannot be replaced, and it should not be left alone. It has been proved that numerous problems can occur after gallbladder removal surgery, such as dyspepsia, duodenal fluid reflux, gastroesophageal reflux, increased incidence of colon cancer, increased incidence of dilated common bile duct and stones, common bile duct injury and postoperative gallbladder syndrome. 3, the logic of gallbladder preservation First of all, the gallbladder is born and received from its parents. This is not just an intuition and belief, the diversity of gallbladder functions has been confirmed by medical science. Secondly, gallbladder preservation surgery, especially the new type of gallbladder preservation invented by Prof. Zhang Baoshan and others, has the advantages of safe surgery, easy operation, reliable efficacy and low recurrence rate. Finally, mankind has shown an unlimited potential to recognize and prevent gallbladder stone formation. With regard to stone recurrence, follow-up times and outcomes vary widely, depending on factors such as patient selection, indications, treatment methods, and post-surgical management. In the face of recurrence, we should ask not only why recurrence, but also why it does not occur, perhaps the latter would provide us with more ideas and clues to solve the recurrence of stones. Prof. Zhang Shengdao pointed out that “even if the recurrence rate is as high as 50% after cholecystectomy, it is still meaningful to have half of the gallbladder preserved”. Therefore, biliary stone retrieval treatment is not only a solution to practical problems in clinical practice, but also an indispensable part of future research on gallstone prevention. 4. Real minimally invasive With reference to the criteria listed at the beginning of this article, the new biliary stone extraction method basically satisfies the conditions, except for the uncertainty of long-term effects. The application of laparoscopic technology in cholecystectomy, however, is minimally invasive from the point of view of human combat, but it is still not truly minimally invasive compared to biliary preservation treatment from the perspective of human structural and physiological integrity as well as the psychological consideration of patients. It not only has all the advantages of minimally invasive surgery, but also differs from cholecystectomy in that it preserves the function of the gallbladder, which can treat the disease while keeping the structure and function of the body intact. 5.The timing of gallbladder stone treatment The history of the causes and natural evolution of gallbladder stones tells us that the formation of stones is the result of a combination of genetic and environmental effects, and the process can be roughly divided into the following successive stages: Phase I – genetic phase, i.e. congenital abnormalities of hepatic bile acid, cholesterol or lipid metabolism; Phase II – chemical phase, the appearance of lithogenic cholesterol supersaturated bile; Phase III – physical phase, the appearance of light microscopically visible cholesterol crystals involving nucleation in the gallbladder; Phase IV – the anagen phase, in which small crystals grow into stones visible to the naked eye; Phase V – the clinical symptoms phase, in which clinical symptoms associated with stones appear, including typical biliary colic symptoms caused by gallbladder jugular or bile duct obstruction, non-specific symptoms of chronic inflammation of the gallbladder (dyspepsia, abdominal distention and epigastric vague pain, etc.), and gallbladder stone symptoms caused by complications (fever, jaundice, left upper abdominal pain, etc.). Based on this understanding, prevention can be broadly divided into four levels: primary prevention, to prevent stones in people susceptible to gallbladder stones; secondary prevention, to effectively treat asymptomatic gallbladder stones to prevent complications or further stone enlargement; tertiary prevention, to treat patients with symptomatic stones to prevent or delay loss of gallbladder function or prevent complications; and quaternary prevention, to eliminate stones and then prevent after stone elimination to prevent stone regeneration. Secondary prevention, the effective treatment of asymptomatic stones to prevent the development of symptoms or complications, challenges the currently popular view —- that asymptomatic stones do not require treatment. For a given individual, if it is possible to know if and when symptoms will develop, then they can be left untreated or wait until the problem is imminent. However, this is not the case, as we can only detect stones early by screening, but cannot predict when, where, or how they will develop. Before the advent of laparoscopic cholecystectomy technology, caesarean section was, after all, more damaging to the human body, and today people are afraid of it, so most of them advocate treating it only when symptoms appear. The advent of the era of minimally invasive surgery, represented by laparoscopic techniques, has naturally alleviated the fear associated with cholecystectomy, leading more and more patients to undergo cholecystectomy in the absence of severe symptoms. On the contrary, encouraged by the advantages of laparoscopic cholecystectomy, a group of “gallbladder cutting professionals” have emerged who ignore the function of gallbladder, as a result, gallbladder becomes more and more cuttable, and more and more early stone carriers have lost their precious gallbladder and become gallbladder carriers. As a result, more and more early stone carriers have lost their precious gallbladders and become “gutless heroes”. The best strategy to solve this paradox is minimally invasive gallbladder stone extraction. The symptoms and complications of gallbladder stones are caused by the stones, which can be eliminated without removing the gallbladder. Moreover, in the asymptomatic stage, the gallbladder functions better, the preservation value is high, the difficulty of surgery is low, the patient’s age is relatively young, and the safety of surgery is also high. Therefore, for gallbladder stones, we advocate: once detected, treat them as early as possible; the method is: preserve the gallbladder and remove the stones.