Early surgical intervention in acute cholecystitis is sometimes fatal to patients in the high-risk group. Since the technical development of ultrasonically guided puncture of the gallbladder, percutaneous transhepatic cholecystostomy has become a safer method for the treatment of acute cholecystitis. We have been developing percutaneous transhepatic cholecystoscopy procedures since 1981, and have used this method in 11 patients with cholecystolithiasis. In all cases, we were able to destroy the stones with the Nd-YAG laser, and remove the fragments with a basket catheter through the fistula. There were no severe complications from percutaneous transhepatic cholecystostomy or cholecystoscopy. This lithotomy technique is a safe and reliable nonsurgical technique for patients with cholecystolithiasis, especially the elderly high-risk group.