We have performed percutaneous transhepatic cholecystoscopic lithotomy (PTCCSL) in 37 cases of cholecystolithiasis and have succeeded in the removal of the stones in all cases without any serious complications. The average period from gallbladder puncture until the completion of lithotomy was 11.8 days and PTCCSL was performed an average of 2.1 times. The follow-up period after lithotomy ranged from one to 60 months, with an average of 24.7 months. Gallbladder function returned to the pretreatment level. However, gallstones recurred in 7 cases (18.9%). In comparison with both cholecystectomy by laparotomy and laparoscopic cholecystectomy, PTCCSL is less invasive, but recurrence may occur in a relatively short period with PTCCSL. Therefore PTCCSL is particularly indicated for high-risk patients who cannot undergo general anesthesia.