• Lifeng Shang, Xin Shen, Wenkai Niu, Yi Zhang, Junwei Han, Haiwang Liu, Lei Liu, Xinli Chen, Yiyue Zhang, and Shi Hai.
• Department of Gastrointestinal Surgery, Xi'an Daxing Hospital, Xi'an, P.R. China.
• Medicine (Baltimore). 2022 Nov 18; 101 (46): e31810e31810.

AbstractCholecystectomy remains the "gold standard" for the management of symptomatic gallstones. Minimally invasive laparoscopic cholecystectomy has been the treatment of choice for the past 3 decades. However, the technique of natural orifice transluminal endoscopic surgery cholecystolithotomy is evolving, with some experts advocating gallbladder stone removal without gallbladder excision in order to preserve gallbladder function and eliminate post-cholecystectomy syndromes, including complications of the surgical incision, bile duct injury, functional gastrointestinal, and psychological conditions, and possibly an increase in colon cancer. In addition, transluminal endoscopic cholecystolithotomy is an option for elderly patients who are not suitable candidates for open surgery and those who desire scar-free minimally invasive surgery with organ preservation. This article summarizes the established pure natural orifice transluminal endoscopic surgery gallbladder preserving gallstone removal techniques and highlights the pros and cons of different popular available endoscopic approaches to gallstone therapy and how flexible endoscopic surgery via the natural orifice is compared to the well-established cholecystectomy.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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