The incidence of open and laparoscopic common bile duct exploration for choledocholithiasis has remarkably declined during the last 2 decades. Endoscopic and percutaneous treatment options provide a minimally invasive solution to even complex biliary lithiasis cases. The percutaneous approach to cholelithiasis is particularly helpful if the surgical or the endoscopic access is difficult. Various clinical examples and radiological images are given in this lecture.