Surgical risks, residual and recurrent stones, and overwhelming infection of the biliary system are still key challenges for cholelithiasis related to high-risk elderly patients. In recent years, stone-removing techniques via sinus has been developed continuously, which provides a new approach for minimally invasive treatment of cholelithiasis. Percutaneous transhepatic gallbladder catheterizing drainage combined with choledochoscopic lithotomy is effective treatment with reliable efficacy for high-risk elderly patients with acute calculous cholecystitis. Percutaneous transhepatic biliary duct catheterization combined with cholangioscopic lithotomy is conducive to treat diffuse hepatolithiasis with acute obstructive cholangitis. Interventional treatment via sinus formed by T-bute, cystic duct tube, U-tube and subcutaneous blind loop are important measures for residual and recurrent stones from the common bile duct and intrahepatic bile duct.