The concept of minimally invasive treatment for choledocholithiasis is transitioning from simple “stone clearance” to “functional preservation”, with its core lying in protecting the structural and functional integrity of the Oddi sphincter (SO). This article systematically explains the innovations and clinical practice progress of SO protection techniques. ①Ultra-fine choledochoscope transcystolithotomy (LTCBDE): Using a choledochoscope with a diameter of 2.0–2.8 mm, zero-incision stone extraction has been achieved through the natural channel of the cystic duct. It is particularly suitable for patients with slender bile ducts (≤0.5 cm), which can effectively avoid SO injury and reduce the risk of postoperative pancreatitis. ② Primary bile duct suture: (with or without temporary internal stent drainage) to avoid complications associated with long-term indwelling of traditional T-tubes and significantly shortens the length of hospital stay. ③ Endoscopic papillary balloon dilation (EPBD): Replacing the permanent incision of EST with reversible dilation, it maximally preserves the anti-reflux function of SO. It is particularly suitable for patients with coagulation dysfunction or high-risk anatomy for EST (such as duodenal diverticulum). ④ Combined the three-mirror technique: (laparoscope, choledochoscope, duodenoscope) to integrate the advantages of multiple minimally invasive approaches, aiming to achieve “one-stop” stone clearance and functional preservation. This article further proposes a stratified decision-making model based on patient characteristics (young, elderly, high-risk) and stone features to guide individualized treatment selection. Current challenges include the lack of real-time intraoperative SO function monitoring methods and insufficient long-term efficacy data. In the future, the “intelligent biliary surgery” paradigm integrating AI intelligent monitoring, regenerative medicine and robotic technology will be the development direction to achieve the ultimate goal of radical treatment and physiological function preservation.