Laparoscopic laser cholecystectomy (LLC) is a less morbid alternative to open cholecystectomy. The advantages of laparoscopic techniques associated with advances in laser technology have heralded a dramatic advancement in the surgical treatment of biliary disease. Earlier return to work, lower morbidity, and lower medical expense are known advantages of laparoscopic surgery. We present the findings of our initial 500 procedures. The outcome of the first 200 procedures is compared to the following 300 procedures. Operating time averaged 88 min, and cholangiograms were achieved in 79%. Thirty-two percent were performed as outpatients and average hospital stay was 0.98 days. Conversion to open cholecystectomy occurred in 1.8% of cases and there were 5 major complications related to the procedure. No wound infections and no respiratory complications were encountered. There were no mortalities. Management of common bile duct stones with combined surgical and endoscopic modalities are discussed.