INTRODUCTION We evaluated a minimally invasive surgical technique involving a single percutaneous access with a laparoscopic trocar under video-cystoscopic vision for managing large bladder stones. All patients were candidates for open surgery. MATERIALS AND SURGICAL TECHNIQUE Fourteen patients with bladder stones larger than 3 cm in diameter or multiple stones were treated with this technique. The procedure involved the percutaneous placement of a laparoscopic trocar under cystoscopic control and the introduction of a rigid nephroscope into the bladder. Stones were cleansed via fragmentation or direct removal. DISCUSSION The technique was successful in all cases, resulting in controlled, stone-free bladders; there were no surgical complications. The mean operation time was comparable to that of standard management. All patients discharged uneventfully. None reported urethral stricture during the 24-month follow-up period. Percutaneous cystolithotripsy under endoscopic control is easy to perform and should be considered as an alternative for large or multiple bladder stones as it decreases the risk of urethral stricture.