Introduction: Cholecystectomy is the commonest operation of the biliary tract. It is known that open upper surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia. Objective: In the present study study we performed laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum with sedation to evaluate, analyze and document whether laparoscopic cholecystectomy could be performed under spinal anesthesia and to assess the benefits and harms of low-tension pneumoperitoneum. The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent was obtained from all patients. Materials and Methods: A prospective observational study with symptoms of cholelithiasis who underwent laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum (7-9 mmHg) was conducted on 40 patients in Surgery Department of Al-Azhar University Hospital in Assiut from December 2018 to June 2019. Results: We successfully performed the operations in 27 patients without major complications. Only 13 patients (32.5%) who converted to general anesthesia due to anxiety despite using sedation. The operation was converted to open cholecystectomy in one case only (2.5%) due to disturbed anatomy and adhesions. Mean age was 45 years (range 21-57years). BMI was ≤ 32. All patients were satisfied on follow up. Conclusion: Laparoscopic cholecystectomy under spinal anesthesia with low-tension pneumoperitoneum with sedation by experienced surgeons is safe, cost-effective, feasible, associated with minimal postoperative pain and smooth recovery