The reaction of organolithium reagents and carboxylic acids constitutes a simple general method for the synthesis of ketones. This preparative route is the method of choice for direct conversion of carboxylic acid to ketones. It is the purpose of this chapter to evaluate critically the scope and limitations of this reaction and to recommend optimal conditions for its applications. The reaction of organolithium reagents with carboxylic acid is limited to the preparation of acyclic ketones. Although the objective of this reaction, the formation of unsymmetrical ketones, the method is clearly applicable to the synthesis of symmetrical ketones. Two different routes are possible and are discussed. To date, the reaction has been applied only to the preparation of monoketones.