J.Jpn. Surg. Soc.. 117(5): 358-363, 2016

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Feature topic

LAPAROSCOPIC AND ENDOSCOPIC COOPERATIVE SURGERY

Laparoscopic wedge resections are performed for the local resection of gastric submucosal tumors. Recently, laparoscopic and endoscopic cooperative surgery (LECS) has been performed for submucosal tumor resection, independent of tumor location and size. The LECS procedure can be performed safely with adequate incision lines. Nonexposed endoscopic wall-inversion (NEWS) and the combination of laparascopic and endoscopic approaches to neoplasia with the nonexposure technique (CLEAN-NET) were reported as new procedures in laparoscopy and endoscopy without perforation of the stomach to avoid tumor seeding. In the classic LECS procedure, both mucosal and submucosal layers around the tumor are dissected circumferentially using endoscopic submucosal dissection. Subsequently, the seromuscular layer is dissected laparoscopically. The submucosal tumor is then exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device. In the NEWS procedure, the seromuscular layer is dissected circumferentially and sutured under laparoscopy, and the mucosubmucosal layer is incised circumferentially under endoscopy. These LECS procedures are applicable for submucosal tumor resection such as gastrointestinal stromal tumors and could be applicable for gastric cancer surgery. Cooperation between surgeons and endoscopists is required to perform and develop LECS procedures.

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