Laparoscopic endoscopic cooperative surgery

Abstract

Laparoscopic and endoscopic cooperative surgery (LECS) is a newly developed concept for tumor dissection of the gastrointestinal tract that was first investigated for local resection of gastric gastrointestinal stromal tumors (GIST). The first reported version of LECS for GIST has been named 'classical LECS' to distinguish it from other modified LECS procedures, such as inverted LECS, a combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). These modified LECS procedures were developed for dissection of malignant tumors which may seed tumor cells into the abdominal cavity. While these LECS-related procedures might prevent tumor seeding, their application is limited by several factors, such as tumor size, location and technical difficulty. Currently, classical LECS is a safe and useful procedure for gastric submucosal tumors without mucosal defects, independent of tumor location, such as proximity to the esophagogastric junction or pyloric ring. For future applications of LECS-related procedures for other malignant diseases with mucosal lesions such as GIST with mucosal defects and gastric cancer, some improvements in the techniques are needed.

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

“…Laparoscopic and endoscopic cooperative surgery (LECS) has been developed as a novel surgical technique for patients with gastric submucosal tumors, such as gastrointestinal stromal tumors 29, 30, 31. As the classical LECS procedure devised by Hiki et al 31.…”

“…As the classical LECS procedure devised by Hiki et al 31. results in an open gastric lumen by intentional perforation, it is useful in patients with a low risk of intra‐abdominal tumor dissemination, such as tumors that are covered by normal gastric mucosa.…”

“…However, it is clinically difficult to adapt classical LECS to patients with gastric cancer because of the risk of tumor dissemination caused by opening the stomach. In order to prevent tumor dissemination induced by surgical procedures, modified LECS has recently been focused on as a promising non‐exposed approach 31. Non‐exposed endoscopic wall‐inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with a non‐exposure technique (CLEAN‐NET) are some representatives of modified LECS 32, 33, 34…”

Nonexposure laparoscopic and endoscopic cooperative surgery (closed laparoscopic and endoscopic cooperative surgery) for gastric submucosal tumor

“…Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumor (SMT) was first reported in 2008 by Hiki et al [1], and its use has rapidly increased recently [2][3][4][5][6]. However, the conventional LECS procedure has the potential risk of gastric contents or tumor cells spilling into the abdominal cavity because the gastric wall has to be opened during the procedure.…”

Flexible magnifying endoscopy with narrow band imaging for the diagnosis of uterine cervical tumors: A cooperative study among gastrointestinal endoscopists and gynecologists to explore a novel microvascular classification system

“…The collaboration of gastro-endoscopists and physicians in other fields is now an option for overcoming conventional issues. Laparoscopic and endoscopic cooperative surgery has been introduced clinically for local resection of intraluminal type GI stromal tumors (19). Endoscopists are able to perform endoscopic full-thickness resection (20) with an accurately set marginal line and controlled bleeding.…”