Laparoscopic endoscopic cooperative surgery (LECS) for the upper gastrointestinal tract

Abstract

We developed the laparoscopic and endoscopic cooperative surgery (LECS) technique, which combines endoscopic submucosal dissection (ESD) and laparoscopic gastric resection to resect gastric submucosal tumors (SMTs). Many researchers have reported LECS to be a feasible technique for gastric submucosal tumor resection regardless of tumor location, including the esophagogastric junction (EGJ).Recently, the Japanese National Health Insurance system approved LECS for insurance coverage, and it is now widely applied for gastric submucosal tumor resection. Initially, we applied LECS to gastric SMTs without ulcerative lesions due to concern about the possibility of tumor cells seeding into the peritoneal cavity, in a procedure termed "classical LECS". To expand the indication of LECS for gastric epithelial neoplasms, modified LECS procedures such as inverted LECS, non-exposed endoscopic wall-inversion surgery (NEWS), combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), and closed laparoscopic and endoscopic cooperative surgery (closed-LECS) have been developed and applied to patients with gastric epithelial neoplasms. As a future perspective of LECS, we plan to combine the modified LECS procedure and sentinel node (SN) navigation surgery (SNNS) for clinical (c)Stage IA gastric cancer resection. This strategy could be a minimally invasive surgical technique for cStage IA early gastric cancer.

Endoscopically Assisted Laparoscopic Gastric Resection for Benign and Malignant Lesions: A Report of Two Cases

“…In EAWR the role of the endoscopy team is the localization and the exposure of the tumor, while the role of the surgical team is the tumor’s full thickness resection [ 9 ]. In classic laparoscopic and endoscopic cooperative surgery, the surgeon stands on the patient’s right side along with the scrub nurse, while the first assistant stands on the patient’s left side, the scope operator on the patient’s foot side and the endoscopist near the patient’s head side [ 13 ]. However, in our cases we used an alternative method, where the patients were placed in the split-legged position with the surgeon positioned between the patients’ legs, which provides a more realistic view of the operative field, something that has also been described in the literature [ 9 , 14 ].…”

“…However, in our cases we used an alternative method, where the patients were placed in the split-legged position with the surgeon positioned between the patients’ legs, which provides a more realistic view of the operative field, something that has also been described in the literature [ 9 , 14 ]. Usually, a 10 mm camera port is inserted into the umbilicus and then four additional ports (three 5 mm ports and one 12 mm port) are placed in the left and right upper and lower quadrants of the abdomen [ 13 ]. This setup was the one we used in our first case.…”

Laparoscopic Endoscopic Cooperative Surgery: Current Status and Perspective

“…This procedure is further c a t e g o r i z e di n t oC L E R ,w h i c hi sa na p p r o a c ht h a t combines ESD and laparoscopic gastric resection to determine the incision line, to resect the tumor and to close the stomach wall. As LECS can minimize the resected region and preserve the function of the stomach after surgery, the procedure was added to the national insurance list in Japan in 2014, and subsequently rapidly diffused throughout the surgical community [21][22][23][24]. Further applications of LECS then developed, so the first version is named classical LECS to distinguish it from subsequent modified LECS techniques.…”

Gastric inflammatory myofibroblastic tumor treated with combined laparoscopic and endoscopic gastric wedge resection: a case report

“…Firstly, the biopsy did not show cancer, but the tumor configuration strongly suggested malignancy; therefore, we selected a non-exposed method to prevent interoperative dissemination of tumor cells. Secondly, the tumor appeared to be a submucosal tumor (SMT), and gastric wedge resection using a combined laparoscopic and endoscopic method is among the safest procedures for resection of gastric SMTs [ 4 , 5 ]. Lastly, we chose a wedge resection because if the tumor was not malignant, a distal gastrectomy could be considered excessive.…”