Laparoscopic and endoscopic cooperative surgery (LECS) combines the advantages of precise endoscopic resection and laparoscopic suturing and lymphadenectomy, enabling accurate tumor localization, complete resection, and function preservation. Currently, various derivative procedures have been developed, including endoscopy assisted laparoscopic wedge resection (EAWR), laparoscopy assisted endoscopic resection (LAER), and non exposure techniques (e.g., CLEAN-NET), each suitable for lesions at different locations, depths of invasion, and risks of metastasis, thereby broadening the indications. Clinical evidence has demonstrated that LECS is safe and effective for early gastric cancer, gastric stromal tumors, and tumors in special locations, and non exposure techniques further reduce the risks of peritoneal contamination and dissemination. In the future, with the integration of three dimensional reconstruction and artificial intelligence assisted planning, it is expected to optimize decision making for lymph node dissection and reduce complications, and indications may be cautiously extended to higher risk stages. However, its long term oncological outcomes still require high level evidence based support from multicenter, large sample, prospective studies.