Laparoscopic and endoscopic cooperative surgery (LECS) represents an important direction in the minimally invasive treatment of gastric tumors. With the integration of sentinel lymph node navigation, function-preserving surgery for early gastric cancer has entered a new phase of development. Currently, the indications for LECS have gradually expanded from submucosal tumors to early gastric cancer. However, controversies remain regarding oncological safety margins, the false negative risk of sentinel lymph node biopsy, tumor size thresholds, differences in technical approaches between Eastern and Western practices, and the clinical role of robot assisted LECS. LECS is inherently a collaborative procedure between endoscopists and surgeons, and its appropriate application requires multidisciplinary assessment involving endoscopy, gastrointestinal surgery, pathology, and radiology. Through multidisciplinary team (MDT) approach that comprehensively evaluates tumor characteristics and patient conditions, the optimal surgical procedure can be selected, thereby ensuring strict adherence to indications and avoiding overtreatment. For emerging techniques such as robot-assisted LECS, it is even more essential to use MDT discussion to rigorously identify complex cases that are likely to benefit, so as to prevent indiscriminate adoption.