With advances in therapeutic endoscopy and laparoscopic surgery, the diagnosis and management of gastric submucosal tumors have shifted from conventional local resection toward precision decision-making based on endoscopic ultrasonographic stratification, histological diagnosis, malignant risk assessment, and functional preservation. The treatment of gastric submucosal tumors should not simply pursue technical resectability; rather, it should begin with determining whether treatment is necessary and which approach is most appropriate. Laparoscopic and endoscopic cooperative surgery (LECS) is a hybrid technique developed on the basis of conventional laparoscopic wedge resection and endoscopic full-thickness resection, integrating the advantages of precise intraluminal localization and safe extraluminal closure. It is particularly suitable for intraluminal lesions, tumors originating from the muscularis propria, and lesions located in functionally sensitive areas such as the cardia, pylorus, and posterior gastric wall. Classical LECS, NEWS, CLEAN-NET, and other related techniques each have specific indications and limitations, and no single approach is applicable to all patients. Surgeons should select individualized strategies according to tumor size, location, growth pattern, risk of contamination and dissemination, and institutional expertise, with the goal of achieving safety, simplicity, reproducibility, oncological adequacy, and gastric functional preservation.