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.
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.
In the transformation of gastric cancer surgery from traditional radical resection to emphasizing both radicality and function preservation, laparo-endoscopic combined surgery (LECS) has become a core supporting technique for function-preserving gastrectomy in early gastric cancer due to its advantages of precise localization, minimal invasiveness and controllable safety. Endoscopy enables precise lesion localization, boundary marking, mucosal dissection and intraluminal exposure, while laparoscopy achieves safe resection, lymph node evaluation, gastric wall defect repair and intra-abdominal exploration. The synergistic effect of the two modalities effectively resolves the contradictions among lesion localization, resection safety, function preservation and radical guarantee faced by single minimally invasive technique, significantly reduces perioperative complications, accelerates postoperative recovery, and improves long term quality of life. With strict adherence to appropriate indications, standardized procedural protocols, and enhanced multidisciplinary collaboration, it can achieve oncological outcomes comparable to those of standard radical gastrectomy. As the technique continues to be optimized and the clinical evidence matures, combined laparoscopic and endoscopic function-preserving surgery is expected to play an increasingly important role in the management of early gastric cancer, offering patients less surgical trauma and better quality of life.
For early gastric cancer, endoscopic resection and surgery are currently standard treatment options. Due to the complex lymphatic drainage of gastric cancer and the potential for skip metastasis—particularly with a significantly increased risk of lymph node involvement in pT1b tumors—laparoscopic and endoscopic cooperative surgery (LECS) has emerged as a novel approach that ensures oncological safety while preserving gastric function and improving quality of life. In LECS, the application of sentinel lymph node dissection for precise removal of perigastric lymph nodes has become a critical and essential step. Selecting appropriate tracers and using standardized injection techniques effectively enables visualization of sentinel lymph nodes. Moreover, en bloc resection of the sentinel lymph node basin is more oncologically sound than the “pickup” method, although it places higher demands on intraoperative frozen-section pathology. In the future, under the guidance of artificial intelligence-based models predicting lymph node metastasis, more precise sentinel lymph node dissection will likely represent an important direction for interdisciplinary collaboration between medicine and engineering.
In recent years, with the successful implementation of the concept of precision surgery, the use of laparoscopy-endoscopy cooperative surgery in early gastric cancer has proven to be safe and effective. Among these techniques, laparoscopy-assisted endoscopic full-thickness resection combined with indocyanine green fluorescence-guided lymph node dissection is a function-preserving procedure that enables patients to achieve a long-term prognosis comparable to that of radical resection. It offers advantages such as minimally invasive surgery, guaranteed horizontal and vertical resection margins, maximal preservation of the normal gastric wall, and full-thickness suturing to ensure primary healing and the restoration of gastric function. With the growing trend towards personalised and precision surgical treatment of cancer, this procedure is bound to see further development.
Laparoscopic-endoscopic cooperative surgery (LECS) has gradually emerged as an important surgical modality in the precise surgical management of gastric cancer. Through the intraoperative synergy of gastroscopy and laparoscopy, LECS provides a reliable technical solution for minimally invasive surgery of complex gastric cancer, effectively enhancing the accuracy of intraoperative margin assessment and addressing clinical challenges such as ambiguous tumor boundaries. Adenocarcinoma of the esophagogastric junction, due to its unique anatomical location and complex lymphatic drainage pathways, carries a relatively high risk of positive surgical margins, thereby imposing more stringent requirements on intraoperative precise localization and margin control. A standard of 3 cm for the proximal resection margin and 4 cm for the distal resection margin is recommended as standards for intraoperative margin management to minimize the incidence of positive margins. A standardized operational workflow comprising “preoperative titanium clip marking and localization - intraoperative dual-scope collaborative confirmation - methylene blue margin marking - precise measurement with a dedicated laparoscopic rod ruler” provides a referable technical pathway and standardized operational framework for the precise implementation and safety assurance of minimally invasive gastric cancer surgery. Nevertheless, the clinical application of LECS still encounters numerous technical difficulties. These challenges can be effectively addressed through the establishment of standardized operational protocols, training surgeons to independently perform endoscopic procedures, appropriately extending the safe margin distance for high-risk pathological types, and reinforcing intraoperative frozen pathological screening. Currently, clinical research on the application of dual-scope combined technology for intraoperative tumor localization and margin assessment in gastric cancer remains relatively scarce, with most studies being single-center or retrospective in design. Future endeavors should focus on conducting more large-scale, multicenter, prospective studies to provide higher-level evidence-based medical evidence.
The aim of laparoscopic and endoscopic cooperative surgery (LECS) is to pursue radical resection while maximizing preservation of gastric function and the patient’s quality of life. For gastric tumors located in special sites—such as the esophagogastric junction, cardia, posterior gastric wall, gastric angle (incisura angularis), and antrum—the complex anatomy, special adjacent relationships, and limited operative space impose significant limitations on both pure endoscopic and pure laparoscopic approaches. LECS integrates the precise intraluminal localization of endoscopy with the minimally invasive manipulation and suturing/hemostatic capabilities of laparoscopy, thus offering unique advantages in treating tumors at these sites. However, its clinical indications remain clearly defined. The real challenge is not technical feasibility, but whether an individualized treatment strategy can be developed for each patient: when there is a risk of lymph node metastasis, standardized lymph node dissection should be performed; when there is no indication of functional compromise, the extent of resection should be carefully controlled to avoid overtreatment.
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.
The surgical management of gastric cancer is steadily advancing into a new era characterized by a dual focus on oncological radicality and functional preservation. This paradigm shift has driven the exploration and application of Laparoscopy and Endoscopy Cooperative Surgery (LECS) in the management of Stage Ⅱ gastric cancer. To mitigate the potential risk of peritoneal micrometastasis associated with conventional procedures, LECS has evolved toward modified non-exposed techniques. These refinements strictly adhere to the tumor-free principle, effectively minimizing the risk of peritoneal seeding caused by tumor cell shedding. In terms of surgical precision, the synergy between endoscopy and laparoscopy not only accurately delineates tumor boundaries to ensure negative margins (R0 resection), but also provides the technical feasibility required to safely perform function-preserving procedures. Furthermore, this dual approach affords direct visual guidance during gastrointestinal reconstruction, thereby contributing to a reduced incidence of postoperative complications. Regarding safety, standardized laparoscopic operations guarantee the completeness of systematic D2 lymphadenectomy, while the physical closure mechanisms of non-exposed techniques effectively prevent the dissemination of cancer cells. Nevertheless, the clinical application of LECS currently faces several practical challenges. These include a lack of high-level evidence regarding long-term survival, uncertainties in preoperative imaging-based staging, and the steep learning curve associated with interdisciplinary collaboration. Moving forward, bolstered by robotic-assisted surgery, indocyanine green (ICG) fluorescence navigation, and standardized multidisciplinary team (MDT) workflows, LECS is poised to accelerate toward greater precision and individualization, further enriching and optimizing surgical treatment strategies for gastric cancer.
Esophagojejunal anastomosis after totally laparoscopic total gastrectomy remains clinically challenging due to deep location, technical difficulty, and demanding teamwork. Current techniques include linear stapling, circular stapling, and hand-sewn anastomosis. Hand-sewn anastomosis requires advanced laparoscopic skill, offers poor reproducibility, and is thus limited in use. Linear stapling, while relatively simple, necessitates resection of 4.5-6.0 cm of normal esophagus and may compromise the proximal margin in high or ill-defined tumors. Circular stapling preserves more distal esophagus and allows higher resection, better aligning with anatomical and functional goals. However, conventional circular stapling methods, such as the reverse puncture and OrVil™ techniques, can be cumbersome, dependent on specialized instruments, or carry higher complication risks. Recently, hand-sewn purse-string sutures and novel laparoscopic purse-string suture clamps and multi-functional seal caps have provided new solutions for totally laparoscopic circular anastomosis. Each step of this procedure, from purse-string creation and anvil placement to mesenteric division, stapler insertion, and anastomosis, may present specific challenges, and technical errors at any step may lead to surgical failure. Thus, proficiency in managing these intraoperative situations is crucial for safe and broader adoption of the technique.
Abdominal wall defect is a common and clinically challenging problem, whose repair and reconstruction require not only wound closure but also restoration of the abdominal wall’s anatomical structure and mechanical function. Abdominal wall defects were classified into three types: type Ⅰ, involving loss of skin and subcutaneous tissue; type Ⅱ, characterized by muscular and fascial defects with intact skin coverage; and type Ⅲ, representing full-thickness abdominal wall defects. In cases with large defect size or those complicated by infection, prior radiotherapy, or multiple previous surgeries, satisfactory long-term outcomes are often difficult to achieve with mesh repair or component separation techniques alone. In such situations, reconstructive procedures incorporating plastic surgical flap techniques are frequently required. Reconstruction of abdominal wall defects should be centered on restoration of load-bearing structures, with individualized decision-making based on soft tissue coverage conditions and infection risk. Plastic surgical flap techniques, autologous fascia, and prosthetic mesh are not mutually exclusive but should be used in a complementary manner. Multidisciplinary collaboration and thorough preoperative evaluation are essential to achieve optimal clinical outcomes.
Objective To investigate the clinical safety and short-term efficacy of non-exposed endoscopic wall-inversion surgery (NEWS) combined with laparoscopic sentinel node navigation surgery (LSNNS) in the treatment of early gastric cancer. Methods A total of 7 patients with early gastric cancer who underwent NEWS combined with LSNNS at the Department of Gastrointestinal Surgery, Peking University People’s Hospital, from January 2025 to May 2026 were retrospectively enrolled. The clinicopathological data and perioperative follow-up data of the patients were collected and sorted to evaluate the clinical safety, radical resection efficacy, and application value of this surgical procedure. Results The median maximum lesion diameter of 7 patients was 2.0 (1.5-3.0) cm, and 2 cases were complicated with ulcers. The pathological types were mainly signet ring cell carcinoma and poorly differentiated adenocarcinoma, and tumor invasion into the submucosa was observed in 3 cases. All patients successfully completed NEWS combined with LSNNS without conversion to open surgery. The average operative time was (268.9±47.7) minutes, and the intraoperative blood loss ranged from 15 to 50 mL. Negative surgical margins were achieved in all patients, with 4 to 9 sentinel lymph nodes dissected per case, and postoperative pathology confirmed no lymph node metastasis. No severe complications such as hemorrhage, perforation or abdominal infection occurred during the perioperative period. Patients presented with mild postoperative pain and slight inflammatory stress response, and only 2 cases developed transient mild gastric emptying disorder. The median postoperative hospital stay was 5 (5-7) days. Conclusion NEWS combined with LSNNS is a safe, feasible and minimally invasive novel surgical approach. It can achieve complete full-thickness resection of lesions and individualized lymph node dissection for high-risk early gastric cancer with reliable perioperative safety, while preserving the anatomical structure and physiological function of the stomach.
Objective To explore the efficacy and safety of the laparoscopic-endoscopic cooperative surgery combined sentinel lymph node navigation surgery (LECS-SNNS) strategy in early gastric cancer (EGC) patients with different indications. Methods A retrospective analysis was conducted on the clinicopathological data of 60 consecutive EGC patients who underwent LECS-SNNS at Beijing Friendship Hospital, Capital Medical University, between August 2023 and November 2025. Among them, 13 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node basin dissection (LSBD) (ESD-LSBD group); 30 received laparoscopic-endoscopic regional gastrectomy (LRG) combined with LSBD (LRG-LSBD group); and 17 underwent LSBD alone (LSBD group). Clinicopathological characteristics, gastric emptying time, nutritional status, quality of life (QoL), and perioperative complications were analyzed and evaluated. Results Four patients were converted to standard D2 radical gastrectomy due to sentinel lymph node metastasis. Except for a significantly higher proportion of pT1b (73.3%) stages in the LRG-LSBD group than in the other two groups (P<0.05), no statistically significant differences were observed among the three groups regarding baseline characteristics and the number of detected lymph nodes. Regarding perioperative indicators, the LSBD group had a significantly shorter operative time than the LRG-LSBD group (P=0.001) and a markedly shorter postoperative hospital stay than the other two groups (both P<0.017). Intraoperative blood loss in the LSBD and ESD-LSBD groups was significantly lower than that in the LRG-LSBD group (both P<0.017). The gastric half-emptying time at 1 week postoperatively was significantly longer than the preoperative baseline across all three groups, which markedly improved at 3 months postoperatively, showing no statistically significant difference compared with the preoperative baseline. At 1 week postoperatively, the gastric half-emptying time in the LSBD group was significantly better than that in the LRG-LSBD group (P<0.017), whereas no significant difference was found among the groups at 3 months postoperatively. Most nutritional indicators in each group decreased significantly at 1 week postoperatively and returned to preoperative levels at 3 months postoperatively, with no significant differences observed among the groups. Regarding QoL, scores for most indicators declined significantly at 1 month postoperatively and recovered to preoperative levels at 3 months postoperatively. At 1 month postoperatively, the LSBD group demonstrated significantly better indigestion symptom scores and total symptom scores in the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) than the LRG-LSBD group (P<0.017), while differences in other scales and postoperative scores among the groups were not statistically significant. Within 90 days postoperatively, two complications occurred (one grade I and one grade II), both of which resolved after conservative treatment; no complications of grade ≥ III were observed. Conclusion LECS-SNNS strategy for EGC provides a safe, individualized treatment selection through accurate preoperative assessment and intraoperative lymph node navigation, achieving oncological R0 resection while effectively maximizing short-term organ function and quality of life preservation.
Objective To compare the surgical safety and postoperative quality of life between laparoscopic pylorus-preserving gastrectomy (LPPG) and laparoscopic distal gastrectomy (LDG) following endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the middle of stomach. Methods A single-center retrospective cohort study was conducted on the clinical and follow-up data of 48 patients who underwent additional surgery after ESD for EGC in the middle of stomach at the Department of Gastric and Hernia Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, between January 2016 and February 2024. Patients were divided into two groups based on the surgical procedure: LPPG (n=9) and LDG (n=39). Clinicopathological characteristics, short-term postoperative outcomes, 2-year survival, and postoperative quality of life scores were compared between the two groups. Results R0 resection was achieved in all patients in both groups. Patients in the LPPG group were significantly younger than those in the LDG group (P=0.038). No statistically significant differences were observed between the two groups in operative time, intraoperative blood loss, number of lymph nodes dissected (median 25 in both groups), time to first flatus or defecation, or length of hospital stay (all P>0.05). The proximal and distal resection margins were significantly shorter in the LPPG group than in the LDG group (P=0.001 and P=0.041, respectively). The incidence of short-term (≤30 d) postoperative complications was 22.2% (2/9) in the LPPG group and 2.6% (1/39) in the LDG group. At 6 months postoperatively, serum albumin levels were numerically higher in the LPPG group than in the LDG group (45.4 g/L vs. 43.2 g/L, Hedges’ g=0.78), but the difference did not reach statistical significance (P=0.065). Hemoglobin levels did not differ significantly between the two groups at either 6 months or 2 years postoperatively (P>0.05). The overall incidence of long-term complications did not differ significantly between the two groups (11.1% vs. 17.9%, P>0.05), although the complication spectra differed. At 2 years postoperatively, life quality scores were comparable between the two groups (all P>0.05); the LPPG group had a significantly higher constipation subscale score than the LDG group (P=0.047). No tumor recurrence, lymph node metastasis, or distant metastasis was observed in either group during the 2-year follow-up. Conclusion Both LPPG and LDG can achieve satisfactory oncological outcomes as salvage surgery after ESD for early gastric cancer in the middle stomach. LPPG shows better nutritional preservation without increasing long-term complications or overall QOL loss, but it has higher short-term complication rates and more constipation, thus being more suitable for carefully selected patients requiring function preservation.
Objective To construct an artificial intelligence surgical workflow reconstruction system integrating instance segmentation and multi-object tracking to realize automatic structural analysis and objective quality evaluation of surgical videos. Methods A total of 20 videos of laparoscopic radical gastrectomy performed between January 2022 and December 2023 at the Department of Gastrointestinal Surgery Xuzhou Central Hospital; the Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School; and the Department of General Surgery, the Fourth Affiliated Hospital of Soochow University were retrospectively analyzed. A total of 7569 images annotated with 11 types of surgical instruments and intraoperative bleeding areas were extracted and divided into training and validation datasets at a ratio of 8:2. Transfer learning was performed based on the YOLO11L-seg model, and the ByteTrack algorithm was integrated for temporal tracking of surgical instruments. Model performance was verified from three dimensions: internal static image validation, external independent dynamic surgical video validation, and blind evaluation by clinical surgeons. Evaluation metrics included mAP@0.5, mask mAP@0.5, recognition accuracy, and F1/Dice coefficient. A surgical procedure heatmap was generated based on the temporal frequency of instrument usage to quantitatively distinguish different surgical procedures and locate key operative steps. Results In the internal static validation, the box mAP@0.5 and mask mAP@0.5 of the model reached 83.5% and 82.8%, respectively. In the external dynamic video test set, the overall recognition accuracy was 92.2% with an F1/Dice coefficient of 0.878, and the recognition accuracy of intraoperative bleeding was 100%. The surgical heatmap could completely distinguish three radical gastrectomy procedures including distal, total and proximal gastrectomy, and the localization accuracy of key operative steps exceeded 90%. The intelligent review time of a single surgical video was reduced by approximately 70% compared with manual review. Blind evaluation by three senior surgeons demonstrated an average accuracy of 100% in instrument identification, bleeding detection and surgical procedure classification. Conclusion The instrument recognition and tracking scheme based on YOLO11L-seg and ByteTrack can accurately reconstruct the temporal workflow of laparoscopic radical gastrectomy. The surgical heatmap can intuitively quantify surgical operation characteristics, providing a feasible technical strategy for automatic and standardized quality control of minimally invasive surgery.
Objective To preliminarily explore the efficacy and safety of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy. Methods This retrospective analysis examined the clinical data of 104 patients who underwent laparoscopic anatomic hepatectomy and were consecutively admitted to Ward 2 of the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical University (Yijishan Hospital) between September 2023 and February 2026. Among these, 48 patients underwent laparoscopic anatomic hepatectomy using the intra-hepatic vein sheath dissection technique (intrasheath dissection of the hepatic veins group), while 56 patients underwent conventional laparoscopic anatomic hepatectomy (conventional group). Baseline data, surgery-related parameters, and postoperative outcomes were recorded and compared between the two groups. Results Both groups of patients successfully underwent surgery; the conversion rate to open surgery was 6.3% in the intra-sheath group and 7.1% in the conventional group. In the intrasheath dissection of the hepatic veins group, 15 cases of isolated hepatic segment resection were performed (4 cases of segment 4, 5 cases of segment 7, and 6 cases of segment 8), and 33 cases of combined hepatic segment resection were performed (8 cases of left hepatic hemispherectomy, 6 cases of right anterior lobe resection, 7 cases of right posterior lobe resection, 6 cases of right hepatic hemispherectomy, 4 cases of right posterior lobe plus dorsal segment of the right anterior lobe resection, and 2 cases of middle hepatic lobe resection); in the conventional group, 16 cases underwent isolated segmental resection (4 cases of segment 4, 9 cases of segment 7, and 3 cases of segment 8), and 40 cases underwent combined segmental resection (11 cases of left hepatic hemispherectomy, 4 cases of right anterior lobe resection, 11 cases of right posterior lobe resection, 8 cases of right hepatic hemispherectomy, and 6 cases of middle hepatic lobe resection); with no statistically significant differences between the groups (P>0.05). The intrasheath dissection of the hepatic veins group had shorter operative times, fewer Pringle maneuvers, shorter occlusion times, and lower intraoperative blood loss compared to the conventional group, and these differences were statistically significant (P<0.05); additionally, 2 cases of air embolism occurred in the intrasheath dissection of the hepatic veins group, compared to 1 case in the conventional group. There was no statistically significant difference in liver function between the two groups on the first postoperative day; regarding postoperative complications, 6 patients in the intrasheath dissection of the hepatic veins group experienced Clavien-Dindo Grade III or lower complications, 5 cases of Grade Ⅲ and Ⅳ complications; in the conventional group, 7 patients experienced Clavien-Dindo Grade Ⅲ or lower complications, and a total of 7 cases of Grade Ⅲ and Ⅴ complications; there was no statistically significant difference between the groups. The postoperative length of hospital stay was (9.3±4.0) days in the intrasheath dissection of the hepatic veins group and (10.1±4.4) days in the conventional group. All patients had negative pathological margins. Conclusion The use of intrasheath dissection of the hepatic veins for laparoscopic anatomic hepatectomy is safe and effective, and can shorten operative time and reduce intraoperative blood loss. However, effective control of central venous pressure is required.
The treatment paradigm for early gastric cancer (EGC) is shifting from extended radical resection toward minimally invasive, precise, and function-preserving approaches. Sentinel lymph node (SN) navigation, laparoscopic endoscopic cooperative surgery (LECS), and robotic endoscopic cooperative surgery (RECS) provide new strategies for local gastric resection, regional lymphadenectomy, and functional preservation. For indocyanine green (ICG) injection, intraoperative endoscopic submucosal direct injection is recommended, with a maximum volume of 1.0 mL per site, following the principle of “shallower rather than deeper,” injecting slowly and observing submucosal elevation to confirm successful delivery. Preoperative workup for LECS and RECS includes magnifying chromoendoscopy to rule out synchronous lesions, endoscopic ultrasonography for T staging, and contrast-enhanced CT to assess lymph node metastasis. Intraoperatively, frozen section pathology of the SN determines whether to proceed with local resection or D2 gastrectomy; positive margins warrant additional extended resection, and invasion beyond T1b stage requires conversion to D2 gastrectomy. Postoperatively, endoscopy is performed to check for suture defects, and a jejunal feeding tube is placed. This protocol constitutes a systematic procedure for function- preserving EGC surgery, aiming to maximize gastric preservation while ensuring oncological radicality and improving patients’ long-term postoperative quality of life.
For esophagogastric anastomotic leakage complicated with mediastinal abscess after proximal gastrectomy, management should focus not only on leak closure or drainage of pleural effusion, but more importantly on timely control of the mediastinal infection source adjacent to the anastomosis. Endoscopic trans-fistula catheter drainage may provide a direct route for mediastinal source control in selected patients with a clearly identified defect communicating with a localized mediastinal abscess, especially when conservative treatment or pleural drainage alone is insufficient. Careful preprocedural imaging, gentle low-resistance catheter placement, adequate external drainage, dynamic irrigation management, and strict tube identification are essential for this technique.
Gastrointestinal stromal tumor (GIST) is a common mesenchymal tumor of the digestive tract, and surgical resection is the preferred treatment method. Laparoscopic and endoscopic cooperative surgery (LECS), combine the respective advantages of laparoscopy and endoscopy to achieve precise localization, complete resection, functional preservation, and minimally invasive treatment of GIST. In recent years, LECS has developed into various surgical techniques with different indications and advantages in clinical application. This article systematically summarizes the main surgical techniques, clinical application selection strategies, and research progress of LECS for the treatment of GIST. Combined with relevant guidelines and clinical practice, it also summarizes the technical points and difficulties in the implementation of LECS, aiming to further promote LECS and provide references for clinical practice.
Laparoscopic-endoscopic cooperative surgery (LECS) for gastric tumors, characterized by the synergistic integration of laparoscopy and digestive endoscopy, successfully overcomes the inherent limitations of standalone minimally invasive techniques. It enables precise lesion localization, targeted local resection, and maximum preservation of gastric function for early gastric cancer (EGC) and gastric submucosal tumors, thereby becoming a pivotal direction in minimally invasive gastric surgery. Recently, the continuous incorporation of cutting-edge technologies, such as artificial intelligence (AI)-assisted recognition, intraoperative image navigation, robotic surgical platforms, fluorescence imaging, and novel stapling/sewing instruments, into the LECS framework has propelled the diagnostic and therapeutic paradigms toward an intelligentized and digitalized era. This transformation not only improves the accuracy and safety of determining resection margins of primary lesions, identifying lymph node metastasis, and reconstructing complex wounds, but also extends integrated care to postoperative remote follow up through wearable devices. Despite its promising prospects, the full clinical translation of intelligent LECS platforms still faces numerous challenges.
Cryoablation (CRA) is currently an effective radical treatment for primary liver cancer (hepatocellular carcinoma). It induces tumor cell necrosis, microvascular damage, and immune activation through ultra-low temperatures, offering advantages of precise ablation and protection of critical anatomical structures. For small hepatocellular carcinoma (maximum diameter ≤3 cm), its efficacy is comparable to that of radiofrequency ablation (RFA) and microwave ablation (MWA), with a lower complication rate when tumors are adjacent to high-risk sites such as blood vessels or the gallbladder. For tumors measuring 3-5 cm in diameter, CRA is associated with a lower local recurrence rate than RFA and MWA, along with milder pain response. In large hepatocellular carcinoma (maximum diameter ≥5 cm), combination with transarterial chemoembolization/hepatic arterial infusion chemotherapy is required to improve control rates. CRA can trigger an immune response and exhibits a synergistic effect with immune checkpoint inhibitors. Animal studies and preliminary clinical research confirm its safety and anti-tumor activity; however, high-level evidence -based medicine evidence is still needed to verify its efficacy in hepatocellular carcinoma. Future efforts should focus on identifying biomarkers for combination therapy, developing individualized strategies, and exploring optimized multimodal treatment regimens.
