| Exploration of minimally-invasive surgery is one of main topics in surgical treatment of gastric tumors. In submucosal tumors (SMTs), such as gastrointestinal stromal tumors, local resection is acceptable due to a less possibility of lymph node metastasis. However, in cases of intraluminally growing tumor, determination of resection area from the outside of the lumen is sometimes difficult, and therefore an excessive resection may be unavoidable to obtain negative surgical margins. Intraluminal approach using peroral flexible endoscopy is a key to solve this issue, by which the resection area can be minimized as far as possible. Laparoscopic endoscopic collaborative surgery (LECS) is a promising option for successful local resection particularly in intraluminally or intramurally growing type submucosal tumors. In cancers or ulcerated SMTs, iatrogenic tumor seeding can be prevented by using nonexposure LECS techniques, such as nonexposed endoscopic wall-inversion surgery (NEWS). Furthermore, in possibly node-positive early gastric cancers, NEWS with sentinel node navigation surgery (SNNS), which includes minimal lymphadenectomy, is expected as one of ideal surgical approaches. Accumulation of clinical cases and long-term outcomes are required to demonstrate feasibility and efficacy of NEWS plus SNNS. Collaboration with laparoscopists can also inspire endoscopists to create new endoscopic techniques. Endoscopic hand suturing (EHS) is one of typical examples inspired by laparoscopic techniques. Feasibility of EHS for prevention of postoperative adverse events has already been demonstrated in cases after NEWS and gastric endoscopic submucosal dissection, respectively. Expansion of the indication in this technique is desired for further development of endoscopic surgery. |
