Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

Table 4 Advantages and disadvantages of the various cooperative laparoscopic endoscopic techniques

Technique name	Pros	Cons
LAER	Minimally invasive approach	Suitable for small lesions with intraluminal expansion
	Monitoring and backup from the laparoscopic team in case of accidental perforation	Requires advanced endoscopy skills
EAWR	No requirement of advanced laparoscopic or endoscopic skills	Leaves larger wall defects compared to other methods
	Good entry level for teams starting cooperative techniques	Risk of gastric deformation or stenosis from stapling
EATR	Favorable access to lesions ≤ 2 cm, situated high on the posterior wall or lesser curvature without mobilizing the stomach	Requires gastrotomy closure
		May lead to spillage with peritoneal contamination and dissemination
LIGS	Similar to EATR	Risk of gastric deformation or stenosis from stapling
ELIS	Same as EATR	Same as LIGS
		Difficulty in orienting the stapler under endoscopic view
Single port LIGS	Less invasive than the classic LIGS	Requires previous experience in single port laparoscopy
	The gastrotomy can be closed through the single port incision	More difficult than EATR and LIGS
LECS	Combines the advantages of both endoscopy and laparoscopy. No restriction in the size or location of the tumor	Requires advanced endoscopy and laparoscopy skills. More adapted in high volume centers
		Risk of spillage and contamination
		Not adapted for early gastric cancer
Inverted LECS	Diminishes the risk of peritoneal cancer dissemination	Not adapted for early gastric cancer
LAEFR	Minimal invasive endoscopic resection	Requires advanced endoscopy skills in dissection techniques and closure of wide wall defects with macro-clips or suturing devices
	The procedure is facilitated by the laparoscopic view and exposure
Clean-NET	Diminishes the risk of peritoneal dissemination of gastric cancer	Limited literature
		Requires special training
		Risk of mucosal tear with cancer cell dissemination
NEWS	Diminishes the risk of peritoneal dissemination of early gastric cancer	Limited literature. Requires special training

LAER: Laparoscopy assisted endoscopic resection; LECS: Laparoscopic endoscopic cooperative surgery; LAEFR: Laparoscopy-assisted endoscopic full thickness resection; NEWS: Non-exposed endoscopic wall-inversion surgery; EAWR: Endoscope-assisted laparoscopic wedge resection; EATR: Endoscope-assisted laparoscopic transgastric surgery; LIGS: Laparoscopic intragastric surgery; ELIS: Endoscope-assisted laparoscopic intragastric stapling; Clean-NET: Clean non exposure technique.