Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12482-12497
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12482
Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status
Dimitrios Ntourakis, Georgios Mavrogenis
Dimitrios Ntourakis, Third Department of Surgery, University of Athens Faculty of Medicine, Attikon University Hospital, Rimini 1, 12463 Chaidari, Athens, Greece
Georgios Mavrogenis, Service de Gastroentérologie, Site Notre Dame, Grand Hôpital de Charleroi, 3 Grande Rue, 6000 Charleroi, Belgium
Georgios Mavrogenis, Gastroenterology and Endoscopy Center of Mytilene, Kavetsou 10, 81100 Mytilene, Greece
Author contributions: Ntourakis D designed the study and performed the research; Mavrogenis G analyzed data; Ntourakis D drew the figures; Ntourakis D and Mavrogenis G wrote the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: The paper dataset and literature search results are available from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dimitrios Ntourakis, MD, PhD, Third Department of Surgery, University of Athens Faculty of Medicine, Attikon University Hospital, Rimini 1, T.K. 12463 Chaidari, Athens, Greece.
Telephone: +30-210-9822952 Fax: +30-210-5326411
Received: April 29, 2015
Peer-review started: May 12, 2015
First decision: August 25, 2015
Revised: September 15, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: November 21, 2015

AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.

METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.

RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described.

CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.

Keywords: Cooperative laparoscopic endoscopic, Hybrid laparoscopic, Laparoscopic endoscopic cooperative surgery, Endoscopy, Laparoscopy, Minimally invasive surgery, Gastrointestinal stromal tumors, Gastric cancer, Submucosal tumor

Core tip: Cooperative laparoscopic and endoscopic surgery for the resection of upper gastrointestinal tumors combines the advantages of intraluminal and extraluminal approach: precise lesion localization, safe excision and reconstruction. It has been used for the resection of benign submucosal tumors and Gastrointestinal stromal tumors. Novel techniques like inverted laparoscopic endoscopic cooperative surgery, laparoscopic assisted endoscopic full thickness resection, clean non exposure technique and non-exposed endoscopic wall-inversion surgery have emerged for the minimally invasive treatment of early gastric cancer. Their oncologic principles are sound and the first results encouraging. Soon, the close collaboration of laparoscopic and endoscopic teams will be “conditio sine qua non” for the institutions that seek excellence in the treatment of upper gastrointestinal neoplasias.