Systematic Reviews
Copyright ©The Author(s) 2015.
World J Gastroenterol. Nov 21, 2015; 21(43): 12482-12497
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12482
Table 1 Publications of cooperative laparoscopic endoscopic techniques with > 10 patients
AuthorsCountryYearStudy typeNo. Cases
Choi et al[20]Korea2000Retrospective series32
Shimizu et al[26]Japan2002Retrospective cohort11
Matthews et al[30]United States2002Retrospective cohort33
Ludwig et al[27]Germany2002Prospective case series18
Bouillot et al[19]France2003Multicenter retrospective case series561
Walsh et al[36]United States2003Retrospective series13
Hindmarsh et al[21]United Kingdom2005Retrospective series30
Schubert et al[28]Germany2005Retrospective series26
Mochizuki et al[24]Japan2006Retrospective series12
Novitsky et al[13]United States2006Prospective case series50
Huguet et al[22]United States2008Retrospective series33
Privette et al[15]United States2008Retrospective series12
Wilhelm et al[16]Germany2008Prospective case series93
Sasaki et al[25]Japan2010Prospective case series45
Kang et al[14]China2013Retrospective series101
Ohata et al[29]China2014Retrospective series22
Qiu et al[6]China2013Retrospective series69
Dong et al[68]China2014Retrospective cohort18
Tsujimoto et al[49]Japan2012Retrospective series20
Kawahira et al[46]Japan2012Retrospective cohort16
Hoteya et al[45]Japan2014Retrospective series25
Cho et al[56]Korea2011Prospective case series14
Hur et al[57]Korea2014Prospective case series13
Mori et al[54]Japan2015Prospective case series16
Shiwaku et al[71]Japan2010Prospective case series16
Table 2 Reported outcome for cooperative laparoscopic endoscopic techniques with > 10 patients
AuthorsYearTechniqueCasesLesionLocationLesion size (mm)Operative time (min)Blood loss (mL)LOS (d)
Choi et al[20]2000EAWR21SMT, leiomyo-sarcomaStomach(20-60)(80-180)NR(6-7)
LIGS10
Proximal gastrectomy1
Shimizu et al[26]2002EAWR11SMTStomachNR145 ± 4398 ± 10713.2 ± 3.7
Matthews et al[30]2002EAWR15GISTStomach45 (17-82)169 (65-300)106 (20-200)3.8 (2.7)
EATR3
Needlescopic LIGS (enucleations)3
Ludwig et al[27]2002EAWR18SMT, EGCStomachNR44.3 (31-67)NR7.5 (3-11)
LIGS867.1 (49-102)10.2 (6-16)
Bouillot et al[19]2003EAWR20SMTStomach38 (15-100)104 (40-120)NR6 (2-12)
Walsh et al[36]2003LIGS13SMTStomach38 (15-70)186NR3.8 (3-8)
Hindmarsh et al[21]2005EAWR30SMTStomach46.6 (12-90)73.8 (26-160)196 (0-1000)5 (1-11)
Schubert et al[28]2005EAWR16SMT, EGCStomach36 (16-47)53 (35-115)NRNR
LIGS7SMT, EGCStomach36 (16-47)83 (56-130)
Mochizuki et al[24]2006EAWR12SMTStomach27 (15-48)1100 (65-180)10 (0-100)17 (5-12)1
Novitsky et al[13]2006EAWR30SMTStomach44 (10-85)135 (49-295)NRNR
LIGS17
other3
Huguet et al[22]2008EAWR11SMTStomach39 (5-10.5)1NRNR3 (1-40)1
EATR
Privette et al[15]2008EAWR5SMTStomach52 (25-60)180 (122-262)80 (50-100)3.4 (2-5)
Distal gastrectomy355 (35-70)322 (256-340)167 (100-200)8.3 (8-9)
LIGS446 (25-75)236 (202-265)100 (50-200)3.3 (3-4)
Wilhelm et al[16]2008LAER1SMTStomach525NR2 (2)
EAWR5525 (3-65)81.2 (35-202)7.68 (4-19)
EATR3426 (5-55)114 (40-275)7.48 (2-14)
Sasaki et al[25]2010EAWR35SMTStomach32 (16-74)73 (30-150)3 (1-80)7 (5-14)
LIGS3145 (100-240)10 (3-65)8 (5-9)
Single port LIGS3
EATR4
Kang et al[14]2013EAWR97SMTStomach(10-82)113 ± 3636 ± 184.5 ± 2.1
Ohata et al[29]2014EAWR22SMT, EDCDuodenum13.3 ± 11.6133 ± 4516 ± 21.115.1 ± 7.7
Qiu et al[6]2013LAER5GISTStomach28 ± 1681.6 ± 31.829.8 ± 15.44.6
EAWR64GISTStomach86.3 ± 28.531.4 ± 11.6
Dong et al[68]2014MLIGS8SMTStomach27.5 ± 10.785 ± 25.7720 ± 10.47.5 ± 1.1
EFR1016.5 ± 5.9120 ± 34.7248 ± 31.910.2 ± 9.1
Tsujimoto et al[49]2012LECS20SMTStomach37.9 (18-66)157.5 (89-316)3.5 (0-20)11.6 (6-13)
Kawahira et al[46]2012LECS16SMTStomachNR172NR10
Hoteya et al[45]2014LECS25SMTStomachNR156NR10.5
Cho et al[56]2011LAEFR + Lymphadenectomy14EGCStomach26 (12-90)1143 (110-253)116 (5-30)16 (4-10)1
Hur et al[57]2014LAEFR + Lymphadenectomy9EGCStomach12 (4-32)181 (125-240)NR5.9 ± 1.3 (4-8)
LADG4
Mori et al[54]2015LAEFR16GISTStomach28.3 (8-54)271 (100-480)NR12.3 (10-15)
Shiwaku et al[71]2010Clean-NET16EGCStomachNR182.119.4NR
Table 3 Cooperative laparoscopic endoscopic techniques data comparison
Technique nameLesionLocationEndoscopy team roleSurgical team roleClosure typeSpecimen retrievalNo. papers2No. cases2
LAER[6,8,9,16]SMTStomach, DuodenumEndoscopic resectionMonitoringNo closureEndoscopic410
EAWR[6,13-29]SMT, EGCStomach, DuodenumTumor localization, exposureFull thickness resectionStapler/suturesSurgical17523
EATR[16,18,22,25,30,31]SMTStomachTumor localizationMucosal resection, full thickness resectionStapler/suturesSurgical670
LIGS[13,15,20,25,27,28,30,32,34-38]SMT, EGCStomachTumor localization, exposureMucosal resection, full thickness resectionStapler/sutures/endo clipsEndoscopic, surgical13101
ELIS[39-41]SMTStomachTumor localization, exposure, endoscopic guidanceStaplingStapler/suturesEndoscopic, surgical313
single port LIGS[25,42,43]SMTStomachTumor localizationMucosal resection, full thickness resectionOpen suturesSurgical313
LECS[44-51]SMT, EDCStomach, DuodenumSubmucosal dissectionSeromuscular disectionStaplerSurgical872
Inverted LECS[52]EGCStomachSubmucosal dissectionSeromuscular disectionStaplerEndoscopic11
LAEFR[53,55-57]SMT, EGC1StomachFull thickness resectionFull thickness resectionSuturesSurgical, endoscopic548
Clean-NET[58,71]SMT, EGCStomachTumor localization, submucosal injectionSeromuscular disectionStaplerSurgical116
NEWS[60,61]GIST, EGC1StomachSubmucosal dissectionSeromuscular disectionSuturesEndoscopic27
Table 4 Advantages and disadvantages of the various cooperative laparoscopic endoscopic techniques
Technique nameProsCons
LAERMinimally invasive approachSuitable for small lesions with intraluminal expansion
Monitoring and backup from the laparoscopic team in case of accidental perforationRequires advanced endoscopy skills
EAWRNo requirement of advanced laparoscopic or endoscopic skillsLeaves larger wall defects compared to other methods
Good entry level for teams starting cooperative techniquesRisk of gastric deformation or stenosis from stapling
EATRFavorable access to lesions ≤ 2 cm, situated high on the posterior wall or lesser curvature without mobilizing the stomachRequires gastrotomy closure
May lead to spillage with peritoneal contamination and dissemination
LIGSSimilar to EATRRisk of gastric deformation or stenosis from stapling
ELISSame as EATRSame as LIGS
Difficulty in orienting the stapler under endoscopic view
Single port LIGSLess invasive than the classic LIGSRequires previous experience in single port laparoscopy
The gastrotomy can be closed through the single port incisionMore difficult than EATR and LIGS
LECSCombines the advantages of both endoscopy and laparoscopy. No restriction in the size or location of the tumorRequires advanced endoscopy and laparoscopy skills. More adapted in high volume centers
Risk of spillage and contamination
Not adapted for early gastric cancer
Inverted LECSDiminishes the risk of peritoneal cancer disseminationNot adapted for early gastric cancer
LAEFRMinimal invasive endoscopic resectionRequires 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-NETDiminishes the risk of peritoneal dissemination of gastric cancerLimited literature
Requires special training
Risk of mucosal tear with cancer cell dissemination
NEWSDiminishes the risk of peritoneal dissemination of early gastric cancerLimited literature. Requires special training