Minimally invasive hybrid techniques combining endoscopy and laparoscopy have expanded therapeutic options for subepithelial gastric tumors and early neuroendocrine neoplasms. However, their implementation remains limited, and real-world data from European centers are still scarce. We present two-cases highlighting the organ-preserving and oncologic adequacy of laparoscopic–endoscopic cooperative techniques for challenging gastric lesions.
Case 1:Endoscopic evaluation in a 67-year-old woman revealed a 5-cm subepithelial lesion on the gastric lesser curvature, initially suggestive of leiomyoma. Given its size and location, we elected to perform laparoscopic-endoscopic cooperative surgery for local resection. The endoscopist delineated the lesion and performed semicircumferential submucosal injection and dissection with controlled full-thickness resection under laparoscopic assistance, after which the surgical team completed the procedure by retrieving the lesion and closing the gastric defect. Final pathology confirmed an R0 resection of a 5-cm low-mitotic index (Ki-67 1%) GIST, with no recurrence at 1-year follow-up.
Case 2: A 58-year-old patient with a type III gastric neuroendocrine tumor (NET) underwent non-exposed endoscopic wall-inversion surgery (NEWS), an endoscopy-driven full-thickness resection technique performed with laparoscopic assistance. Endoscopic inspection identified the lesion on the anterior gastric wall, in close proximity to the gastroesophageal junction, and allowed precise demarcation of its margins using coagulation marking. Under laparoscopic visualization, controlled seromuscular dissection was performed externally while preserving the integrity of the mucosal and submucosal layers. Endoluminal traction was established primarily through a snare, complemented by clip-line counter-traction to optimize lesion exposure and ensure stable tissue manipulation throughout the dissection. Following laparoscopic closure of the seromuscular defect, which resulted in inward inversion of the targeted gastric segment, the endoscopist completed an en bloc intraluminal resection using TT and IT knives. The specimen was retrieved in its entirety, without violation of the mucosal surface. Histopathologic examination confirmed a pT2, R0 gastric NET with a mitotic index of 13 mitoses per 2 mm² and no lymphovascular invasion. At the 6-month follow-up, both endoscopic ultrasound and contrast-enhanced computed tomography demonstrated no evidence of residual or recurrent disease.
Conclusion: These two cases illustrate the clinical value of advanced collaborative techniques such as LECS and NEWS for gastric tumors requiring precise, full-thickness resection while minimizing morbidity and preserving gastric anatomy. Both procedures achieved complete oncologic resection with uneventful recovery, emphasizing the role of multidisciplinary endoscopic–surgical strategies in expanding curative, organ-preserving options for selected gastric neoplasms.