Laparoscopic-endoscopic cooperative surgery procedure in Korea : the present and future

Minimally invasive surgery, including laparoscopic and endoscopic procedures, has transformed gastrointestinal treatment by reducing recovery times and improving outcomes.However, submucosal tumors and subepithelial lesions remain challenging to manage with these techniques alone.Laparoscopic-endoscopic cooperative surgery (LECS), introduced by professor Hiki, combines laparoscopic and endoscopic approaches to overcome these limitations, enabling precise tumor localization, complete resection, and improved oncological outcomes.LECS involves endoscopic dissection of mucosal layers and laparoscopic resection of seromuscular layers, making it effective for tumors in difficult-to-access regions.Despite its benefits, its adoption in South Korea faced regulatory hurdles due to separate procedural environments for endoscopy and laparoscopy.Recently approved as a "new medical technology in 2024," LECS demonstrates superior resection and recurrence rates compared to traditional methods.Applications include endoscope-assisted wedge resection, non-exposed endoscopic wall-inversion surgery, and combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), each tailored to specific tumor locations.LECS's recognition in Korea highlights its potential as a cornerstone of advanced minimally invasive surgery.