Combined surgical and endoscopic approaches to full-thickness resection

With the emergence of advanced endoscopic technologies and techniques, endoscopic resection has emerged as an important therapeutic modality. However, endoscopic full-thickness resection can be limited by concerns for R0 resection, margins, potential for seeding the peritoneal cavity, perforation, or difficulty in closing the full-thickness defect. Combined laparoscopic surgery with endoscopic-full thickness resection has become an important cooperative strategy that leverages the unique skillsets of both the endoscopist and the laparoscopic surgeon. Several techniques have emerged that range from endoscopic resection with laparoscopic assistance, laparoscopic resection with endoscopic assistance, and finally to truly cooperative laparoendoscopic surgery. The application of combined laparoscopic surgery and endoscopic full-thickness resection shows great promise especially for subepithelial tumors of the upper gastrointestinal tract, but more widespread applications need to be tempered by focusing on clinical benefit to the patient.