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The <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> concept was initially developed from the classical <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> procedure for gastric submucosal tumor resection. Many researchers reported that classical <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> was a safe and feasible technique for resection of gastric submucosal tumors, regardless of tumor location, including the esophagogastric junction. Recently, <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> was approved for insurance coverage by Japan's National Health Insurance plan and widely applied for gastric submucosal tumor resection. However, the limitations of classical <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> are the risk of abdominal infection, scattering of tumor cells in the abdominal cavity, and tumor cell seeding in the peritoneum. The development of modified <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> procedures, such as inverted\u2010<jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content>, non\u2010exposed endoscopic wall\u2010inversion surgery, a combination of laparoscopic and endoscopic approaches to neoplasia with a non\u2010exposure technique, and closed\u2010<jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content>, has almost resolved these drawbacks. This has led to a recent increase in the indication of modified <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> to include patients with gastric epithelial neoplasms. The <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> concept is also beginning to be applied to tumor excision in other organs, such as the duodenum, colon and rectum. Further evolution of <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> procedures is expected in the future. Sentinel lymph node mapping could also be combined with <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content>, resulting in a portion of early gastric cancers being treated by <jats:styled-content style=\"fixed-case\">LECS<\/jats:styled-content> with sentinel node mapping.<\/jats:p>","DOI":"10.1002\/ags3.12238","type":"journal-article","created":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T14:10:28Z","timestamp":1550585428000},"page":"239-246","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Laparoscopic endoscopic cooperative surgery (<scp>LECS<\/scp>) for the gastrointestinal tract: Updated indications"],"prefix":"10.1002","volume":"3","author":[{"given":"Naoki","family":"Hiki","sequence":"first","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery Kitasato University School of Medicine  Sagamihara Kanagawa 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