Review Collaboration between laparoscopic surgery and endoscopic resection: An evidence-based review Anthony Yuen Bun Teoh and Philip Wai Yan Chiu CUHK Jockey Club Minimally Invasive Surgical Skills Center and Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Developments in endoscopy and laparoscopy have made monu- mental changes to the way gastrointestinal diseases are being managed. Many diseases that were traditionally managed by open surgical resection could now be treated by endoscopy alone. However, there are still instances where endoscopic treat- ment alone is inadequate for disease control and laparoscopic surgery is required. In addition, the collaboration between lapa- roscopic surgery and endoscopic submucosal dissection or other endoscopic resectional techniques represents a new frontier for further research. The present manuscript aims to discuss the complementary role of laparoscopic surgery to endoscopic resection in the traditional context and also its future development. Key words: endoscopic submucosal dissection (ESD), gastric cancer, gastrointestinal stromal tumor, laparoscopic surgery, robotic endoscopic system INTRODUCTION D EVELOPMENTS OF ENDOSCOPY and laparoscopy have made monumental changes to the way gastroin- testinal diseases are being managed. These technologies have reduced the need for invasive procedures and improved patient outcomes. Many diseases that were traditionally managed by surgical resection could now be treated by endoscopy alone. The use endoscopic submucosal dissection (ESD) has revolutionized the treatment of early gastric cancer. 1–4 The procedure allowed for preservation of the function of the stomach and reduced the need for extensive surgery with its associated morbidities and mortalities. 5 However, there are still instances where endoscopic treat- ment alone is inadequate for disease control and laparo- scopic surgery is required. In addition, collaboration between laparoscopic surgery and ESD or other endoscopic resectional techniques represents a new frontier for further research. The availability of endoscopic-laparoscopic oper- ating rooms with compatible systems allowing simultaneous collaboration further enhances this advancement. 6 Current endoscopes and laparoscopes are also gaining functionality. Magnifying endoscopes with narrow-band imaging (NBI) are now in high definition and 3-D laparo- scopes with augmented imaging through computed tomog- raphy (CT) are becoming a reality. 7,8 It is thus not unimaginable that, in the near future, laparoscopes may be equipped with magnifying lenses to aid diagnosis of perito- neal metastasis during surgery or endoscopes be equipped with 3-D navigation systems that allow visualization of extraluminal organs during the procedure. The advent of natural orifice transluminal endoscopic surgery (NOTES) further made the distinction between the two instruments even more ambiguous. 9,10 The present manuscript aims to discuss the complementary role of laparoscopic surgery to endoscopic resection in the traditional context and also its future development. This review focuses on how the strategies can complement each other in certain clinical scenarios, but will not discuss the role of ESD in patients with prior surgical resection of the gastro- intestinal tract or the carrying out of surgery for complica- tions of ESD. Studies were identified by carrying out electronic searches of MEDLINE, EMBASE, Current Con- tents, Cochrane Library, and Entrez PubMed until June 2013. Only English articles with human subjects were included. Corresponding: Philip W. Y. Chiu, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, New Territories, Hong Kong. Email: philipchiu@surgery.cuhk.edu.hk This study was not supported by any research grant. Received 26 June 2013; accepted 18 September 2013. Digestive Endoscopy 2014; 26 (Suppl. 1): 12–19 doi: 10.1111/den.12193 © 2013 The Authors Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society 12