Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

Figure 5 Non-exposed endoscopic wall-inversion surgery. A: Endoscopic submucosal injection around the tumor; B: Laparoscopic seromuscular dissection around the tumor down to the stained submucosal plane; C: Retraction of the tumor with its overlying normal gastric wall towards the gastric lumen, and closure of the gastric wall by laparoscopic seromuscular extramucosal suturing; D: The gastric wall opening is completely closed and the tumor is invaginated inside the gastric lumen; endoscopic mucosal resection around the tumor with a needle knife. E: Endoscopic extraction of the tumor, and the gastric mucosa is approximated with clips.