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Updated: Aug 22, 2025

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Published on: August 9, 2016

Submucosal Tunneling Techniques for Tumor Resection.

Zi-Han Geng¹, Ping-Hong Zhou¹, Ming-Yan Cai¹

¹Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.

Gastrointestinal Endoscopy Clinics of North America

|November 14, 2022

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Third space endoscopy allows access to deeper gastrointestinal layers by tunneling through the submucosa. This minimally invasive technique is safe and effective for various disorders, including tumor resection.

Area of Science:

Gastroenterology
Minimally Invasive Surgery
Endoscopic Techniques

Background:

Third space endoscopy accesses deeper GI layers by tunneling submucosally, preserving mucosal integrity.
A mucosal flap safety valve enhances secure submucosal space utilization.
This technique originated with peroral endoscopic myotomy for achalasia.

Purpose of the Study:

To review indications, techniques, clinical management, and adverse events of submucosal tunneling for tumor resection.
To highlight third space endoscopy as a minimally invasive surgical alternative.
To assess the safety and efficacy of submucosal tunneling techniques.

Main Methods:

Review of existing literature on submucosal tunneling techniques.
Focus on tumor resection applications within the third space.

Keywords:

Endoscopic submucosal tunnel dissection (ESTD)Extraluminal tumors Submucosal tumors (SMTs)Submucosal tunneling endoscopic resection (STER)Third space endoscopy

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Last Updated: Aug 22, 2025

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Published on: August 9, 2016

Analysis of clinical management and adverse event data.

Main Results:

Third space endoscopy has expanded to treat diverse GI disorders beyond achalasia.
Applications include mucosal/submucosal/extraluminal tumors, gastroparesis, Zenker diverticulum, and esophageal obstruction.
Studies indicate the technique is safe and effective with excellent outcomes.

Conclusions:

Submucosal tunneling techniques are a rapidly emerging, minimally invasive approach.
The technique offers a safe and effective alternative to conventional surgery for various GI conditions.
Further review of indications, management, and adverse events supports its clinical utility, particularly for tumor resection.