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Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
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Mastering the third space: Innovations in intramural endoscopic surgery for gastrointestinal disorders
Gabriela Restrepo-Rodas1,2, John Rodriguez1,3
1General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi 00000, United Arab Emirates.
World Journal of Gastrointestinal Endoscopy
|January 2, 2026
Summary
Third-space endoscopy, or intramural surgery, advances minimally invasive gastrointestinal procedures by operating within the submucosal layer. This technique offers precise interventions for conditions like achalasia and gastroparesis, improving patient outcomes and recovery times.
Area of Science:
- Gastroenterology and minimally invasive surgery.
Background:
- Third-space endoscopy, a novel approach to gastrointestinal interventions, evolved from natural orifice transluminal endoscopic surgery.
- It involves creating a controlled submucosal working space for precise therapeutic procedures, minimizing risks associated with traditional surgery.
Purpose of the Study:
- To provide a comprehensive analysis of third-space endoscopy's evolution, technical advancements, and clinical outcomes.
- To highlight its expanding role in foregut surgery and its potential to transform gastrointestinal disorder management.
Main Methods:
- Review of current literature and evidence on third-space endoscopy techniques.
- Analysis of clinical outcomes, focusing on peroral endoscopic myotomy procedures.
Main Results:
- Third-space endoscopy enables precise interventions, notably peroral endoscopic myotomy for achalasia, gastroparesis, and Zenker's diverticulum.
- Recent advancements have expanded indications and improved safety, offering durable symptom relief and reduced recovery.
Conclusions:
- Third-space endoscopy represents a significant advancement in minimally invasive gastrointestinal surgery.
- Despite challenges in standardization and training, it holds substantial potential for managing complex foregut disorders.
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