With the continuous improvement and maturation of laparoscopic technology and the deepening of surgeons’ understanding of the concept of minimally invasive surgery, the application of laparoscopic technology in gastrointestinal tumor surgery has been widely popularized and promoted. The application of laparoscopic technology in gastric cancer surgery has also become a hot issue explored and discussed by gastrointestinal surgeons in recent years. Because of the strong specialization of radical gastric cancer surgery and the technical difficulty of laparoscopic technology, the application of laparoscopic gastric cancer surgery technology in gastrointestinal surgery at home and abroad is still limited to a certain extent. The concept of laparoscopic radical gastric cancer surgery and minimally invasive concept of laparoscopic radical gastric cancer surgery is precisely the application of laparoscopic technology to complete the traditional radical gastric cancer surgery, which is the product of the surgeon combining a new technology with traditional surgical methods. Therefore, there are different surgical procedures such as laparoscopic partial resection of gastric cancer, laparoscopic major distal gastrectomy (LADG), laparoscopic major proximal gastrectomy (LAPG), laparoscopic total gastrectomy (LAPG), and even combined laparoscopic total gastrectomy, pancreatic tail, and spleen. According to the different characteristics and methods of laparoscopic technology application, it can be divided into three types of procedures, such as completely laparoscopic gastric cancer surgery, laparoscopic-assisted gastric cancer surgery and hand-assisted laparoscopic gastric cancer surgery (HALS). After more than 10 years of clinical practice and experience, laparoscopic-assisted gastric cancer surgery is now most frequently used by surgeons, which fully reflects the superiority of minimally invasive and the effectiveness of radical gastric cancer surgery. At the same time, according to the lymph node clearance scope of laparoscopic radical gastric cancer surgery, it can be divided into D1 surgery and D2 surgery. At the early stage of applying laparoscopic technology to such complex surgery as gastric cancer surgery, people often focused more on the process of laparoscopic technology application, technical success and perfection, and excessively pursued radical gastric cancer surgery under full laparoscopy, thus ignoring the increased difficulty of the technology under full laparoscopy, which prolonged the operation time, and the harm to patients caused by the increased trauma. Therefore, it is important to emphasize that the minimally invasive concept is the fundamental purpose of laparoscopic techniques applied to conventional procedures. The application of laparoscopic techniques is a means to achieve the minimally invasive concept, to reduce the damage to the patient, and not to perform laparoscopic surgery for the purpose of performing laparoscopic techniques. All applications of laparoscopic techniques that go against the minimally invasive concept are undesirable. From several clinical comparison studies between laparoscopic radical gastric cancer surgery and open radical gastric cancer surgery reported from abroad in recent years, it can be seen that patients who underwent laparoscopic gastric cancer surgery had less bleeding during surgery, less postoperative pain, faster recovery of gastrointestinal function, and shorter hospital stay, while the operation time was similar to or slightly longer than that of open surgery. These clinical findings demonstrate the minimally invasive superiority of laparoscopic radical gastric cancer surgery. Moreover, the results of relevant comparative studies also prove that laparoscopic radical gastric cancer treatment follows the principle of radical tumor treatment and achieves good near-term and long-term efficacy. Difficulties in performing laparoscopic radical gastric cancer surgery and rational selection of surgical indications Standard radical gastric cancer surgery includes adequate gastric resection and regional lymph node dissection. Therefore, one of the difficulties of laparoscopic radical gastric cancer surgery is the D2 lymph node dissection in standard radical surgery. The extent of gastrectomy and the number of lymph node groups to be dissected are different for different sites of gastric cancer. The LADG should include: N01, 3, 4, 6, 5, 8, 12a, 7, 9, 11p, 14v; LAPG should include: N01-4, 7, 8, 9, 10, 11; LATG should include: N01-7, 8a, 9, 10, 11, 12a. and the lymph nodes in the hepatoduodenal ligament that are closely connected to the hepatic artery are the most difficult to dissect. If the technique is not performed properly, the vessels can be easily injured, or the view can be blurred or the patient can be forced to undergo a laparotomy. Due to the magnification of the laparoscopic image, the identification of the vascular anatomy and lymph nodes is much clearer, which in theory makes lymph node dissection easier. However, in actual surgery, the flat laparoscopic images make it more difficult to determine the anatomical position of the body and the surgeon lacks direct hand contact with the anatomical site, thus placing higher technical demands on the surgeon. Due to the need for fine dissection, a 5-mm ultrasonic knife should be chosen for lymph node dissection in laparoscopic radical gastric cancer surgery, or some surgeons may use an electric knife in conjunction with dissection based on their experience. Some surgeons have also reported in the literature that an auxiliary port can be used to perform lymph node dissection to reduce the difficulty and time of surgery. Therefore, it is certain that lymph node dissection is a difficult and key point in laparoscopic radical gastric cancer surgery, which requires surgeons to have both a proficient foundation in surgical anatomy of gastric cancer and a skilled laparoscopic operation technique, one of which is indispensable. From the historical development of laparoscopic gastric cancer surgery technology, Japanese surgeon Kitano first reported the application of laparoscopic technology in gastric cancer surgery in the early 1990s. Subsequently, clinical experience of laparoscopic gastric cancer surgery was reported by European and American scholars and many Japanese scholars in the relevant foreign literature one after another. Most of the cases selected were early gastric cancer patients who underwent laparoscopic radical gastric cancer surgery + D1 lymph node dissection. Later, patients with progressive gastric cancer were also gradually selected for laparoscopic radical gastric cancer surgery + D2 lymph node dissection. Worldwide, laparoscopic radical gastric cancer surgery is used in the majority of cases of early gastric cancer. Therefore, we can conclude that the application of laparoscopic radical gastric cancer surgery is more suitable for early gastric cancer, both in terms of technical difficulty and in terms of the effect of tumor eradication. For laparoscopic surgery for progressive gastric cancer, the preliminary results of existing domestic and international clinical studies show that laparoscopic techniques can achieve the same adequate margins and standard D2 lymph node dissection as open surgery. However, the clinical practice and related studies on laparoscopic radical surgery for progressive gastric cancer are still limited, both in terms of the number of cases and the scope of surgery performed, which is still limited to a few cases in a few hospitals in the field of gastrointestinal surgery both at home and abroad. Most scholars believe that stage II and some stage IIIa patients should be selected and laparoscopic gastric cancer surgery should be performed by experienced gastrointestinal surgeons who are skilled in laparoscopic techniques. For progressive gastric cancer beyond T3N2, laparoscopic radical gastric cancer surgery should not be performed, but open surgery should be performed. This is because whole tumor resection and D3 lymph node dissection for such cases are difficult to accomplish laparoscopically. Laparoscopic radical surgery for progressive gastric cancer carried out blindly, indiscriminately, and without technical preparation may lead to failure of surgical treatment for gastric cancer, seriously affecting the efficacy and inevitably contradicting the minimally invasive purpose of laparoscopic surgery. In conclusion, the selection of cases for laparoscopic radical gastric cancer surgery should be based on the premise that the principle of tumor eradication can be achieved. In terms of procedure selection, laparoscopic major distal gastrectomy (LADG) for lower gastric cancer should be preferred. Currently, LADG has been performed in the largest number of cases worldwide. Although many clinical experiences have demonstrated that laparoscopic proximal gastrectomy or total gastrectomy (LAPG, LATG) can be performed technically, it is much more difficult, especially the reconstruction of the gastrointestinal tract and the anastomosis at the esophagus. Therefore, LADG should be preferred in the initial stage of laparoscopic gastric cancer surgery, and LAPG and LATG should be performed carefully after sufficient experience has been accumulated. The current situation and development prospect of laparoscopic radical gastric cancer surgery From the history of laparoscopic radical gastric cancer surgery, it has been more than 10 years since the clinical report of Kita-no in the early 1990s. The history of laparoscopic radical gastric cancer surgery Laparoscopic radical surgery for gastric cancer has also evolved from initial technical exploration and clinical practice summary to various prospective, comparative, and multicenter clinical studies, including studies on D2 lymph node dissection for progressive gastric cancer, the effectiveness of radical tumor treatment, and the evaluation of survival rate indicators for long-term follow-up outcomes. For example, Dulucq et al. recently conducted a prospective comparative study of patients with progressive gastric cancer, comparing laparoscopic total gastrectomy with open total gastrectomy, and laparoscopic major gastrectomy with open major gastrectomy for gastric cancer in terms of intraoperative and postoperative parameters. Azaqra et al. showed that laparoscopic gastrectomy with various lymph node dissection is a safe and effective way to remove lymph nodes in a prospective study of 101 patients with gastric cancer and long-term follow-up. The results of the prospective study and long-term follow-up of 101 patients with gastric cancer showed that laparoscopic gastrectomy with various lymph node dissection was safe and effective, and laparoscopic gastrectomy for patients with progressive gastric cancer could achieve the same goal of tumor eradication as open surgery. From the results of these clinical studies, it can be seen that laparoscopic radical gastrectomy for gastric cancer has gradually matured in terms of technical feasibility and tumor curative properties. However, the results of these studies were based on the premise that they were performed by surgeons with extensive clinical experience and proficiency in laparoscopic techniques, and therefore do not represent a technique that can be performed by all surgeons with such good results. If laparoscopic radical gastric cancer surgery is widely performed or performed without adequate technical preparation, it will definitely affect the efficacy of radical gastric cancer surgery. In our opinion, laparoscopic radical gastric cancer surgery should be performed in large hospitals with sufficient surgical experts, rich clinical experience in radical gastric cancer surgery and skilled laparoscopic techniques, and in a gradual manner from simpler to more complex techniques, from early gastric cancer to progressive gastric cancer, from distal gastric cancer to gastric body and proximal gastric cancer. In this way, we can ensure that laparoscopic radical gastric cancer surgery is carried out on the premise of obtaining good clinical efficacy and facilitating the development of this new technology of laparoscopic gastric cancer surgery. We believe that laparoscopic radical gastric cancer surgery will become an increasingly mature surgical method in the surgical treatment of gastric cancer through the joint efforts of specialists in gastrointestinal oncology and experts in laparoscopic technology.