Objective: This report analyzes the results of 10 years' experience using a novel laparoscopic technique for performing cystgastrostomy (LCG) for pancreatic pseudocysts. Methods: In 1991 we devised a unique radially-expanding trocar that could be inserted percutaneously into the gastric lumen and used as an access tool for performing an intragastric LCG. Once the setup is established, it is easy to make the opening between the stomach and an adherent posterior pseudocyst, and the puncture wounds in the anterior wall of the stomach from the trocars are simple to close. We report the results in 46 consecutive operations for pancreatic pseudocysts, which were thought possibly to be amenable to LCG. Treatment indications were a symptomatic retrogastric pseudocyst > 4cm on imaging studies. Results: Forty-six LCG were attempted in 45 patients. The etiology was gallstones in 22 (49%), alcohol in 11 (24%), trauma in 3 (7%), post ERCP pancreatitis in 3 (7%), and other in 6 (13%). The longest diameter of the pseudocyst was 11±5 cm (range 4.5-24). Success for the LCG was defined as a completely laparoscopic operation with permanent resolution of the pseudocyst. Thirty-six (76%) of the operations were successfully completed laparoscopically, and ten were converted. The principal reason for conversion was anatomy unsuitable for cystgastrostomy (8 cases). The operative time was 167±52minutes (range 96-295) for laparoscopic cases and 233±90 minutes (range 125-390) for converted cases. Operative blood loss for LCG cases was negligible in each. Median hospital stay for laparoscopic cases was 4±4.6 days (range 1-25). Postoperative bleeding, treated endoscopically, occurred in two LCG cases, one from the cystgastrostomy margin, and one from inside the cyst. The former was the only complication directly attributable to the laparoscopic technique itself. The cyst recurred in one (4%) laparoscopically treated patient, but this recurrent collection responded to reopening the anastomosis with a push from the tip of an endoscope. Conclusion: Laparoscopic intraluminal cystgastrostomy is a technically straightforward, highly successful, and much less invasive method than laparotomy for treating retrogastric pseudocysts. Currently, the average LCG takes less than 2-h. Most patients are eating a full diet within 48-h of surgery and are ready to be discharged shortly thereafter. The technique has few complications and a minimal recurrence rate. We recommend laparoscopic intragastric cystgastrostomy as the preferred surgical approach for retrogastric pseudocysts.