We present the case of a 60-year-old man with a family history of gastric and breast cancer. He was found to carry the CDH1 gene mutation that confers a 70% lifetime risk of diffuse gastric cancer. After discussion of surgical options, he underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy. Although no consensus exists regarding prophylactic gastrectomy in mutation carriers, it is clear that endoscopic surveillance is of limited effectiveness and diffuse gastric cancer carries a grim prognosis. In this video, we demonstrate that prophylactic laparoscopic total gastrectomy can be performed safely and may be an excellent therapeutic option for these patients.