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Background: Laparoscopic gastric resection has been well established in Asia but has been slow to develop in the United States. Few centers have been able to replicate the Asian experience with resection and outcomes. Methods: We present a single-institution retrospective study of our recent experience with laparoscopic gastric resections from January 2007 to August 2010. All patients undergoing planned resections for benign and/or malignant disease were included in this study. Our technique is similar to that described elsewhere in the literature. We routinely perform a modified D2 nodal dissection for all adenocarcinoma including peri-pancreatic, hepatic and celiac nodes, sparing only the splenic hilum. All anastamoses were completed intra-corporeally. Wedge resections were performed with linear staplers.Results: A total of 39 consecutive patients with a mean age of 67.72 years of age were included in our analysis. The study included 16 men and 23 women. Demographics, ASA status, pTNM stage, histologic type of the tumor, number of resected lymph nodes, and postoperative complications were studied. The operations performed included total gastrectomy (8 pts), subtotal gastrectomy (13 pts), distal gastrectomy (6 pts), and wedge resection (10 pts). Indications for resection were gastric adenocarcinoma in 22 patients (56.41%), GIST in 9 patients (23.08%), and ulcers or dysplasia in 8 patients (20.51%). One total gastrectomy (2.56%) was performed laparoscopic-assisted. The mean operating time was 262 minutes (median 257 min, range 86-635 min). Average blood loss was 177 cc (median 150 cc, range 25-600 cc). The average length of stay was 9.85 days (median 8 days, range 2-86 days). The mean time to bowel function was 3.88 days (median 3.5 days, range 1-9 days). The mean tumor size for GIST was 4.09 cm (range 1.4-13.3 cm). Mean tumor size for adenocarcinoma was 4.34cm (range 1.3-16.3 cm) and the mean number of lymph nodes harvested was 16.39 (median 15, range 4-32 nodes). All 31 patients with malignant disease achieved R0 resections. There was no mortality. There were no anastomotic leaks. Major post-operative morbidities (defined as reoperation for any cause, intra-abdominal abscess, further invasive procedure, or duodenal stump complication) occurred 9 times in 6 patients (15.38%). Minor post-operative morbidities occurred 14 times in 11 patients (28.21%). At the time of this report, one patient had died of unrelated causes, and all remaining patients were alive and free of disease.Conclusions: Laparoscopic gastric resection can be performed with equivalent or improved peri-operative outcomes relative to open gastrectomy, while maintaining oncologic principles. Long-term follow up is necessary to ensure oncologic equivalency. We are prospectively following all gastrectomy patients to report short and long term oncologic survival.