Gastric cancer is the second most common malignancy worldwide, and surgical resection is the only curative treatment. Traditionally, open total gastrectomy has been the procedure of choice for large and proximal carcinomas. Over the past decade, however, laparoscopic gastrectomy has emerged and an oncologically safe and feasible alternative to open surgery, and its use has become particularly widespread in Japan and Korea. Patients in the United States have important biological and anatomic distinctions from East Asian patients, and these become important factors when considering minimally invasive resection techniques. The goal of this paper is to describe the technique we have developed for laparoscopic total gastrectomy in our 10-year experience with a western patient population.