Apparatus and methods for transgastric tissue manipulation are described herein. Procedures are performed transgastrically through a trocar or insert, e.g., to create tissue plications and approximating those plications towards one another for accomplishing gastroplasty procedures. The trocar is positioned through the abdominal wall of the patient and into the stomach. A multi-lumen insertion tool is positioned within the trocar and comprises one or several channels, e.g., two, three, or more channels as practicable, through the single insertion tool. Each of the channels is aligned and individually sealable with a reversible seal which allows for insertion or removal of a tool therethrough without comprising sealing of the entire trocar or port. A proximal section of the shafts comprise a flexible section to allow for the flexing of each respective control handle away from one another such that the surgeon can manipulate the tools without interference between the handles.