Use of the NOSE Technique for Minimally Invasive Laparoscopic Surgery and Robotic-Assisted Surgery in Deep Endometriosis

Introduction Laparoscopic surgery for colon diseases has seen increased use by surgeons due to its many advantages, such as reduced morbidity, less pain, and earlier ambulation compared to open surgery. Current techniques require an abdominal incision for specimen removal, which increases pain and complication rates, such as infection, hernia formation, and less favorable cosmetic outcomes. Thus, there is a trend toward performing intracorporeal anastomosis, and the technique called NOSE (Natural Orifice Specimen Extraction) has become more widespread either by opportunity or by choice. Current studies show benefits for patients who undergo this procedure, including improved postoperative pain, faster recovery, reduced nerve injury and surgical site infection, and fewer incisional hernias, leading to better cosmetic outcomes. This technique has a short learning curve, both in laparoscopy and robotic surgery.

Objective To demonstrate that transvaginal specimen extraction is a viable and safe approach in colorectal resection for deep endometriosis.

Method Video of surgery using the NOSE technique and retrospective analysis of hospitalization time, surgery duration, and incidence of fistulas in segmental rectosigmoidectomy.

Result A multidisciplinary surgical team from a large hospital in São Paulo performed a total of 1,216 surgeries, with 944 performed via robotic surgery and 272 via laparoscopy. There were no cases of conversion to laparotomy. The NOSE technique was used in 102 surgeries for specimen extraction. There was no increase in hospitalization time when comparing this technique to conventional surgery, and no increase in the incidence of rectovaginal fistulas.

Conclusion The NOSE technique is an interesting approach for patients undergoing rectosigmoidectomy for endometriosis. The complication rate appears comparable to the conventional surgical approach (minilaparotomy) and has shown to improve postoperative pain, enable early discharge, and reduce the risk of infection and hernia at the abdominal incision site.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025