Asian Journal of Case Reports in Surgery

Introduction: Natural orifice specimen extraction (NOSE) has become an important extension of minimally invasive colorectal surgery, enabling removal of the surgical specimen through a natural orifice rather than an abdominal incision. By avoiding a dedicated extraction site, this approach may help reduce postoperative pain, wound-related complications, and the long-term risk of incisional hernias.

Case Presentation: We report the case of a 44-year-old woman with recurrent episodes of uncomplicated sigmoid diverticulitis and a history of multiple abdominal procedures ( two cesarean sections, abdominoplasty, and laparoscopic cholecystectomy). She underwent elective laparoscopic sigmoidectomy with intracorporeal anastomosis and transanal specimen extraction. Intraoperatively, anvil positioning proved to be the most technically demanding step. Her postoperative course was favourable, and she was discharged on postoperative day 5.

Discussion: As minimally invasive colorectal surgery continues to evolve, NOSE techniques provide an alternative to mini-laparotomy for specimen retrieval. Evidence suggests that NOSE offers comparable surgical and functional outcomes to traditional laparoscopy while reducing abdominal wall trauma and translating into lower postoperative pain, surgical site infection and incisional hérnia. These benefits are particularly relevant in patients with previous abdominal operations, who inherently carry a higher risk of wound-related morbidity.

Conclusion: Transanal NOSE in laparoscopic sigmoidectomy is a safe and effective alternative for selected cases of diverticular disease, offering reduced wound morbidity and faster recovery.