Endometriosis affects approximately 10% of reproductive-age women1 causing considerable discomfort and functional impairment when deep infiltrative endometriosis (DIE) involves the bowel, bladder, ureter, and vagina2,3 Surgical intervention is often necessary for cases resistant to medication or associated with subfertility.4 Surgical management options for DIE include various techniques, leading to varying practices due to differences in training and institutional preferences.5,6

Traditional large tissue resections typically involve expanding skin incisions for effective extraction.7 However, an innovative approach, known as Natural Orifice Specimen Extraction (NOSE), introduced in 1996 by Redwine et al.8, has gained attention. NOSE leverages natural body orifices, such as the anus, for tissue removal, offering potential benefits such as faster recovery and reduced postoperative hernia risk.9,10 While concerns about contamination risks and anastomosis quality in bowel surgery persist11, emerging research supports NOSE as a promising alternative to traditional minilaparotomy.12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23

Although NOSE marked a surgical milestone, it also introduced new challenges, including fears of fistulas and infection, especially among general surgeons.24 This study aims to evaluate the safety and efficacy of NOSE compared to minilaparotomy in treating bowel endometriosis by analyzing operation duration, hospital stay, blood loss, and postoperative complications. The findings could contribute to better-informed surgical decisions and improved patient outcomes in the management of this challenging condition.