ABOUT NOSES

 

Natural Orifice Specimen Extraction Surgery (NOSES) is an advanced minimally invasive surgical technique that enables removal of resected specimens through natural orifices, avoiding the need for an abdominal extraction incision. This approach aims to reduce surgical trauma, postoperative pain, wound complications, and improve cosmetic and functional outcomes while maintaining oncological safety and rigor.

 

Guided by the philosophy of “Minimal Invasion, Maximal Compassion,” NOSES integrates patient-centred care with surgical innovation, standardization, and international collaboration.

 

NOSES techniques have been developed across multiple surgical disciplines, including colorectal, gastric, gynaecologic, and urologic surgery.

 

The SCRS–NOSES Interest Group represents the first formal subspecialty interest group established within the Singapore Society of Colorectal Surgeons. Through this initiative, we aim to foster structured collaboration across institutions, promote academic and clinical excellence, and inspire the future development of additional cross-hospital subspecialty interest groups within SCRS.

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MEMBERS

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​The SCRS –NOSES Interest Group aims to serve as a regional academic and clinical hub for colorectal Natural Orifice Specimen Extraction Surgery in Southeast Asia. Its role includes promoting clinical standardization, supporting structured training, coordinating multicentre research, and strengthening international collaboration in alignment with the International Alliance of Natural Orifice Specimen Extraction Surgery (IMANOSES).

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CLINICAL PRACTICE

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Natural Orifice Specimen Extraction techniques may be applied in selected patients undergoing colorectal surgery for both benign and malignant conditions.

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Indications include:

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• Colorectal malignancy

• Benign colorectal disease (e.g. sigmoid volvulus, inflammatory conditions)

• Selected combined resections (e.g. colorectal and liver metastases)

 

Key NOSES techniques include:

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• Transanal Natural Orifice Specimen Extraction (TA-NOSE)

• Transvaginal Natural Orifice Specimen Extraction (TV-NOSE)

• Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES)

 

All procedures are performed within established institutional governance frameworks, guided by international expert consensus, careful patient selection, and continuous clinical audit to ensure safety and quality.

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RESEARCH AND REGISTRY

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The SCRS–NOSES Interest Group is developing a multicentre NOSES clinical registry to support:

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• Outcome monitoring and benchmarking

• Quality assurance and clinical governance

• International comparison and collaboration

• Generation of evidence-based clinical data

 

Current and ongoing research includes:

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• Long-term oncologic and functional outcomes

• Cost-effectiveness and health-economic analyses

 

Research efforts are aligned with international NOSES databases and collaborative studies under the International Alliance framework.

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TRAINING AND EDUCATION

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The Interest Group is committed to structured education and skill development in NOSES.

 

Future activities include:

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• Hands-on surgical workshops

• Live case demonstrations

• Simulation-based technical training

• Structured training pathways and competency development

• International observerships and exchange programmes with high-volume NOSES centres

 

These initiatives aim to promote safe adoption, technical standardization, and progressive expertise in NOSES.

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PUBLICATIONS

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Members of the SCRS–NOSES Interest Group have contributed actively to the academic development of Natural Orifice Specimen Extraction Surgery (NOSES), demonstrating its clinical benefits, safety, and utility in colorectal practice. Through ongoing research and technical innovation, the group has helped expand the indications and refine operative techniques for NOSES. A number of publications include detailed step-by-step surgical videos, which may serve as useful instructional resources for surgeons seeking to begin or further develop their NOSES practice.

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Selected publications

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1. Seow-En I, Chang SC, Ke TW, Shen MY, Chen HC, William Tzu-Liang Chen. Uncomplicated sigmoid volvulus is ideal for laparoscopic sigmoidectomy with transrectal natural orifice specimen extraction. Diseases of the Colon & Rectum. 2021;64(5):e90-e93.

2. Seow-En I, Koo CH, Chen LR, Tan EK. 3-port laparoscopic D3 right hemicolectomy with transvaginal natural orifice specimen extraction – a video vignette. Colorectal Disease. 2022;24(7):880-881.

3. Seow-En I, Koh YX, Tan EK. Transvaginal natural orifice specimen extraction following laparoscopic combined D3 right hemicolectomy and liver resection. Diseases of the Colon & Rectum. 2022;65(12):e1070-e1071.

4. Seow-En I, Chen LR, Li YX, Zhao Y, Chen JH, Abdullah HR, Tan EK. Outcomes after natural orifice extraction versus conventional specimen extraction surgery for colorectal cancer: a propensity score-matched analysis. World Journal of Clinical Oncology. 2022;13(10):789-801.

5. Seow-En I, Khor SN, Tan KW. Laparoscopic 3-port anterior resection with transvaginal natural orifice specimen extraction in a patient with high BMI: a video vignette. Colorectal Disease. 2022;24(11):1443-1444.

6. Seow-En I, Koh YX, Tan EK. Transanal natural orifice specimen extraction following combined laparoscopic anterior resection and liver resection. Diseases of the Colon & Rectum. 2023;66(5):e216-e217.

7. Seow-En I, Lin W, Chen LR, Tan EK. Three-port laparoscopic anterior resection for sigmoid cancer with transanal natural orifice specimen extraction and single-stapling colorectal anastomosis. Techniques in Coloproctology. 2023;27(8):695-696.

8. Seow-En I, Li KK, Khor SN, Tan EK. Laparoscopic sigmoid colectomy with transanal natural orifice specimen extraction for sigmoid volvulus – a video vignette. Colorectal Disease. 2023;25(8):1746-1747.

9. Seow-En I, Khor SN, Koo CH, Wee IJY, Tan EK. Transvaginal natural orifice specimen extraction in laparoscopic colorectal cancer surgery: new insights on technique and patient selection. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2023;33(5):571-575.

10. Seow-En I, Li KK, Khor SN, Tan EK. Three-port laparoscopic splenic flexure colectomy for descending colon cancer with intracorporeal colocolic anastomosis and transvaginal natural orifice specimen extraction. Videoscopy. 2023.

11. Seow-En I, Li KK, Tan EK. Intracorporeal antimesenteric ancillary trocar: an anastomotic technique facilitating natural orifice specimen extraction in left-sided colorectal surgery. Colorectal Disease. 2024;26(4):766-771.

12. Chang JHE, Xu H, Zhao Y, Wee IJY, Ang JX, Tan EK, Seow-En I. Transvaginal versus transabdominal specimen extraction in minimally invasive surgery: a systematic review and meta-analysis. Langenbeck’s Archives of Surgery. 2024;409(1):172.

13. Seow-En I, Koh YX, Tan EK, Tan EK. Simultaneous laparoscopic colectomy and liver metastasectomy with natural orifice specimen extraction: a proof-of-concept study. Heliyon. 2024;10(12):e33065.

14.  Seow-En I, Villanueva ME, Seah AWM, Tan EJKW, Ang JX. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) right hemicolectomy with intracorporeal anastomosis for cecal cancer. Techniques in Coloproctology. 2024;28(1):108.

15. Seow-En I, Lee TSQ, Tan EK, Ang JX. Vaginal natural orifice transluminal endoscopic surgery D3 right hemicolectomy with intracorporeal anastomosis for caecal cancer – a video vignette. Colorectal Disease. 2025;27(1):e17270.

16. Seow-En I, Ng WK, Padernal Villanueva ME, Tan EJ. Colorectal natural orifice specimen extraction surgery in an Asian cohort: does obesity matter? Minerva Surgery. 2025;80(4):293-299.

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EVENTS AND COLLABORATIONS

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​The SCRS–NOSES Interest Group participates in and organizes academic and clinical activities to promote collaboration, education, and knowledge exchange in Natural Orifice Specimen Extraction Surgery (NOSES).

 

A Colorectal NOSES Symposium was held at Khoo Teck Puat Hospital (KTPH) on 2 August 2025, featuring Professor Wang Xishan (Beijing), President of the International Alliance of Natural Orifice Specimen Extraction Surgery, as invited faculty. This landmark event marked the formation of the Singapore Branch of the International NOSES Alliance and helped inspire the subsequent establishment of the SCRS–NOSES Interest Group.

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Future activities include:

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• SCRS–NOSES Symposia and workshops

• Participation in international NOSES congresses and scientific meetings

• Collaborative research and academic partnerships

• Engagement with industry and research institutions for development of dedicated NOSES technologies and devices

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​​MEMBERSHIP AND CONTACT

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Membership in the SCRS–NOSES Interest Group is open to colorectal surgeons, surgical trainees, and researchers with an interest in minimally invasive colorectal surgery and Natural Orifice Specimen Extraction techniques.

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For enquiries or collaboration, please contact:

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SCRS–NOSES Interest Group Secretariat
Singapore Society of Colorectal Surgeons

Email: scrs@scrs.org.sg

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