Natural orifice specimen extraction for diverticular disease: technique, outcomes and role of inflammatory markers

Background: Minimally invasive colectomy is common for diverticular disease. Natural orifice specimen extraction (NOSE) is an innovative adjunct that avoids the morbidity of abdominal incisions. The aim of this study is to evaluate the outcome of NOSE in laparoscopic surgery for complications of diverticular disease, and assess the role of post-operative inflammatory markers. Methods: A multi-centre prospective study was conducted from 2012 to 2024. Consecutive patients who underwent emergency and elective NOSE colectomy for diverticular disease were included. Demographics, surgical techniques, post-operative complications and biochemical results were analysed. Results: NOSE colectomy was successful in 99.4% of patients (171/172), with a mean age of 59.9 years. Indications for surgery were phlegmon (35%), recurrent diverticulitis (27%), stricture (21%), fistulae (14%) and haemorrhage (2%). Mean length of stay was 5.7 days (SD 3.8), and anastomotic leak rate was 1.8%. Specimen longitudinal splitting increased operative time (254 vs. 220 min, p < 0.01) and length of stay (6.6 vs. 5.3 days, p = 0.02). Significantly higher inflammatory markers were observed in the longitudinal split group on post-operative days 2–4 without increased complication or anastomotic leak rates. Conclusion: NOSE colectomy demonstrates excellent perioperative outcomes in this large series and is an effective approach for diverticular disease. Specimen debulking facilitates successful NOSE procedures, with expected increases in inflammatory markers which are not associated with higher complication rates.