Natural orifice specimen extraction in robotic sigmoid resection for diverticulitis is associated with reduced postoperative pain and shorter operative time compared with transabdominal specimen extraction: a retrospective single-center study.

BACKGROUND: Natural orifice specimen extraction (NOSE) has emerged as a minimally invasive alternative to transabdominal specimen extraction (TASE) in robotic sigmoid resection for diverticulitis. However, comparative perioperative data remain limited. This study compared perioperative and postoperative outcomes of robotic sigmoid resection using NOSE versus TASE. METHODS: Fifty-two patients undergoing elective robotic sigmoid resection for diverticulitis between 2022 and 2025 were retrospectively analyzed, including 26 NOSE and 26 TASE procedures. Primary endpoints were operative time, postoperative pain assessed by Visual Analog Scale (VAS), and length of hospital stay (LOS). Secondary endpoints included inflammatory markers, hemoglobin changes, complications according to the Clavien-Dindo classification, time to first bowel movement, and analgesic requirements. Continuous variables were analyzed using Welch's t test or Wilcoxon rank-sum test, and categorical variables using chi-square or Fisher's exact test. RESULTS: Baseline characteristics did not differ significantly between groups. Operative time (108 vs 153 min; p < 0.001) and console time were significantly shorter in the NOSE group. Postoperative pain was significantly lower following NOSE at 24, 48, and 72 h (all p < 0.01). LOS showed a borderline difference favoring TASE (p = 0.051). No significant differences were observed regarding inflammatory markers, hemoglobin changes, or additional morphine requirements. Major and wound-related complications occurred exclusively in the TASE group (4 Clavien-Dindo ≥ II complications). CONCLUSIONS: Robotic NOSE appears to be a safe and feasible alternative to TASE in sigmoid resection for diverticulitis and was associated with shorter operative time, reduced postoperative pain, and fewer wound-related complications.