Letter to the Editor: "Conventional laparoscopic segmental bowel resection with mini-laparotomy specimen extraction compared with Natural Orifice Specimen Extraction (NOSE) procedures in patients with colorectal endometriosis"

Colorectal endometriosis, natural orifice specimen extraction (NOSE), laparoscopic surgery Facts Views Vis Obgyn 2026;18(3):281-282 282 evolution in practice rather than the surgical technique itself. Second, a number of potentially significant confounding factors, such as lesion complexity, disease severity, prior surgical history, and concomitant pelvic involvement, were not taken into account even though baseline data including age, body mass index, and symptom levels were compared. Additionally, neither multivariable regression analysis nor propensity score matching were used to reduce baseline imbalance across groups. Thus, residual confusion is still a possibility.4 Despite these considerations, we commend the authors for their valuable contribution to the growing body of literature on surgical management of colorectal endometriosis. Their study provides important insights into the feasibility and safety of NOSE techniques and highlights an evolving area of minimally invasive surgery. We appreciate the authors’ efforts in addressing this clinically relevant topic and believe their findings will stimulate further research. We concur that larger prospective, multicenter randomized studies are warranted to further clarify the comparative effectiveness and long-term outcomes of these surgical approaches.

Not applicable. Contributors: Concept: A.J.J., H.J., A.K., Design: A.J.J., H.J., A.K., Literature Search: A.J.J., H.J., A.K., Writing: A.J.J., H.J., S.H.A. Funding: The authors declared that this study received no financial support. Competing interests: No conflict of interest was declared by the authors. Ethical approval: Not applicable. Informed consent: Not applicable. Data sharing: Not applicable. Transparency: Not applicable.

1. Popov A, Mamedova S, Fedorov A, Kliushnikov I, Glebov T, Sopova J, et al. Conventional laparoscopic segmental bowel resection with mini-laparotomy specimen extraction compared with natural orifice specimen extraction (NOSE) procedures in patients with colorectal endometriosis. Facts Views Vis ObGyn. 2026;18:104-12. 2. Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J. 2003;20:54-60. 3. Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J. 2007;83:777-9. 4. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399-424.