To analyze the current clinical application status of natural orifice specimen extraction surgery (NOSES) in China, providing important reference for its standardized and scientific promotion.

A WeChat-based questionnaire survey was conducted among physicians specializing in general surgery, oncological surgery, gynecology, and urology across China. The survey covered physician demographics, NOSES implementation status, challenges encountered, and the current state of NOSES technical training and research.

The survey covered 31 provinces, autonomous regions, and municipalities in China, yielding 1 710 valid responses. Among respondents, 1 166 (68.2%) performed NOSES procedures, while 544 (31.8%) did not. A total of 854 hospitals performed NOSES procedures, conducting 120 835 cases. By specialty: colorectal tumors (86 430 cases, 71%); gastric tumors (11 574 cases, 10%); gynecological tumors (5 612 cases, 5%); other benign conditions (17 219 cases, 14%). By specimen retrieval route: 95 553 cases (79.1%) via the anus, 23 383 cases (19.4%) via the vagina, and 1 375 cases (1.1%) via anterior rectal wall incision. By proportion of NOSES procedures among similar surgeries, 478 hospitals performed NOSES procedures accounting for less than 10% of similar surgeries, 317 hospitals performed them between 10% and 20%, and 59 hospitals performed them at over 20%. The survey revealed that most physicians primarily encountered NOSES techniques through large academic conferences (53%). Training methods predominantly involved attending workshops (42%) and watching live surgical demonstrations by experts (38%). 88% of surgeons who have performed NOSES believed that their assistants should receive training in NOSES techniques at experienced centers, while 92% of those who have not performed NOSES agreed that they themselves need to undergo such training. 50.3% of surgeons who have performed NOSES held the view that their assistants can be authorized to independently perform the procedure after completing 10~20 cases of hands-on training, and 55.3% of those who have not performed NOSES believed that they can independently carry out the procedure after such training. 290 individuals conducted NOSES-related research projects, with 212 publishing Chinese papers and 125 publishing English papers. Database data uploads (67 individuals) increased by 42.86%, 26.19%, 50.60%, and 131.03% respectively compared to previous periods. 83.2% and 82.7% of hospitals support their institutions and physicians in performing NOSES procedures, with 99.5% of treated patients expressing high satisfaction with NOSES outcomes.

NOSES surgery has gained widespread attention and experienced rapid growth in China, with over 120 000 procedures performed across disciplines including colorectal, gastric, gynecological, hepatobiliary, and urological surgery. It has generated positive impacts at the hospital, physician, and patient levels. In recent years, young and middle-aged physicians have become the main force performing NOSES procedures; primary-care physicians outside tertiary hospitals have acquired the capability to routinely perform NOSES surgery; major academic conferences have increased awareness of NOSES procedures, with surgical demonstrations and training workshops driving its dissemination. Training at accredited centers remains the most efficient pathway for young physicians to master the technique. Currently, NOSES-related research articles and projects continue to increase, with clinical studies gradually emerging to provide higher-level evidence-based support for the technique.