The integration of laparoscopy and endoscopy has led to the emergence of colonoscopy-assisted natural orifice specimen extraction surgery (CA-NOSES) as a significant development in minimally invasive procedures. Natural orifice specimen extraction surgery (NOSES) is increasingly favored by surgeons for its benefits such as reduced trauma, faster recovery, better aesthetics, and lower psychological impact on patients. However, the Guidelines for Natural Orifice Specimen Extraction Surgery for Colorectal Tumors (2023 Edition) do not recommend transvaginal NOSES for unmarried women, women without prior childbirth, or married women who intend to conceive in the future. In male patients with early-stage tumors of the ascending colon, transverse colon, or descending colon, the implementation of natural orifice specimen extraction remains technically challenging because of current limitations in specimen extraction techniques and anatomical constraints. Consequently, its clinical application is still subject to certain limitations. CA-NOSES, incorporating endoscopy for specimen retrieval, broadens the scope of NOSES within defined criteria but demands skilled surgical teams and applies to specific cases. Concerns persist regarding aseptic practices, tumor spread, and infection risks during specimen extraction, necessitating robust research to verify surgical and oncological outcomes.