Natural orifice specimen extraction surgery (NOSES) is a significant technological innovation in the field of minimally invasive surgery, hailed as “the minimally invasive surgery of minimally invasive surgeris”. By eliminating the need for an auxiliary abdominal wall incision for specimen extraction, NOSES may reduce the risks of incision-related pain, infection and incisional hernia, and facilitate postoperative recovery. Some studies have also reported advantages in psychological well-being and quality of life. From the novel perspective of the “abdominal wall organ theory”, this article systematically elaborates on the value of NOSES in preserving the structural integrity of the abdominal wall and protecting the function of the abdominal wall organ, and discusses its future directions under the concept of “minimally invasive surgery with organ protection (MIS-OP)”.