From April 2018 to June 2022, four patients with small intestinal stromal tumors (SIST) underwent total laparoscopic resection of small intestinal stromal tumors by natural orifice specimen extraction without abdominal incision under general anesthesia. All operations were completed successfully. Postoperative pathology confirmed small intestinal stromal tumor. Median tumor diameter was 3.85 cm (1.2 cm~5 cm). Median operative time was 90 min (60~100 min). Median intraoperative bleeding was 10 mL (5~20 mL). Median postoperative exhaust time was 21 h (12~48 h). Mean postoperative hospital stay 5 d (4~7 d). No complications occurred. In selected patients with small intestinal stromal tumors, totally laparoscopic resection of small intestinal stromal tumors with natural orifice specimen extraction is safe and feasible, and has good short-term outcomes.