International Classic Surgical Video Contest of NOSES (Natural Orifice Specimen Extraction Surgery) is one of the authoritative competitions in the field of gastrointestinal surgery in China. On November 25, 2023, the 4^th International Classic Surgical Video Contest of NOSES (northwest division) was held in the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU). Professor Wang Xishan, Director of Department of Colorectal Surgery of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Chairman of China NOSES Alliance/International NOSES Alliance, served as Honorary Chairman of the contest. Professor Sun Xuejun from Department of General Surgery of the FAH of XJTU, and Professor He Xianli from Department of General Surgery of Tangdu Hospital of Air Force Medical University served as Executive Chairman of the contest. Expert judges were from the Second Affiliated Hospital of XJTU, the FAH of XJTU, Xijing Hospital of Air Force Medical University, Tangdu Hospital of Air Force Medical University, Shaanxi Provincial People's Hospital, Shaanxi Provincial Cancer Hospital, Xi'an Daxing Hospital, the 940^th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, the First Affiliated Hospital of Xinjiang Medical University and Xinjiang Uygur Municipal People's Hospital, respectively.

First, Professor Wang Xishan delivered an online speech, highlighting that the FAH of XJTU plays a regional leading role in the promotion of NOSES technology, and hoping that all participants can utilize International Classic Surgical Video Contest of NOSES to mutually learn from each other, make NOSES surgery more standardized and apply NOSES technology to the full potential.

After strict preliminary screening, 8 contestants from Shaanxi, Gansu and Qinghai provinces participated in the contest. All contestants demonstrated and orally illustrated surgical videos through anonymous online explanations, and two experienced experts in gastrointestinal surgery delivered scores and comments after watching surgical videos at the venue. This contest was brilliant and intriguing, attracting nearly 20,000 online viewers. It comprised classic NOSES-II, NOSES-III, NOSES-IV, NOSES-V, NOSES-VIII, and Da Vinci robot-assisted NOSES-I surgery. Each team fully demonstrated standardized aseptic and tumor-free operation, and also showcased a variety of innovative ideas and NOSES skills.

Finally, Physician Shi Feiyu from Department of General Surgery of the FAH Hospital of XJTU, and Physician Du Kunli from Department of Digestive Surgery of Xijing Hospital of Air Force Medical University grabbed the first prizes, and they will represent the Northwest Division to participate the National Finals of the 4^th International Classic Surgical Video Contest of NOSES in Shenzhen in January, 2024. Meantime, Shaanxi province team, composed of the FAH of XJTU, Xijing Hospital of Air Force Medical University and Shaanxi Provincial People's Hospital, will participate in the team competition of the 4^th International Classic Surgical Video Contest of NOSES.