Abstract: Objective To give a conceptual description of natural orifice translumenal endoscopic surgery (NOTES), review theearly efforts in the NOTES field, and discuss its challenges and limitations.Data sources The data were retrieved mainly from publications listed in MEDLINE, PubMed and China WanfangDatabase from 2005 to 2009. The search term was "NOTES". Study selection The articles involved in the "NOTES" study were selected and the review articles were excluded from the comparison. Results A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animalexperiments with "NOTES" have been carried out in China from 2007, and two independent "NOTES" procedures onhumans were reported in 2009. Conclusion Although still in its infancy, the "NOTES" procedure is promising as another type of minimally invasivesurgery and favorable alternative to current interventions.