Since the publication of the first paper on NOTES, a dramatic increase of activities in this new surgical field is to be observed. However, a "pure" NOTES operation does not yet exist. Only NOTES-like operations have been proposed so far. One of the essential barriers is the limited intraoperative performance due to the lack of suitable mechatronic platforms. Some solutions have already been suggested but they are still far from having any practical impact upon the development of more advanced NOTES procedures. The "Highly Versatile Single Port System", a two-armed device with two manipulators and a semi-flexible telescope, was developed to overcome these drawbacks. A transsigmoid cholecystectomy on a NOTES simulator (the ELITE) could be accomplished successfully in 75 minutes. We could therefore show that the HVSPS is in principle applicable for such a NOTES procedure. However, before these mechatronic support systems can be used under clinical conditions, required human machine interface and extended intelligence have to be solved.