Natural orifice translumenal endoscopic surgery (NOTES) has attracted great interests from both of surgeons and gastroenterologists as a next generation minimally invasive surgery completely eliminating need for skin incision, and also a paradigm shift for flexible endoscopy to explore new frontiers beyond the confines of the gut wall. Various translumenal routes have been studied to access into the peritoneal cavity, and pros and cons of each procedure have been clarified. Although clinical introduction of NOTES has been spreading very slowly, technologies growing from the concept of NOTES may resolve an array of challenges currently associated with endoscopic surgery and flexible endoscopy. There is little dought that NOTES would yield rewards not only to surgeons, but also to gastroenterologists.