Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that utilizes the natural orifices of the human body (e.g., the mouth, anus, vagina and urethra) for surgical procedures. After insertion of an endoscope into organs such as the esophagus, stomach and urinary bladder, these hollow organs are intentionally cut to reach the peritoneal or thoracic cavity to perform various surgical procedures. NOTES is anticipated to become an important part of future medical procedures to treat diverse conditions that cannot endure ordinary surgery with the use of laparotomy or laparoscopy. To take advantage of this new technology, a number of researchers have devoted time and effort to improve both the basic and clinical aspects of NOTES in order to apply this medicinal art fully in the near future. In this review, we evaluate the status of NOTES and attempt to examine the future use of this promising technique that has also been subject to skepticism. (Korean J Gastrointest Endosc 2009;38:121-127)