Natural orifice transluminal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgical techniques with flexible endoscopy technology. Surgical treatment has been in constant evolution in the search for minimizing incisions, regardless of the complexity of the operation. NOTES represents another step in this ongoing progression toward less invasive procedures. The advantages of such an approach include reduced incisional pain, decreased wound complications, such as infections and hernias, improved cosmetic results, and potentially faster recovery and return to work. Until substantial improvement in NOTES instrumentation are made to optimize this approach, these procedures are likely to require laparoscopic assistance. Critics challenge the safety and advantages of this technique in the face of effective minimally invasive surgical options such as laparoscopic surgery. Here, we discuss the current NOTES status and techniques.