Natural orifice translumenal endoscopic surgery (NOTES) has gained much attention worldwide since the first report of transgastric peritoneoscopy in a porcine model in 2004. In this review, we summarize and highlight the current status and future directions of NOTES. Thousands of human NOTES procedures have been performed. The most common procedures are cholecystectomy and appendectomy, mainly performed through transvaginal access in a hybrid fashion with laparoscopic assistance, and the general complication rate is acceptable. Although much work is still needed to refine the techniques for NOTES, the development of NOTES has the potential to create a paradigm shift in minimally invasive surgery.