Update in Natural Orifice Translumenal Endoscopic Surgery (NOTES)Bernhardt, Joerna,b; Sasse, Sarahb; Ludwig, Kajab; Meier, Peter N.cCurrent Opinion in Gastroenterology: September 2017 - Volume 33 - Issue 5 - p 346–351 doi: 10.1097/MOG.0000000000000385 ENDOSCOPY: Edited by Anthony Kalloo Abstract Author Information Purpose of review: The recent developments and clinical applications of natural orifice translumenal endoscopic surgery (NOTES)-procedures and technologies are going to be presented. Recent findings: In experimental as well as clinical settings, NOTES-procedures are predominantly performed in hybrid technique. Current experimental studies focus on the implementation of new surgical approaches as well as on the training of procedures. One emphasis in the clinical application is transrectal and transanal interventions. Transanal total mesorectal excision is equivalent to laparoscopic procedures but with the benefit of an even less invasive access. Transvaginal cholecystectomy can achieve results that are comparable to surgeries that are performed with laparoscopic techniques alone. An analysis of the German NOTES-Register concerning appendectomies as well as the national performance of NOTES-interventions in Switzerland is presented. Apart from intraabdominal approaches, several centers proclaim transoral thyroidectomies and transoral mediastinoscopies. Summary: NOTES-procedures are performed in animal experiments as well as in clinical setting although with less frequency. At this time, hybrid techniques using rigid instruments are mainly applied. aDepartment of Diagnostic and Interventional Endoscopy bDepartment of Surgery, Medical Center Suedstadt, Rostock cDepartment of Gastroenterology, Henriettenstift, Hannover, Germany Correspondence to Joern Bernhardt, MD, PhD, Head of Department of Diagnostic and Interventional Endoscopy, Medical Center Suedstadt, Suedring 81, 18059 Rostock, Germany. Tel: +49 381 4401 4000; fax: +49 381 4401 4099; e-mail: firstname.lastname@example.org Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.