Surgical scars, in the more than 100-year history of surgical development, were considered to be an inevitable product of surgery, and in order to obtain adequate field exposure, larger surgical incisions had to be used for major operations, hence the saying “big doctors, big incisions”. Until the 1980s, the rise of minimally invasive laparoscopic surgery technology made people gradually realize that small incisions through the abdominal wall can also perform conventional abdominal surgery, and have the advantages of fast postoperative recovery, less patient pain and good cosmetic results. With the popularization of minimally invasive technology and the concept of minimally invasive, people gradually change their understanding of the previous surgical approach, and “big doctor, small incision” is the future direction of surgical development. In recent years, a new technique that nearly overturns the traditional concept of surgery has attracted the great interest of laparoscopic surgeons and endoscopic endoscopists, and has become the focus of research and debate, which is called “scarless surgery”, NOTES: Natural Orifice Transluminal Endoscopic Surgery (NOTES). As far as the development of NOTES is concerned, the scope of its clinical application is still quite limited due to a more cautious attitude, and it is still mainly at the stage of animal experimental validation. Non-technical questions such as who and where to perform NOTES and the training of physicians need to be further answered. Of course, there are still a significant number of physicians who are skeptical of NOTES and see limited potential for its development. However, there are still many endoscopists and lumpectors who are enthusiastic about the development of NOTES, and the development of related devices has contributed to further research related to NOTES. It can be said that NOTES is one of the most controversial and fastest growing research topics in recent years. The emergence of NOTES has profoundly changed people’s perception of the traditional concept of surgery. We will pay close attention to its future development.