Natural orifice transluminal endoscopic surgery is an advanced surgical methodology that utilizes flexible endoscopes passed through natural external orifices to gain access to the peritoneal cavity and other internal spaces by creating a controlled transmural incision. This research concept investigates the feasibility and safety of performing intra-abdominal and intrathoracic procedures without external skin incisions. Its key characteristics include the potential for reduced postoperative pain, faster recovery, and the avoidance of visible scarring, while presenting significant technical challenges related to instrumentation, orientation, and secure access site closure. As a field, it explores novel endoscopic platforms, techniques for tissue manipulation and anastomosis, and the expansion of indications for ultra-minimally invasive interventions.