# Worldwide research tendencies on natural orifice transluminal endoscopic surgery: a bibliometric analysis

## TL;DR

This paper analyzes global research trends in natural orifice transluminal endoscopic surgery (NOTES) using bibliometric methods to understand its development and future directions.

## Contribution

The study provides a comprehensive bibliometric analysis of NOTES research, highlighting trends and key areas of focus from 1998 to 2025.

## Key findings

- The United States led in NOTES-related publications, with Surgical Endoscopy And Other Interventional Techniques being the most productive journal.
- Clinical trials have focused on the advantages of NOTES over traditional laparoscopic surgery and the efficacy of VNOTES in gynecological treatments.
- The keyword 'cholecystectomy' has seen increased popularity, indicating a growing focus on specific surgical applications.

## Abstract

Natural orifice transluminal endoscopic surgery, abbreviated as NOTES, a novel surgical technique, involves the insertion of a flexible endoscope into a natural orifice, such as the oral cavity, stomach, vagina, colon, or bladder, to access a specific site for endoscopically assisted surgical procedures. In recent years, endoscopy-mediated NOTES research has witnessed substantial progress.

This study seeks to offer a bibliometric analysis of the trends and prospects within the NOTES domain.

On January 3, 2026, this study utilized the Web of Science Core Collection (WOSCC) to retrieve literature related to NOTES. The R package “Bibliometrix” was employed to provide fundamental bibliometric data. VOSviewer was instrumental in conducting keyword analysis, authors analysis, and co-occurrence analysis. Meanwhile, CiteSpace was employed for the analysis of reference bursts and keyword bursts. Moreover, we obtained clinical trial data published within the study period via the PubMed database, aiming to assess clinical advancements in this domain.

This study identified a total of 2,196 publications spanning a 28-year period from 1998 to 2025. The United States led in the number of articles published, with Surgical Endoscopy And Other Interventional Techniques being the most prolific journal, and Harvard University emerging as the most productive institution. The keyword “cholecystectomy” has gained considerable popularity in recent years. Clinical trials in this field have focused on the advantages of NOTES over traditional laparoscopic surgery, as well as the surgical efficacy of VNOTES in the treatment of benign gynecological diseases. Through bibliometric analysis, this paper delineates a foundational intellectual framework, suggesting that NOTES is entering a novel phase of development and is poised to retain its academic significance in forthcoming research endeavors.