Objective To evaluate the feasibility, advantages and pitfalls of trans-gastric, trans-co- lonie and trans-umbilical peritoneoseopy, and to compare pure natural orifice transluminal endoscopic surgery （NOTES） with hybrid NOTES. Methods Two female pigs of 30kg were used in the study, one for pure NOTES, the other for hybrid NOTES. Each pig received trans-gastric, trans-eolonie and trans-umbilical per- itoneoscopy, respectively, followed by postmortem examination for organic lesions and closure of incisions. The two approaches were compared in terms of intra-operative situation and manipulation. Results The vital signs of the pigs were stable during the procedures, with no peri-ineision organic lesions. There were blind areas in trans-gastric as well as in trans-colonic peritoneoscopy. It was easier to close the colonic incision than the gastric one. The situation in trans-umbilieal peritoneoseopy was similar to laparoseopic surgery. Hy- brid NOTES seemed superior to pure NOTES with regard to safe access, stable pneumo-peritoneum and adequate visualization. Conclusion Three routes for NOTES appear to be reasonable and feasible. Hybrid NOTES is more effective and safer than pure NOTES with current instruments.