Natural orifice translumenal endoscopic surgery (NOTES™) was officially born in 2005 when a forward thinking group of gastroenterologists and surgeons convened to discuss, organize, codify, and elucidate concerns about this potential new disruptive surgical idea. This meeting came on the heels of a report of “flexible transgastric peritoneoscopy” from Johns Hopkins University and several subsequent experiments in animal models expanding upon the possibilities this technique represented . The NOTES moniker was adopted at this meeting, as was the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR®) . But a peek into the history of surgery via the natural orifice reveals that the idea was an old one, dating back into the 1800s in some cases. Many animal experiments were performed, demonstrating many new and novel techniques to commonly performed operations, and scientific investigation was undertaken to determine the safety and feasibility of these approaches. Human work began to emerge in 2005 and continues to develop; in some cases, becoming widely adopted.