The article discusses the emerging field of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which aims to perform major intraperitoneal surgeries without skin incisions. The American Society of Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) held a meeting in July 2005 to discuss the potential benefits and challenges of NOTES. Key benefits include reduced pain, faster recovery, and better cosmetic outcomes compared to current laparoscopic techniques. The group identified several barriers to the safe introduction of NOTES, including the need for secure gastric closure, understanding physiological changes, and managing intraperitoneal complications. They also discussed optimal peritoneal access techniques, the importance of infection prevention, and the development of suturing and anastomotic devices. The group agreed on the need for a multidisciplinary team with advanced endoscopic and laparoscopic skills, animal laboratory facilities, and adherence to ethical guidelines. The working group, named the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), aims to expand participation and advance the field through research and training.The article discusses the emerging field of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which aims to perform major intraperitoneal surgeries without skin incisions. The American Society of Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) held a meeting in July 2005 to discuss the potential benefits and challenges of NOTES. Key benefits include reduced pain, faster recovery, and better cosmetic outcomes compared to current laparoscopic techniques. The group identified several barriers to the safe introduction of NOTES, including the need for secure gastric closure, understanding physiological changes, and managing intraperitoneal complications. They also discussed optimal peritoneal access techniques, the importance of infection prevention, and the development of suturing and anastomotic devices. The group agreed on the need for a multidisciplinary team with advanced endoscopic and laparoscopic skills, animal laboratory facilities, and adherence to ethical guidelines. The working group, named the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), aims to expand participation and advance the field through research and training.