I attended this conference last weekend in Chicago to learn about the national and international surgical progress relating to NOTES. NOTES is a very innovative surgical approach to abdominal surgery. It uses natural orifices as access into the abdominal cavity. Examples of natural orifices include: mouth to stomach into the abdomen, vagina, rectum, and urethra. With this approach, patients are left without any visible scar on their abdominal wall (skin). The issues with this approach are very obvious. For instance, to remove the gallbladder through the vagina, although possible, leaves the patient with possible complications and pain at the access site, which can be completely avoided by accessing the abdominal cavity through the belly button instead of the vagina. Also, if the tran-gastric (thought the stomach) access is used, the surgeon runs the risk of having a leak at that site, which potentially will make the patient very ill. The advantage I see with the NOTES approach is the potential development of very innovative technology, which ultimately may be useful for minimally invasive surgery, more specifically single incision laparoscopic surgery. I enjoyed the conference, however, there was no real advancement in surgical technique or product development in the past year. Hopefully next year will be more productive.