Since 2000, there has been an impressive and growing body of published data dedicated to natural orifice translumenal endoscopic surgery (NOTES) from all over the world. This issue of the "Gastrointestinal Endoscopy Clinics of North America" seeks to harness this data and place perspective on the current and future position of NOTES for surgical interventions. The Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) has been instrumental in organizing, directing, and funding research with a mantra for safe introduction of NOTES to clinical practice. This issue focuses on topics that NOSCAR has touted for safe promulgation of NOTES.