Gynecologists have long considered transvaginal access to the peritoneum as a safe route of entry into the abdomen. Transvaginal hysterectomy and transvaginal tubal ligation have indeed become a regular part of the gynecologic armamentarium. NOTES surgeons have learned from this access approach and have begun to employ it as a safe route into the abdomen. In fact, investigators in New York1,2; San Diego3; Strasbourg, France4; Mallorca, Spain5; Hamburg, Germany6, Milan, Italy7; and Rio de Janeiro8,9 and São Paulo10, Brazil have all announced transvaginal NOTES procedures involving the gallbladder. All of these approaches, to date, have utilized one or more laparoscopic trocars for safety reasons.