Background More recently Natural Orifice Translumenal Endoscopic Surgery (NOTES) has been highlighted to the attention of lay literature and media, after first clinical reports. Concept and feasibility had been tested in animal experiments since 20041, leading to the creation of new scientific societies and committees with the declared aim to regulate research activity, through sponsorships and registers, without reaching the goal completely. After less than three years, the race for the first cholecystectomy under NOTES conditions in a human being was having its course. Since then, many authors have reported various case collections, while many others presented consistent research activity in vitro or in vivo, but it looks evident that two different branches of research were being defined2 .