The NOTES team at Baystate began animal studies in May, 2006. Multiple procedures, including but not limited to uterine horn resection (simulating appendectomy), cholecystectomy, nephrectomy, splenectomy, distal pancreatectomy, small bowel resection, mediastinal exploration, and sleeve gastrectomy have been completed successfully by the team. This work has led to a separate, IRB-approved protocol to perform NOTES pancreatic pseudocystgastrostomy in human patients. To date, 2 patients have successfully undergone entirely transluminal, endoscopic cystgastrostomy with a third case upcoming. The focus of much of our research (as well as that of many other investigators), is to develop a secure closure method for the stomach. Unfortunately, key scientific questions remain regarding this technique and thus have limited human trials to date. Given this, we have begun to explore other access techniques.