On the horizon is a new paradigm in minimally invasive therapy called natural orifice transluminal endoscopic surgery (NOTES). This new approach will most certainly disrupt both those living in the gut lumen with flexible endoscopes as well as those living in the peritoneal cavity using laparoscopes to perform surgical procedures. The question is what changes will need to occur in training and practice to accommodate this new paradigm? Those of us who consider ourselves to be gastrointestinal interventionalists are in a unique and exciting position because the answers to the question about training and practice in NOTES will unfold before us in the coming decade. For now however, we can only speculate on the course of these events.