The way to move natural orifice translumenal endoscopic surgery (NOTES) from the laboratory to the clinical arena is to do high-quality research in the areas recommended by the NOSCAR working group representing barriers to NOTES procedures. Additionally, good experimental work needs to be done to determine whether the theorized advantages of the NOTES approach actually represent reality. It is anticipated that monies will continue to flow to sponsor the necessary research in NOTES. It is clear that momentum continues to build in this exciting new potential paradigm shift in minimally invasive surgery, but one of the keys is to produce good science to validate the NOTES approach.