Since Anthony Kalloo’s publication on transgastric peritoneoscopy in 2004, the field of natural orifice transluminal endoscopic surgery (NOTES) has evolved from the ethereal to the tangible. In a short lapse of time, NOTES has shown to be feasible in numerous laboratory animal studies and in specific clinical cases. But there is an ongoing debate on who should be involved in NOTES: the surgeons or the endoscopists and gastroenterologists? In this interesting lecture, Dr. Jeffrey Ponsky explains why NOTES is surgery while endoscopy is only the vehicle to deliver NOTES.