In 2005, leaders of both SAGES (The Society of American Gastrointestinal and Endoscopic Surgeons) and ASGE (American Society for Gastrointestinal Endoscopy) recognized the potential importance of Natural Orifice Translu-menal Endoscopic Surgery?(NOTES?. As NOTES burst onto the scene it was apparent that this approach held potential for patients to derive a great deal of benefit in terms of diminished pain and a shorter convalescence, but also carried a risk of introducing new and potentially serious complications. Mindful of lessons learned from the rapid adoption of laparoscopic cholecystectomy as well as the inherently interdisciplinary nature of NOTES, the governing boards of the two societies created a working group to consider the issues surrounding the development and introduction to clinical practice of NOTES. This working group published its recommendations for NOTES development as a "White Paper that laid out not only the fundamental research problems to be solved, but also stated that all human NOTES procedures be performed under IRB oversight and that the results be recorded in a registry accessible to all SAGES and ASGE members so that they might learn from other therapists' experiences.
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