We read with great interest the recent report by Marescaux et al1 of a purely transvaginal cholecystectomy. Justifiably, there is much enthusiasm over an accomplishment that heralds a new era in natural orifice transluminal endoscopic surgery (NOTES) and over a technology that will change the face of general surgery. Yet, the current excitement is hauntingly reminiscent of the explosive force of the endoscopic revolution of the 1990s and specifically the rapid acceptance of the laparoscopic cholecystectomy (LC). It is both useful and necessary to examine the parallels between the recent developments in NOTES and the push toward minimally invasive surgery in the 1990s, for as the American philosopher George Santayana famously put it, “Those who cannot remember the past are condemned to repeat it.”
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