In the past, abdominal surgery mandated a large abdominal wall incision. The minimal invasive surgery techniques including Laparoscopy, created an option for performing intraabdominal surgery through small incisions. In this article, the authors present new surgical techniques: the natural orifice trans-luminal endoscopic surgery (NOTES], and the singLe incision laparoscopic surgery (SILS). It seems that these evolving techniques are the third generation of surgery.