Natural Orifice Transgastric Endoscopic (NOTES) Transgastric Diagnostic Peritoneoscopy With Laparoscopic Assistance

Inclusion Criteria: Men and women will be enrolled in this study who: * Are willing to give consent and comply with evaluation and treatment schedule; * At least 18 years of age; * Are a candidate for surgical weight loss intervention (i.e. meet ASMBS and NIH criteria) for an RYGB procedure at the Investigational site; * Have a history of open abdominal surgery or laparoscopic abdominal surgery; * ASA Classification I, II, or III (Appendix II); and * Have a negative serum pregnancy test (for women of childbearing potential). Exclusion Criteria: Subjects will be excluded from the study for any of the following: * Use of immunosuppressive medications (within 6 months of surgery; single burst dosages and inhalable steroids are acceptable); * Acute cholecystitis or acute pancreatitis; * Evidence of abdominal abscess or mass; * Diffuse peritonitis; * Use of anticoagulants or anti-platelet agents (use of daily cardio protective doses of aspirin, up to 81 mg/day, is acceptable and shall not constitute an exclusion criterion) or the presence of coagulopathy; * Clinical diagnosis of sepsis; * Co-morbid condition(s) that could limit the subject's ability to participate in the study or to comply with follow-up requirements, or that could impact the scientific integrity of the trial; * Planned concurrent surgical procedure other than RYGB or adhesiolysis; * Prior or planned major surgical procedure within 30 days before or after study procedure; * Participation in any other investigational device or drug trial that has not completed the primary endpoint or that clinically interferes with the current study endpoints; * Previously enrolled in the current series of 4 trials investigating the EES NOTES GEN1 Toolbox; or * Any condition which precludes compliance with the study (Investigator discretion).