A Trial to Evaluate Natural Orifice Transgastric Endoscopic Cholecystectomy 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, able to understand and complete study questionnaires; * At least 18 years of age; * Have a clinical diagnosis of gallbladder disease indicated for cholecystectomy; * ASA Classification I or II (Appendix II); and * Have a negative serum pregnancy test (for women of childbearing potential); * Have the study procedure attempted. Exclusion Criteria: * BMI \> 35; * Use of immunosuppressive medications (within 6 months of surgery; single burst dosages and inhalable steroids are acceptable); * Suspicion of gallbladder cancer, tumor, polyps, or mass; * Acute cholecystitis or acute pancreatitis; * Presence of common bile duct stones; * History of open abdominal surgery; * 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; * History of peritoneal trauma; * 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; * Prior or planned major surgical procedure within 30 days before or after study procedure; * Previous diagnosis of intra-abdominal adhesions; * 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).