Here we present a novel NOTES approach for a transrectal simulated appendectomy in a porcine model. To safely enter the mesorectal space, and eventually the retroperitoneum, we have used endoscopic balloon dilation. This dilation was enhanced using an Apollo endosurgery (Austin, TX) tangentially dilating endoscopic balloon. The retroperitoneum was easily accessed and safely dilated using this balloon. This access allowed the tissue to slowly be displaced in the direction of dissection and created an adequate space for the endoscope to be passed. This novel balloon has simplified and is an important tool for transrectal access in NOTES procedures