**2. Challenges in complex laparoscopic digestive surgery**

Surgical training is traditionally an apprenticeship model, based on a trainee learning to perform surgery under an experienced surgeon. Laparoscopic surgery requires a different skill set, which is dissimilar to open surgery; this poses a unique set of challenges for learners. The technical challenges include an unstable video camera platform, loss of depth perception, reduced range of movement of instruments compared to open surgery, decreased tactile feedback, and fulcrum effect, which is the disparity between visual and proprioceptive feedback (**Table 2**) [7]. Many of these technical challenges may be mitigated with the increasing experience of the surgeon and operating team. However, patient characteristics, such as pathology and comorbidities, and geography of practice limit the efficiency of achieving the volume required to master those specific skills.


#### **Table 2.** *Technical challenges of laparoscopic surgery [6].*
