**4.3 Gastrectomy**

Simulation for gastric surgery is also limited in the literature. The learning curve for laparoscopic total gastrectomy is between 40–100 procedures [37]. Recently, a stepwise method for training for laparoscopic gastrectomy was described [31]. The initial training involves using a box trainer with supervision from a trainer, followed by animal model and cadaver model training, followed by clinical experience with standardization and preoperative 3D modeling. The results showed an overall reduction in operative time and blood loss for total and distal gastrectomy.
