**2.5 Overcoming the learning curve**

The other challenge of complex laparoscopic surgery is an increased rate of adverse clinical outcomes during the learning curve [12]. This raises ethical issues and reinforces the need for ways to decrease complications, particularly in the early part of learning a

new operation. Simulation can also play an important role in training for different parts of complex procedures such as forming a jejuno-jejunostomy [6] or medial to lateral colonic mobilization during colectomy [13]. Simulation may also be utilized by experienced surgeons to maintain skill sets and focus on specific procedural aspects that may decay over time and when they often take on the most difficult cases. In the current era, it is no longer acceptable for surgeons to acquire new skills at the expense of patient safety, especially when other methods such as simulation are available to facilitate skill acquisition [14].
