The learning curve is also steeper in minimally invasive procedures than for open surgery as trainees have to learn not only new technology and overcome obstacles like the fulcrum effect but they also have to have a good fundamental ability for these procedures as well. The same can be said for endovascular procedures and endoscopy. If a complication were to arise during the course of the surgery it would be more difficult for the expert surgeon to intervene and rectify the situation. In laparoscopy however the expert surgeon has less control over what the trainee is doing. With the traditional open approach the supervising surgeon can directly guide the hands of the trainee and immediately intervene if a problem or difficulty arises. This skill set cannot be taught easily in the real life environment under the supervision of a senior surgeon. This is due to lack of tactile feedback, precise hand eye coordination, and a change from 3D to 2D visualisation as well as adaption to the fulcrum effect. The skill set required in laparoscopy is very different compared with open conventional surgery. The advent of laparoscopy and minimally invasive procedures has created a necessity for more novel techniques to learn surgical skills. The most paramount reason being the adoption of laparoscopy which was first introduced in the 1990s. The introduction of virtual reality and simulation into the world of surgery came about for a number of reasons.
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