As others have emphasized, a progressive and structured training process is necessary to understand and avoid the potential pitfalls of laparoscopy. A surgeon who is poorly trained or has minimal skills and experience finds that many cases are "difficult." Nevertheless, even those with appropriate skill and experience encounter intellectual and technical challenges in laparoscopy. It is also very important to realize that some procedures simply should not be done laparoscopically. A review of 77,604 laparoscopic cholecystectomies documented that more than half the deaths were from technical complications occurring during the procedure. Traditional methods of surgery may have their own characteristics of limitations and morbidity, but in most cases, the old operation might still be a very good one in the face of unfavorable laparoscopic conditions.