The cognitive demands of endoscopic surgery are amplified when rotations of the displayed surgical field cause discrepancies between intended and actual movements. While Visuo-Motor Misalignment (VMM) often impairs surgical technical performance, motor learning literature has demonstrated adaptation acquisition with practice. It is unknown whether these findings can be generalized to complex tasks of surgery. Two experiments investigated VMM adaptation processes within a laparoscopic context. The first examined the effects of practice and angle of visual rotation while the second investigated if, and how, the Contextual Interference Effect facilitates VMM adaptations. Laparoscopic performance was positively affected with smaller angles of visual rotation (p<.001) and increasing trials (p<.001). While not significant, performance was better after blocked versus random practice. In order to facilitate VMM adaptation acquisition, it is recommended that future simulated trainers incorporate the capacity for practice under visual rotation with flexibility in practice schedule.