Hands-on training for advanced laparoscopic procedures is more difficult to obtain than for basic laparoscopy, but because morbidity and mortality rates for these technically demanding procedures are higher, adequate training is essential and obtained, ideally, through a formal fellowship in advanced laparoscopy. Shorter preceptorships can provide adequate training but are more difficult to find. Few advanced laparoscopic procedures are experimental, but the safety of each must be ensured before a hospital awards privileges for their performance. Vigilance regarding local and national outcomes of these new procedures is essential in this rapidly evolving field.