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The purpose of this paper is to review factors related to extended range operations with twin-engine transport aircraft (ETOPS) from the viewpoint of the pilot. The review relies on the years of experience of pilots from around the world for operational insight and interpretations of historic, current, and forecast events. In particular, technical issues are addressed, present-day operations are critiqued, and recommendations are made. It is hoped that this paper will provide the reader with a real-world look at bookbound rules and regulations, computer-generated statistics about rare events, and advertised equipment reliabilities.