If you are talking about using a 50mp digital back on a technical camera to make a panoramic, or a medium format camera to make a stitched image, it is not terribly hard if you have the right gear, and use good technique. I do this all the time with my Hasselblad cameras and CFV50c back because I prefer using my 100mm and 180mm lenses over wides. I use to make stitched images with my ALPA Max, but decided the Hasselblad cameras I have used for decades did just as well for my needs once I got the right gimbal head and leveling base.
Here is a recent example made from nine images and cropped to a square during post.
MY EQUIPMENT
I use this Gimbal Head (Fotopro E-6H) with a RRS tripod (14 Series) and Leveling Base (TA-2U):
I had a more expensive RRS Pano Head system, but sold it off and got a smaller setup because I travel with my gear and I do not enjoy carrying a lot of heavy gear.
TECHNIQUE
How I shoot is quite simple IMO. I decide what my composition will be and in the above shot it was all about the young pine tree. I waited for sunset, had the camera set up and practiced where my rows would be by looking through the viewfinder, finding the correct row areas (overlap by at least 1/3) and made note of the numerical guide on the angle knob.
When the light I wanted to shoot under appeared, I took a row of three bottom shots from left to right, then moved the gimbal head a few degrees up and began shooting the middle row from right to left, then moved the gimbal head another few degrees up for the top row and shot from left to right. I did this series of exposures a few times to ensure I got a good set.
Post processing was completed in Lightroom's pano builder and finished in Photoshop. I do not use any other pano processing software, although through the years I have but now Lightroom and Photoshop are more than enough for my needs.
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There is a lot of gear out there that can accomplish this. Do not think you have to have the most expensive, etc. that is unless you are wealthy and like to buy gear, and by all means do support the camera industry! My point is, look at what you have and go from there.
You mention a 4x5, assuming you mean a 4x5 camera, I shoot with an expensive Linhof Master Technika 3000, but I would never use it for stitching as it would not be the right gear for my situations. The ALPA Max I once owned allowed stitching by using sliding partitions with the lens and digital back, but I like doing it better with my old Hasselblad 500 series cameras and lenses. Is it perfect? Probably not for everyone, but it works for me. Depending what you are shooting (landscape in my example) and what the environment your shooting in is, (calm weather in my case), these factors can play importance in your technique.
Hope this helps,
Darr