A paradigm shift is occurring in the educational approach to surgical procedures. A variety of pressures are forcing the initial education of surgeons of all disciplines out of the operating department and into simulation. Fortunately, increasing evidence suggests that surgeons can learn many fundamental skills and specific procedures with simulators. Evidence also supports the expectation that surgeons trained in simulation laboratories initially perform better in the operating department than those who are not. Minimally invasive procedures lend themselves to simulation particularly well. Currently, many different models are available for training and improvement in skills are seen with both low- and high-fidelity models. Developing an effective curriculum principally requires a commitment to the concept, and the time and space, for residents to learn and practice. Although many questions remain about how to optimally apply and evaluate the educational tools being developed, it appears certain that surgical simulation, in some form, is the educational paradigm of the present and future.