In recent years there has been both a paradigm shift in the way surgery is carried out and also in the way in which we train health professionals undertaking interventional procedures. Endoscopic procedures have replaced many traditional operations and the benefits of such an approach to patient care are well documented. However, evidence exists of higher patient complications during a surgeon's learning curve in endoscopic surgery, and it is now considered essential that endoscopic skills are learned in training laboratories rather than on patients. A new model of structured education, where surgical skills are practiced on models and virtual reality simulators, is set to replace the traditional apprenticeship model of training. Simulation is a rapidly evolving field that can provide a safe and increasingly realistic learning environment for trainees to practice in. This paper explores the current role of simulation in endoscopic training and provides a review of the developments in the field, including advances in simulation technology, progress in curriculum design and the use of simulation in nontechnical skills training.