[Simulation in surgery. Where are we now and where to from here?]

With the introduction of new techniques and technologies, operative skills became a crucial part of surgical competence, deserving more attention. Implementation of validated simulation modalities into the training curriculum is emphasized. It became obvious that operative skills should be brought to an adequate level of proficiency using different available approaches. At the dawn of the 21st century it became apparent that the use of simulation to train and to assess technical surgical skills provided a good solution to offset the curtailed apprenticeship system. The current state and future perspectives of simulation in surgical training are discussed. Development and use of multimodality simulation supported by e-learning, video-learning in web-based modules, is needed to support the apprenticeship system in order to achieve the necessary competences to become an expert surgeon.