The use of animals for surgical training not only improves surgical skills, but also influences confidence levels of trainees in the operating room positively. Even though relatively few animals are used for surgical training, and the level of harms to the animals is categorized as a terminal procedure, the lowest harm level on the scale terminal-mild-moderate-severe for the use of animals in scientific procedures, the opinion on the use of animals in education and training in the general public has a negative tendency. Simulation training contributes significantly to a reduction in the number of animals necessary for surgical training, although it currently is not possible to replace the use of animals in this field completely. A typical training pathway for surgical residents at Odense University Hospital consists of one day of basic theoretical course, which is blended with hands-on exercises. Hereafter, the individual residents practice skills on a laparoscopic simulator, with the aim to pass the course’s compulsory exercises. First when the mandatory exercises have been passed, training is continued on an anaesthetized pig. With the current simulation programs training on anaesthetized animals is still essential, as simulation does not provide accurate tactile feedback of handling tissues, and the prevention of bleeding and hemostasis is not realistic using current computer programs. However, developments in simulation training may further reduce the necessary numbers and eventually replace animals for surgical training.