This paper explains about endoscopic surgery simulation based on medical image processing. Due to the progress of medical imaging devices, it is possible to acquire very precise volumetric images of a patient. These precise volumetric images enable us to simulate endoscopic surgery. This paper classifies types of surgical simulation into three categories:(a) simulation based on simple visualization, (b) deformation simulation of single organ, and (c) integrated simulation of endoscopic surgery. Here, we show examples of surgical simulation including virtualized endoscopy system, TBLB path simulation, virtual unfolded view generation of the stomach, and virtual laparoscopic image generation. Several simulation images are also presented here.