A new framework guides the ethical adoption of AI in surgical practice.

• AI-enabled decision support systems can now match or exceed human performance in certain tasks.
• A 19-item consensus framework developed through expert consensus highlights key governance areas: technical design, implementation, ethics, and bias.
• Addressing these themes is crucial for ensuring AI adoption enhances care quality and minimizes risks to patients.
• This framework can help surgeons navigate AI integration effectively, aligning advanced technology with ethical standards.