Comprehensive overview of artificial intelligence in surgery: a systematic review and perspectives

The rapid integration of artificial intelligence (AI) into surgical practice necessitates a comprehensive evaluation of its applications, challenges, and physiological impact. This systematic review synthesizes current AI applications in surgery, with a particular focus on machine learning (ML) and its role in optimizing preoperative planning, intraoperative decision-making, and postoperative patient management. Using PRISMA guidelines and PICO criteria, we analyzed key studies addressing AI's contributions to surgical precision, outcome prediction, and real-time physiological monitoring. While AI has demonstrated significant promise-from enhancing diagnostics to improving intraoperative safety-many surgeons remain skeptical due to concerns over algorithmic unpredictability, surgeon autonomy, and ethical transparency. This review explores AI's physiological integration into surgery, discussing its role in real-time hemodynamic assessments, AI-guided tissue characterization, and intraoperative physiological modeling. Ethical concerns, including algorithmic opacity and liability in high-stakes scenarios, are critically examined alongside AI's potential to augment surgical expertise. We conclude that longitudinal validation, improved AI explainability, and adaptive regulatory frameworks are essential to ensure safe, effective, and ethically sound integration of AI into surgical decision-making. Future research should focus on bridging AI-driven analytics with real-time physiological feedback to refine precision surgery and patient safety strategies.