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Innovation is being freed from the design constraints of the opposable digits of a surgeon's hand through the use of programmable binary digits. Surgeons must be the drivers of change and central to the application of innovations. We should collaborate with industry, engineers and scientists to think out of the box but must consider also expense, environmental impact, equity, and ethics. But we should not be blinded by shiny technology: innovation without impact is mere noise. The ultimate considerations are the diagnosis and management of surgical disease, of improving the care of our patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Expert surgeons, scientists and engineers across the world were identified and invited to describe areas of innovation within surgery. They were given free rein to review their areas of expertise and to discuss both current and future applications of technology within surgical care.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The Commission spans multiple surgical specialties and scientific domains. It reviews translational genomics, including the role of ctDNA, alongside microbiomic and proteomic applications in improving the diagnosis, treatment and monitoring of surgical disease. Applications to enhance surgical procedures are described, from medical micro\/nanorobots for minimally invasive interventions, sensory-enriched surgery with visual optimization and molecular image-guidance to intelligent and semiautomated instruments. The expansion and broad influence of artificial intelligence in surgical writing, training and simulation, diagnosis and robotics is widely described. The role of surgical innovation and technology in driving personalized care for benign and malignant surgical disease from genomic profiling to bespoke surgical and non-surgical treatment pathways and surveillance is considered.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The future of surgery is poised to become more precise, personalized, and effective. Collaboration with engineers, data scientists, and industry partners not only represents an exciting opportunity for surgeons to participate in team science but is critical to focus innovation goals on optimizing patient care and outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/bjs\/znaf224","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T11:45:35Z","timestamp":1758627935000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical innovation and technology"],"prefix":"10.1093","volume":"113","author":[{"given":"Jeffrey B","family":"Matthews","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Chicago , Chicago, Illinois ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelle P","family":"Ruurda","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Centre Utrecht , Utrecht ,","place":["The 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