Human roles in the era of intelligent surgery.

BACKGROUND: Surgical expertise has traditionally rested on cumulative clinical knowledge and technical experience. Advances in artificial intelligence, robotics, computer vision, intraoperative analytics, and sensor-rich operating environments may reshape the foundational characteristics of surgical performance. METHODS: A narrative review of emerging surgical technologies was performed alongside historical parallels from aviation, manufacturing, diagnostic radiology, geospatial sciences, and military decision systems with resultant identification of four themes characterizing how expertise may migrate from manual execution toward cognitive integration and system stewardship. RESULTS: Across prior transitions, mature technologies reduced manual variability, elevated supervisory competencies, generated new perceptual paradigms, and enabled distributed expertise. If these patterns apply to surgery, they suggest a potential shift toward decision-making under uncertainty, anomaly management, system orchestration, and multimodal data integration. CONCLUSIONS: As intelligent systems assume greater operative roles, defining surgical competencies may increasingly become cognitive, integrative, and systems-level. Training, credentialing, workforce models, and policy should anticipate this potential evolution to ensure human-machine partnerships enhance safety, equity, and value.