The integration of artificial intelligence (AI) and robotic tools into modern surgical practice marks a transformation toward increasingly precise, minimally invasive operations with unprecedented precision, efficiency, and data-driven perioperative decision-making. However, these advancements introduce complex ethical dilemmas that require thoughtful considerations by surgeons. This chapter examines the ethical landscape of AI- and robotic-assisted surgery from a surgical perspective, discussing historical context and current ethical questions in a medical and surgical ethical framework. Key concerns include maintaining patient autonomy amid “black box” algorithms, ensuring robust informed consent, and determining accountability when machine-generated decisions contribute to surgical complications or errors. AI technology’s growing autonomy and reliance on large patient datasets raise additional dilemmas of privacy, adequate data governance, and algorithmic bias, with significant implications for equity in healthcare access and outcomes. AI and robotics have the potential to revolutionize surgical workflows and clinical decision-making but can alter the surgeon-patient relationship, risking depersonalization and diminished trust. Robust oversight, multidisciplinary collaboration, and ongoing ethical discourse are critical to guide a responsible innovation process. Furthermore, there is an urgent need for equitable distribution of advanced technologies, transparent governance frameworks, and formal education on the ethical, legal, and social implications of AI for both surgical trainees and practicing surgeons. The ethical integration of AI and robotic tools into the practice of surgery depends on maintaining human oversight, empathy, and professional accountability while harnessing technological advancements to enhance—not replace—the core values of surgical care.