Transforming surgical decisions: the rise of predictive and personalized digital tools

INTRODUCTION: Artificial intelligence (AI) has the potential to profoundly transform surgical decision-making (SDM) by enabling more predictive, personalized, and data-driven care. Its integration across the surgical pathway can improve clinical outcomes, efficiency, and patient safety. AREAS COVERED: This narrative review provides an overview of the current and emerging applications of AI in SDM. A structured search of electronic databases was conducted using PubMed, Scopus, Web of Science, and Google Scholar. The search primarily focused on peer-reviewed publications from 2015 to 2025. AI applications include radiologic image analysis for preoperative planning, electronic health record mining for individualized surgical strategies, risk and immunological response prediction, and genomic analysis to guide treatment selection. Intraoperative, AI-based video, image, and physiological data processing can support real-time decision-making by improving precision, identifying anatomical targets, and predicting complications earlier. Postoperatively, AI systems can monitor patient data to detect complications, evaluate outcomes, and tailor follow-up therapy. Despite these advantages, challenges remain, including data quality and availability, model explainability, and others. Overcoming these barriers requires explainable and secure AI models, scalable infrastructures, clinician engagement, and robust regulatory frameworks. EXPERT OPINION: Advances in AI-assisted robotics and interpretability are expected to support safer, more ethical, and more effective surgical decision-making.