Surgical innovation has significantly advanced patient care, enabling complex procedures and improving outcomes. However, the integration of new technologies presents challenges related to patient safety, regulatory oversight, cost-effectiveness, and equitable global access. The balance between fostering innovation and ensuring responsible implementation remains a critical issue in modern healthcare. This narrative review explores the evolution of surgical innovation, highlighting key historical advancements, regulatory frameworks, and emerging technologies such as artificial intelligence (AI) in intraoperative decision-making and virtual reality (VR) in surgical education, as illustrative examples of transformative technologies. It discusses financial and ethical considerations, including the impact of frugal innovation in low-resource settings and the role of tiered regulatory approaches in mitigating risk. Effective adoption of surgical innovations requires adaptable regulatory models, continuous training programmes, and a multi-stakeholder approach that includes policymakers, healthcare providers, and industry leaders. Addressing financial constraints and ethical dilemmas is essential to ensure that novel surgical technologies are accessible, safe, and sustainable. Future efforts should prioritise dynamic regulatory mechanisms, equitable innovation dissemination, and interdisciplinary collaboration to maximise the benefits of surgical advancements while minimising risks. A structured approach, balancing technological progress, patient safety, and global equity, is crucial to shaping the future of surgery.