The article explores the current issues, risks, and methodological challenges associated with the widespread integration of artificial intelligence (AI) systems into surgical research, routine clinical surgical practice, and medical education. This paper serves as the first part of an extensive study dedicated to establishing a realistic and constructive approach to the digital transformation of surgical care. Based on the critical analysis of the ratio between technocratic optimism and the actual clinical efficacy of AI in research and surgical education, the authors assert the imperative for the medical community to shift from passive compliance with administrative and market guidelines toward actively positioning the surgeon as a qualified customer and independent expert filter for AI integration. The paper provides an in-depth analysis of the inherent technical and cognitive constraints of contemporary algorithms such as “black box” architectural opacity, linguistic and factual “hallucinations”, and the lack of causal analysis. It also uses latest international literature to outline the infrastructural and methodological barriers to integration, while highlighting the detrimental consequences of uncritically adopting large language models (LLMs) in clinical and research practice as well as training of personnel. Particular emphasis is placed on safeguarding the legal and professional status of the operating surgeon as the undisputed “captain of the ship” who bears personal responsibility for treatment outcomes and preserves the genuine humanistic and ethical foundations of medical treatment in the era of digitalization.