Abstract:Artificial Intelligence (AI) is transforming medicine, with generative AI models like ChatGPT reshaping perceptions of its potential. This study examines surgeons' awareness, expectations, and involvement with AI in surgery through comparative surveys conducted in 2021 and 2024. Two cross-sectional surveys were distributed globally in 2021 and 2024, the first before an IRCAD webinar and the second during the annual EAES meeting. The surveys assessed demographics, AI awareness, expectations, involvement, and ethics (2024 only). The surveys collected a total of 671 responses from 98 countries, 522 in 2021 and 149 in 2024. Awareness of AI courses rose from 14.5% in 2021 to 44.6% in 2024, while course attendance increased from 12.9% to 23%. Despite this, familiarity with foundational AI concepts remained limited. Expectations for AI's role shifted in 2024, with hospital management gaining relevance. Ethical concerns gained prominence, with 87.2% of 2024 participants emphasizing accountability and transparency. Infrastructure limitations remained the primary obstacle to implementation. Interdisciplinary collaboration and structured training were identified as critical for successful AI adoption. Optimism about AI's transformative potential remained high, with 79.9% of respondents believing AI would positively impact surgery and 96.6% willing to integrate AI into their clinical practice. Surgeons' perceptions of AI are evolving, driven by the rise of generative AI and advancements in surgical data science. While enthusiasm for integration is strong, knowledge gaps and infrastructural challenges persist. Addressing these through education, ethical frameworks, and infrastructure development is essential.