Surgical intelligence is poised to revolutionize the field of surgery by enhancing safety and consistency, but current AI frameworks are limited by their task-specific nature and inability to generalize across procedures and institutions. Recent advances in multimodal foundation models, such as large language models, have shown promise in bridging this gap, demonstrating strong cross-task capabilities across various medical domains1. The introduction of Surg$Σ$ marks a significant milestone in this pursuit, offering a comprehensive spectrum of large-scale multimodal data and foundation models tailored for surgical intelligence. By leveraging these models, surgical AI can potentially transcend its current limitations, enabling more effective and widespread adoption. The security implications of such developments, however, are substantial, as they introduce new risk surfaces that must be carefully mitigated to ensure the integrity of surgical care, so what matters most to practitioners is the need to carefully assess and address these emerging security concerns.