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Figure 1. Human-AI co-adaptation in AI-assisted surgery: two conceptual patient-safety trajectories. The figure illustrates how increasing AI capability may follow either a safer or less safe trajectory depending on how surgeons and the surrounding surgical system adapt to its use. These trajectories are presented as a conceptual framework rather than empirically derived categories. The central Human-AI Surgical System includes workflow, governance, team, and communication elements that influence how AI guidance is integrated into operative care. The five domains of IAIL are shown at the base of the figure as the surgeon-level competency foundation proposed in this paper. While workflow, governance, and institutional factors contribute to safe adoption, the primary focus of this manuscript is the surgeon competencies required to interpret, verify, question, and override AI guidance appropriately. AI: Artificial intelligence; IAIL: Intraoperative AI Literacy.