Global surgery: thinking beyond borders: A narrative review of the value, systemic gaps, and the formation of the global surgeon at the Global Surgery Session at the 44th ACOI National Congress, 2026

Background: More than a decade after the Lancet Commission on Global Surgery recognized surgical care as essential to universal health coverage, an estimated five billion people still lack access to safe, timely, and affordable surgical and anesthesia care. The “Global Surgery – Thinking Beyond Borders” session at the 44th ACOI National Congress examined persistent inequalities and the evolving competencies required of the modern global surgeon. Methods: This narrative review re-elaborates the scientific contributions presented during the session according to an artificial intelligence–assisted, clinician-supervised methodology. The complete transcript and available presentation materials were used to reconstruct key themes and multidisciplinary discussions. Factual statements and quantitative data were verified against peer-reviewed literature and original editorial sources. Unsupported information and electronic-only contributions were excluded. Results: The Lancet Commission framework and its six core indicators remain central to surgical-system planning. Progress includes regional training programs with high graduate retention, but major inequalities persist in workforce availability, epidemiological data, financial protection, scientific leadership, and academic authorship. Increasingly, Global South-led solutions emphasize context-specific metrics, sustainable infrastructure, and frugal innovation. Digital technologies and artificial intelligence are expanding opportunities for education, simulation, telementoring, and knowledge dissemination. The global surgeon requires broad surgical competence, emergency and mass-casualty training, leadership, and intercultural communication skills, with military surgery providing a longstanding model of adaptive practice in resource-constrained settings. Conclusions: Global surgery is a strategic component of universal health coverage. Future progress requires sustainable, locally led, adequately financed, and rigorously measured surgical systems alongside surgeons trained to deliver high-quality care across diverse resource settings.