Professor Richard Huxtable examines the promise and peril of surgical innovation, highlighting its potential to benefit patients while addressing the risks of harm seen in controversies like vaginal mesh and trachea transplants. He explores the challenges of defining “surgical innovation” and determining the appropriate ethical and regulatory oversight, such as Research Ethics Committees or Clinical Ethics Committees. Drawing from his work with Bristol’s NIHR Biomedical Research Centre, Professor Huxtable delves into the complexities of governance and the legal basis for performing surgery, offering insights relevant to both England and Wales and beyond.