Reply to: Surgical scene understanding and the emerging challenge of independent validation in an industry-led AI ecosystem.

In this reply to MacAonghusa and Cahill, we reflect on fundamental validation challenges in AI-enabled surgical scene understanding and propose key priorities that academic, clinical, and industry stakeholders must collaboratively address to achieve safe and impactful clinical translation of surgical video AI: First, tying descriptive analytics to outcomes that matter to patients or surgical teams, second, establishing longitudinal, multimodal, and outcome-linked data infrastructure, and third, implementation research.