This chapter, Personalized Surgery: Innovations, Ethics, and Equity by Claudio S. Cinà, traces the arc from ancient bespoke instruments to today’s genomics, artificial-intelligence guidance, and 3-D-printed implants, showing how personalization is redefining surgical practice. It reviews the clinical evidence behind genetic testing, pharmacogenomics, AI-driven planning, advanced manufacturing and wearable analytics, then maps the ethical terrain they create: data privacy, informed consent, algorithmic bias, economic and environmental costs, and global equity. Cross-cultural perspectives—from Islamic amanah to Buddhist ahimsā—and three real-world case studies illustrate how values translate into bedside decisions. The chapter concludes with an actionable four-pillar framework (access, bias-control, data stewardship, and informed agency) and practical tools, next-generation consent pathways, bias audits, low-cost bioprinting, and public–private partnerships that help clinicians deliver precision care without sacrificing justice or trust.