Surgeons want AI to show where it might be wrong

If an AI overlay helps a surgeon identify anatomy, its uncertainty should be part of the conversation. A study of 47 neurosurgeons explored which explanations clinicians found useful when interpreting AI-supported surgical anatomy recognition. Certainty-focused displays were preferred over some alternative explanation approaches. The result is a useful design signal, not evidence that those displays make an operation safer. The supplied June preprint now has a peer-reviewed counterpart published in Scientific Reports on October 24. That changes the publication status, not the study design: it remains an international cross-sectional electronic survey using a still surgical image and illustrative segmentation. Participants considered numerical certainty, spatial certainty maps and other explanation methods. Preferences are important when building an interface people must understand under pressure, but liking an explanation is different from using it to catch an error. There is also a distinction between displaying a confidence score and proving that it is calibrated. A confident-looking interface can mislead if its apparent precision does not correspond to reliability. A better evaluation would ask whether clinicians reject incorrect suggestions, recognize unfamiliar cases and retain an independent view of the anatomy. Those are proposed next tests, not results this survey established. A separate, small first-in-human feasibility study from the same team offers a grounded reminder of deployment complexity: two of eight planned deployments failed before surgery because of configuration problems. It is neither independent replication nor a broad safety verdict. The constructive lesson is to design uncertainty and fallback into the workflow from the beginning. Surgeons are asking for information about the tool's limits. That is an invitation to build a more useful assistant, not an obstacle to progress.