Abstract: The deep integration of artificial intelligence and robotics technology has propelled surgical robots from auxiliary tools to autonomous entities. This evolution not only represents technological iteration but also heralds profound transformations in the surgical paradigms, including the doctor-patient relationships, responsibility structures, and trust foundation. By reviewing the autonomy classification system and technological evolution path of surgical robots, this study justifies the legitimacy basis of autonomous surgical robots from the ethical perspective. Focusing on clinical application scenarios, it identifies core ethical issues (relative to traditional master-slave surgical robots) in three key dimensions: responsibility attribution, decision-making transparency, and safety reliability. It further analyzes limitations of existing governance frameworks in major economies worldwide, and proposes a systematic ethical governance system, encompassing three core mechanisms: a black box recording responsibility chain and review mechanism, an algorithm transparency grading review and spot check mechanism, and a resilient security management monitoring mechanism. This exploration, which transcends the limitations of principled discussions, provides an operational governance framework for the responsible innovation and clinical application of autonomous surgical robots, offers academic support for the forward-looking regulatory policies and industry standards, and guides the coordinated development of related technological innovations with patient welfare and social values.