Abstract: The deep integration of artificial intelligence and robotics technology has propelled surgical robots from auxiliary tools to entities with autonomy. This evolution not only represents technological iteration but also heralds profound transformations in the paradigm of surgical procedures, including the doctor-patient relationship, responsibility structure, and trust foundation. By reviewing the autonomy classification system and technological evolution path of surgical robots, arguing the legitimacy basis of autonomous surgical robots from the ethical perspective, and further focusing on clinical application scenarios, core ethical issues are identified in three key dimensions in comparison with master-slave surgical robots: responsibility attribution, decision-making transparency, and safety reliability. Limitations of existing governance frameworks in major economies worldwide are further analyzed, and a systematic ethical governance system is accordingly proposed, encompassing three core mechanisms: the black box recording responsibility chain review mechanism, the algorithm transparency grading review and spot check mechanism, and the resilient security management monitoring mechanism. Exploration that goes beyond the limitations of principled discussions, can provide an operational governance framework for the responsible innovation and clinical application of autonomous surgical robots, offer academic support for the formulation of forward-looking regulatory policies and industry standards, and guide the coordinated development of related technological innovations with patient welfare and social values.