Abstract: Surgical video recording has shown promise in identifying best practices, documenting errors, and establishing an objective record of surgical activities for patient care, education, training, and research. These opportunities have fueled an increasing number of academic studies, commercial enterprises, and proposed legislation to increase the utilization of recording in the operating room. As recording becomes more routine and expands from intracorporeal images to full room video and audio capture, important ethical, legal, and social (ELSI) issues grow in importance and must now be addressed. This is complex due to phenomena inherent in the surgical process. Patients are unaware of what happens once they are anesthetized, and the modern operating room is closed to non-medical observers, making the introduction of surveillance and transparency a significant shift in practice. Further, the multi-subject nature of procedural recordings--depicting both the patient's body and the surgical team's performance--are a novel consideration for medical data protection and ownership policies. Herein we address uncertainties regarding ownership, liability, risk, and privacy, and offer strategies to overcome barriers to routine recording.