On 26 April 2023, past and present members of the department of surgery and cancer as well as those of wider supporting medical specialties of St Mary’s Hospital (SMH), London, congregated at the Royal Society under the headship of Professor Ara Darzi to celebrate 100 years since the establishment of an academic chair of surgery at SMH. The day also sought to recognise the global impact this institution has had on the surgical field over the past century and to look forwards to the major innovations that will shape the next. The event was divided into nine key sessions: cancer and minimally invasive surgery, vascular surgery, trauma and orthopaedic surgery, medicine’s impact on surgery, design, surgical education, artificial intelligence and digital health, patient safety, and allied technologies. In this article, we describe the founding of academic surgical units in the UK, and also present the key surgical ‘firsts’, breakthroughs and innovations realised at SMH in each of these realms. We finish with a look forwards to what the future holds for this institution and indeed the field of surgery as a whole.