Human space exploration poses inherent risks to human health, with the last six decades providing invaluable insights into how our physiology responds to the extremes of the space environment. While our engagement in low-Earth orbit (LEO) missions affords relative comfort and enables timely evacuation to Earth in medical emergencies, imminent plans for lunar missions and a sustained presence in cislunar space, exemplified by the Lunar Gateway and missions to Mars, raise concerns about more complex health risks with limited evacuation options. The current 'scoop and run' strategy on the International Space Station (ISS) serves well in the proximity of Earth. However, as we transition beyond LEO, the impracticality of this approach becomes evident, emphasizing the need for astronauts to possess basic surgical skills. This shift in strategy acknowledges the potential emergence of 'low probability' surgical conditions, which, despite their rarity, carry substantial risks to crew health and mission success in the absence of rapid evacuation options. This presentation delves into the evolving field of space surgery, with the aim to elucidate the importance of comprehensive preparedness, addressing the unique challenges posed by surgical conditions in microgravity environment, and fostering interdisciplinary collaboration for the well-being of our astronauts as we venture into the next frontier.