This article examines the problem of ghost surgeries in South Korea, which gained national attention following the death of Kwon Dae-hee and led to revisions in the Medical Service Act, including a government mandate for video surveillance in operating rooms. While ghost surgeries have been discussed in legal and academic circles, there has been a lack of analysis from the perspective of actual clinical practice. In South Korea, ghost surgeries vary widely depending on the type of hospital, the person replacing the primary surgeon, and the underlying motivation. In teaching hospitals, surgeries performed by residents or fellows during training can be misinterpreted as ghost surgeries, creating a legal and ethical gray area. Despite stricter training regulations, there are still no clear, standardized guidelines for surgical education. Accordingly, this article argues that the relevant authorities—such as the Ministry of Health and Welfare, surgical societies, and medical education institutions—should examine international models and develop clear principles for resident and fellow participation in surgery. This would help ensure informed patient consent, protect medical trainees, promote ethical practices, and ultimately contribute to greater transparency, enhanced surgical education, and a safer healthcare environment for both patients and providers.