A capable surgical AI model should reason from visual evidence; yet, many existing surgical benchmarks can be partially solved without visual input, as models may exploit procedural priors or common anatomy-instrument interactions to infer answers from language alone. To address this, we introduce SUREON, a video question-answering (QA) dataset and benchmark designed to evaluate visually grounded surgical reasoning. Our pipeline generates QA pairs from narrated surgical academic videos, refines incorrect options using multiple models to reduce linguistic biases, and uses trained adversarial guessers to filter out questions answerable without visual evidence. The resulting dataset contains 76K training pairs covering 168 procedures and 10 specialties, alongside a benchmark of 340 questions across 10 categories verified by expert surgeons. Benchmarking leading commercial and open-source models shows that surgical visual reasoning remains largely unsolved--no model exceeds 53% accuracy and even expert surgeons reach only 64.9%. We also introduce SUREON-VLM, a baseline trained on our curated data that avoids language shortcuts, outperforms existing open-source models on SUREON, and matches larger specialist models on multiple standard surgical benchmarks. Our training ablations show that distractor refinement and blind curation strengthen visual grounding, increasing the multimodal gain from 8.7 to 29.1 percentage points while reducing the training set from 176.6K to 76K filtered samples. SUREON thus offers both a verified testbed for surgical visual reasoning and training data that strengthens visual grounding.

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