Modern surgical systems increasingly rely on intelligent scene understanding to improve intra-operative safety and situational awareness, with surgical scene segmentation playing a fundamental role in fine-grained surgical perception. Although recent ANN models, especially large foundation models, have achieved impressive accuracy, their high computational and energy demands often hinder deployment in resource-constrained operative environments. To address this challenge, we explore SNN as a highly efficient paradigm. However, its performance in surgical scene segmentation remains constrained by sparse spike representations and limited annotated surgical data. We therefore propose SpikeSurgSeg, the first spike-driven video Transformer for surgical scene segmentation. It preserves the real-time and energy-efficient advantages of SNN, while achieving competitive performance against most ANN models in data-scarce surgical scenarios. Specifically, we introudce a spike-informed pretraining strategy based on MAE, where mask generation is guided by spike firing activity to better align with sparse spike representations, together with a layer-wise tube masking scheme that reduces information leakage and encourages contextual reasoning. To further strengthen semantic representation, we introduce multi-spectral knowledge distillation, which aligns teacher ANN and student SNN features in the frequency domain, where the mismatch between continuous activation patterns and spike-driven temporal representations can be effectively mitigated. Built on the pretrained SNN encoder, we further design a lightweight spike-driven segmentation head. Extensive experiments on EndoVis18 and our in-house SurgBleed dataset show that SpikeSurgSeg achieves mIoU comparable to SOTA ANN models while reducing inference latency by at least 8x. Notably, it delivers over 20x speedup relative to most foundation models.