What Is Autonomous Surgery?

A plain-English guide to robots that operate without a surgeon steering them: what the word means, how far the machines have come, and what still stands in the way.

At a glance: Autonomous surgery means a robot carries out surgical steps by itself, deciding its own movements, instead of copying a surgeon’s hands. Most surgical robots in hospitals today, like the da Vinci, are not autonomous: a surgeon controls every move from a console. Researchers rate robots on a 0 to 5 scale proposed in 2017. Robots have done parts of operations alone on pigs and on pig organs in the lab, but as of October 2026 no robot has operated on a person by itself.

Not medical advice. This page explains how AI is being used in medicine; it can’t tell you what’s right for your health, so talk to a doctor or pharmacist about your own care. Facts checked against the linked sources on October 29, 2026. How we research and check our guides.

Table of Contents

What does autonomous surgery mean, in one sentence?

Autonomous surgery is surgery where a robot decides and performs at least some of the steps on its own, using cameras, sensors and software, while a human watches or approves instead of moving the instruments.

The key word is decides. A robot that copies a surgeon’s hands is a tool. A robot that looks at the tissue, works out where the next stitch goes and places it is acting with some autonomy.

Robot-assisted surgery is not the same thing

Hospital surgical robots today are robot-assisted. The best known, the da Vinci system from Intuitive Surgical, is run by a surgeon sitting at a console a few feet from the patient. The robot turns the surgeon’s hand movements into small, steady movements of instruments inside the body, filtering out tremor, but it doesn’t choose anything.

Robot-assisted, not autonomous. A da Vinci Xi in a US Army hospital. Its four arms move only when the surgeon at the console moves the controls. Image: U.S. Army photo by Marcy Sanchez (public domain).

On the scale below, that is Level 0. The 2017 editorial that set out the levels counts a robot like this as “no autonomy” because its output is still the surgeon’s own movement.

A few terms used on this page:

Laparoscopic surgery: Keyhole surgery: the surgeon works through small cuts using a thin camera and long, thin tools.
Ex vivo: Latin for “outside the living body.” Tests on organs that have been removed, usually from animals.
Teleoperated: Steered remotely by a person. The robot moves only when the human operator moves the controls.

What are the levels of autonomy in surgery?

In March 2017, a group of 12 authors led by Guang-Zhong Yang, editor of the journal Science Robotics, proposed six levels of autonomy for medical robots, numbered 0 to 5. Self-driving cars already had levels; medical robots didn’t. Here is what each one means for surgery:

Level 0, no autonomy. The robot follows the surgeon’s commands and nothing else. Most surgical robots in use today sit here.
Level 1, robot assistance. The surgeon stays in continuous control, but the robot gives some physical guidance, such as an invisible wall that stops a tool from drifting into the wrong area.
Level 2, task autonomy. The surgeon starts a specific task, such as a line of stitches, and the robot carries it out while the surgeon watches and steps in if needed.
Level 3, conditional autonomy. The robot comes up with its own plans for a task, and the human picks one or approves the robot’s choice.
Level 4, high autonomy. The robot makes medical decisions under a qualified doctor’s supervision. The editorial compares it to a resident (a surgeon in training) operating while a senior surgeon looks on.
Level 5, full autonomy. A robotic surgeon that can do an entire operation with no human needed. In 2017 the authors called this “the realm of science fiction.”

Even in 2017, the authors wrote that some devices had reached Level 3. The hard part is moving from narrow tasks to whole operations.

Which robots have operated on their own so far?

These are the milestones we could check against a journal, a university or company release, or a regulator.

From stitching pig intestine to drawing blood: the steps so far

Jan 2022: STARStitches intestine in four live pigs; a person picks the plan.
Mar 2025: ScoPilotFDA-cleared AI feature that makes the camera follow the surgeon’s tool.
Jul 2025: SRT-HClip-and-cut stage of gallbladder removal, 8 of 8 pig organs, no human help.
Dec 2025: ToumaiCompany says its robot cut a bile duct in a pig. No paper.
Jul 2026: SurgieHumanoid robots operate on live animals, steered by surgeons. Not autonomous.
Aug 2026: AlettaFDA authorizes a robot that draws blood with no hands-on operator.
Oct 2026: ExinAI agent picks a gene therapy and injects a mouse. One source.

Sources: Saeidi et al., Science Robotics 2022; Moon Surgical, March 2025; Kim et al., Science Robotics 2025; South China Morning Post, January 2026; UC San Diego, July 2026; AABB, August 2026; Ocana-Santero on X, October 2026.

STAR, 2022. The Smart Tissue Autonomous Robot from Johns Hopkins joined two ends of pig intestine in keyhole surgery on four live pigs, which were then watched for a week. The robot proposed stitching plans and a person picked one, which fits Level 3. Of its 86 stitches, 29 needed a manual adjustment, yet its work was more consistent than the surgeons it was compared with.

STAR at work. A Johns Hopkins researcher watches the Smart Tissue Autonomous Robot place stitches. The robot planned the stitches and placed them once a person approved the plan; an operator still adjusted some of them. Image: Jiawei Ge, IMERSE lab, Johns Hopkins University, via NIBIB.

SRT-H, July 2025. The same Johns Hopkins group did the clip-and-cut stage of gallbladder removal on eight gallbladders taken from pigs, with a 100% success rate and no human stepping in. The system learned by imitating recorded demonstrations, and a planning layer writes out its next instruction in plain words, which helps it recover from mistakes. The authors call it step-level autonomy. The organs were outside a body, so there was no breathing or bleeding.

The SRT-H tools. The robot learned the clip-and-cut stage by watching recorded demonstrations, then did it on its own. Image: XinHao Chen, Johns Hopkins University, via EurekAlert.

An earlier demo from the same Johns Hopkins team (November 2024), showing the robot copying skills it learned from video. Video: Johns Hopkins University.

MicroPort Toumai, December 2025. The Chinese company MicroPort MedBot said its Toumai robot, run by its own AI model, clamped and cut a bile duct in a 30 kg pig on December 24, getting 88% of the steps right on the first try and correcting the rest as it went. Surgeons supervised. The claim comes from a company statement and hasn’t been peer reviewed.

UC San Diego humanoids, July 2026. Surgeons used two human-shaped robots nicknamed Surgie to operate on live animals, including a gallbladder removal, reported in Nature. The robots were teleoperated: a surgeon steered them throughout. UC San Diego describes it as a first for humanoid robots in surgery, but the robots made no decisions of their own.

Humanoids in the operating room. Two off-the-shelf humanoid robots hold standard keyhole tools during a gallbladder operation on an animal. A surgeon steered every movement from a console. Image: UC San Diego Jacobs School of Engineering, CC BY 4.0.

Smaller jobs already in use. In March 2025 the FDA cleared Moon Surgical’s ScoPilot, which lets the keyhole camera follow a chosen instrument on request while the surgeon keeps control. In August 2026 the FDA authorized Vitestro’s Aletta as a new type of device. It finds a vein with infrared light and ultrasound, then draws blood without hands-on help; a staff member starts each session and can oversee up to three machines. Drawing blood isn’t surgery, but it is a machine putting a needle into a patient on its own.

Vitestro explains its Aletta blood-draw robot (2023, before its FDA authorization). Video: Vitestro / MedTech Innovator.

An AI agent in charge, October 2026. The startup Exin Therapeutics says an AI agent picked a gene therapy from 19 options, chose the spot in a mouse’s brain, and drove a needle to inject it, while a human opened and closed the skull. The only source is the cofounder’s thread on X, with no paper yet. We cover it in detail in An AI Agent Just Operated on a Mouse.

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Machine surgery around the world

Most of these operations are remote, not autonomous: a surgeon controls the robot from far away. They matter because remote control over long distances is the step that autonomy will build on. Here is a selection:

London to Gibraltar, 2026. A London surgeon removed a patient’s prostate in Gibraltar, about 2,400 km away, using a Chinese-made Toumai robot, with a full team standing by at the patient’s side (The London Clinic).
Shanghai to Kashgar, China, 2024. A Shanghai surgeon removed a lung tumor from a patient about 5,000 km away in Xinjiang over a remote link (Shanghai government Information Office).
Gurugram to Jaipur, India, 2025. Heart operations on patients 286 km away, using the Indian-made SSi Mantra robot (The Week).
Strasbourg to Indore, 2026. Ten weight-loss operations in a single session over a remote link between IRCAD France in Strasbourg and IRCAD India in Indore, according to the robot’s maker (MicroPort).
Kobe, Japan, 2020. Japan’s first home-grown surgical robot, hinotori, did its first operation, a prostate removal (Nature Portfolio).
Barranquilla, Colombia, 2024. The US company Perceptive said its robot prepared a patient’s tooth for a crown on its own after a 3D scan (Eureka), a claim not yet backed by published data (STAT).
Israel and the US, 2019 onward. XACT Robotics’ hands-free robot steers needles for CT-guided biopsies, with the doctor checking CT scans at set checkpoints along the way (Fierce Biotech).

The London Clinic on its first remote operation in Gibraltar (2026). Video: The London Clinic.

A remote urologic operation in Xinjiang, with the surgeon thousands of kilometers away (July 2024). Video: New China TV.

Robots have even gone to space. In 2024, a small surgical robot called MIRA was tested on the International Space Station, cutting rubber bands controlled from Earth, to see how remote surgery could work far from a hospital.

Surgery practice in orbit. NASA astronaut Loral O’Hara with the small MIRA robot from Virtual Incision and the University of Nebraska, February 2024. Image: NASA (public domain).

Why hasn’t a robot operated on a person by itself?

Regulation. In the US, the FDA regulates medical devices. It does not license doctors; medical boards do that. The Yang editorial points out that a robot at Level 5, and possibly Level 4, is not only a device but is also practicing medicine. MicroPort itself said its system has no approval for autonomous surgery on people anywhere and has not entered human trials.

Liability. When a robot chooses a cut, the blame could fall on the surgeon who supervised, the hospital, the company that built it, or the people who trained its software. The 2017 editorial named legal and ethical questions as barriers alongside technical ones.

Safety evidence. The best results so far are small: four pigs for STAR, eight organs for SRT-H. Living patients breathe, bleed and vary, and a robot has to handle the rare surprise too. Proving that takes many more tests and then human trials. The 2017 editorial cited a survey that put the average path to market for a high-risk device at 54 months.

What comes next for autonomous surgery

Autonomy looks likely to arrive one task at a time: narrow jobs like camera control and stitching first, then single stages of an operation under close supervision, as SRT-H showed in the lab.

The UC San Diego team sees remote and autonomous robots as a way to reach patients far from surgeons. The Exin experiment points to a different shift: one system that both chooses the treatment and carries it out. Our guide to AI in medicine covers AI in hospitals more broadly, and for robots outside medicine, see the Robotics Frontier.

Common questions

Is the da Vinci robot autonomous?

No. A surgeon controls every movement from a console. The robot steadies and scales the surgeon’s hand movements but makes no choices, which puts it at Level 0 on the autonomy scale.

Has a robot ever done surgery on a human by itself?

Not a full operation, as of October 2026. Robots do narrow jobs on people, such as moving the camera or drawing blood. Autonomous operations have only been done on animals or animal organs.

What is the most autonomous surgery so far?

Among peer-reviewed work, the SRT-H gallbladder study from July 2025 went furthest: it finished the clip-and-cut stage on all eight pig organs with no human help. It was done on organs outside the body, not in a living animal.

Are the UC San Diego humanoid robots autonomous?

No. Surgeons steered them remotely during every operation. The study shows humanoid robots can hold standard surgical tools on live animals. Next steps include remote surgery over longer distances and an autonomous surgical assistant.

What’s the difference between an AI agent and a surgical robot?

A surgical robot is the machine that moves the tools. An AI agent is software that plans and takes actions toward a goal. In the Exin experiment the agent controlled a motorized rig. Our beginner’s guide to AI agents explains how agents work.

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