Will Elon Musk’s Robot Perform Surgery? A Neurosurgeon Explains

Elon Musk has recently touted an audacious vision for Tesla’s Optimus humanoid robot, positing that it could supplant most human surgeons within three years and surpass even the most elite practitioners in approximately five years.

In a November 2025 discussion with investor Ron Baron, Musk elaborated that Optimus could execute “very sophisticated medical procedures—any medical procedure, perhaps things that humans can’t even do because they’re too difficult,” leveraging “superhuman precision” to democratize access to elite surgical care.

He further contended that this scalability—enabled by mass production in factories—would eradicate healthcare disparities, affording underserved populations the same caliber of intervention as the affluent, with the robot serving as an “incredible surgeon” available to all.

Is Automatous Robotic Surgery Feasible?

While Musk’s timeline evokes his characteristic hyperbole—reminiscent of repeated, projections for Tesla’s full self-driving capabilities—the underlying technological trajectory renders the concept plausible, albeit on an extended horizon.

Current surgical robotics, such as Intuitive Surgical’s da Vinci system, already augment human surgeons by enhancing precision in minimally invasive procedures, reducing tremor, and enabling 3D visualization; these tools have facilitated over 12 million operations worldwide since 1999, with complication rates often lower than traditional methods in specialties like prostatectomy.

Martin Pham, MD, Associate Professor of Neurosurgery at the University of California San Diego and member of the Comprehensive Spine Study Group, integrates robotics routinely in his spine practice. He offered the following perspective for this discussion:

“Robotics is a powerful tool in spine surgery, enabling exceptional precision and consistency—particularly in complex spinal conditions. However, it can never replace surgical judgment. The surgeon must critically apply core principles before, during, and after the procedure. When properly integrated, robotics streamlines the delivery of operative care with extraordinary safety and efficiency.”

Optimus, however, aspires to full autonomy, integrating Tesla’s advancements in AI (e.g., neural networks from full self-driving), dexterous manipulation (with the forthcoming Gen 3 hand featuring 50 actuators versus the prototype’s 17), and bipedal mobility to navigate dynamic operating environments.

It’s possible but the timeline is opaque.

The Robot Cannot Solve All Healthcare Disparities

Objective outcomes and metrics certainly exist, yet patient-specific risk factors—comorbidities, anatomy, and socioeconomic variables—make comprehensive modeling extraordinarily difficult.

Whether there are enough truly excellent surgeons is a complex question, shaped by profound supply-and-demand constraints. As Elon Musk recently observed, “Money doesn’t solve it, because there are only so many—there’s a very limited number of great doctors and surgeons. They don’t grow on trees. But now they will get built in factories.”

The deeper challenge, however, lies in recognizing that an outstanding surgeon is far more than a technically proficient operator. Excellent surgical outcomes depend on an excellent team. Even the world’s most renowned surgeons invest substantial effort in cultivating their teams, precisely because they understand that transformative care extends well beyond the operating theater.

Musk has envisioned a radically different future: “Imagine if everyone had access to an incredible surgeon. Of course, we need to make sure Optimus is safe and everything. But I do think we’re headed for a world of sustainable abundance… a world without poverty where everyone has access to the finest medical care.”

While the argument for universal access to high-quality surgery is compelling, much of what passes for “world-class” care in the United States is profoundly systems-dependent. It relies on pharmacists rigorously verifying medication orders, environmental services upholding impeccable cleanliness standards, and—critically—bedside nurses and physical therapists delivering meticulous postoperative care. Any experienced neurosurgeon will affirm that nursing quality and rehabilitation expertise often determine functional recovery as much as the index operation itself.

A robot may brilliantly execute a twelve-hour spinal deformity reconstruction, but will it be present to manage the complex, human-intensive six-month rehabilitation that ultimately defines success?

Potential Unintended Consequences Of Enabling Technology In Neurosurgery

The primary objective of contemporary enabling technologies in neurosurgery is to enhance procedural safety, reduce variability, and render outcomes more predictable and reproducible. A secondary goal is to extend safe, acceptable-standard care to the broadest possible patient population. Achieving equilibrium between these two aims remains a central challenge of this technological evolution.

Although intraoperative navigation (similar to a GPS system for the spine), robotic platforms, and augmented-reality systems may reduce certain technical errors and improve consistency for many practitioners, they also introduce subtle yet significant perturbations to the ecosystem of surgical competence and patient selection. By lowering the perceived (and sometimes actual) threshold for executing complex maneuvers, these tools can inadvertently shift case allocation, training paradigms and self-assessment norms in ways that merit careful scrutiny.

Complex, resource-intensive spinal reconstructions generate substantial revenue for both institutions and surgeons. These same procedures are also the least forgiving of technical or judgment errors. By lowering the threshold for executing high-risk maneuvers—most notably pedicle and pelvic screw placement in deformity surgery, as well as precise osteotomies for spinal realignment—enabling technologies can inadvertently allow less experienced or less proficient surgeons to undertake cases that would previously have been deferred or referred to tertiary specialists. In effect, the technology creates a form of moral hazard: the perceived safety net encourages case acceptance beyond a surgeon’s unassisted competence with economic forces lurking in the background.

Robotics or enabling technology is not a substitute for core knowledge. True expertise resides in understanding why a particular construct restores side and front balance to the spine, how lordosis or forward bend should be regionally apportioned, and whether operative intervention is indicated at all—domains of judgment that no current robotic device can adjudicate.

I don’t routinely use robotics or navigation for my complex spine cases. Many acknowledged leaders in the spine field—surgeons whose outcomes I do not presume to match—routinely and skillfully integrate navigation and robotics into their practice without compromising conceptual mastery. The hazard emerges instead at the margins: when technology serves primarily as a crutch that masks deficits in foundational knowledge, situational awareness, or operative judgment. A robot can minimize instrumentation malposition, but it cannot determine whether a multilevel fusion in an elderly patient with poor bone quality represents overtreatment, whether non-operative management would yield equivalent long-term benefit, or whether the patient’s symptoms are truly mechanical in origin.

Only a sophisticated, reasoning artificial intelligence—one capable of synthesizing patient-specific natural history, multimodal imaging, functional data, and nuanced risk–benefit calculus—could begin to supplant human judgment in these higher-order decisions. Until such systems exist, enabling technologies will continue to amplify both the ceiling and the effective floor of surgical performance, simultaneously empowering the exceptional and potentially enabling the merely adequate to operate in domains that exceed their native insight.

Vigilance is therefore required to ensure that technological assistance augments, rather than erodes, the rigorous standards of training, mentorship, and self-aware limitation that have traditionally defined surgical excellence.

Interesting Questions For The Future

Will patients continue to prefer human surgeons? A striking dichotomy already exists: individuals express unease about riding in fully autonomous vehicles despite safety data demonstrating their superiority over human drivers. Yet, in my clinic, patients frequently—and often enthusiastically—ask whether their spine surgery will be performed “with the robot” or incorporate “laser” technology.

The liability question is equally complex. When an adverse event occurs, who is truly performing the operation, and who bears ultimate responsibility? Patients and families will demand accountability from a person, not a corporate entity or an algorithm. A company is unlikely to satisfy that deeply human need for an identifiable individual to answer for outcomes.

The economic implications are no less profound. Hospitals are acquiring physician practices at an accelerating pace, transforming highly trained surgeons into commoditized employees within large systems. Deploying a surgical robot entails substantial upfront capital expenditure, but if it eventually replaces or significantly reduces reliance on human surgeons, long-term labor costs could decline. Maybe patients eventually won’t have a choice if the robot performs their surgery.

The more probable near- to mid-term scenario, however, is that robots function as physician extenders, dramatically increasing throughput and enabling individual surgeons to treat far more patients with greater efficiency. This expanded capacity will actually drive higher short-term healthcare utilization and immediate revenue. At present, operating-room availability serves as a form of implicit rationing. Could widespread robotic adoption effectively dismantle that bottleneck, further accelerating procedural volume?

We’ll see where we are in three years.