The Surgeon Is Still the System

There is a version of the surgical robotics story that gets told a lot: bold founders built robots, skeptics were proven wrong, and now a new generation is doing it again with better components and AI. That story is true, but it misses the more interesting part.

Last week, I sat down with three people who have spent their careers building at the intersection of technology and the operating room:

• Rony Abovitz, founder of Mako Surgical, whose haptic robotic system was acquired by Stryker and is now used worldwide, and who went on to found Magic Leap and most recently SynthBee
• Josh DeFonzo, founder of Mendaera, which uses collaborative AI to standardize and scale needle-based medical procedures
• Chris Morley, founder of Medivis, which builds augmented reality visualization systems for surgery and recently became the first company to receive FDA clearance to guide neurosurgery using AR

Their clarity about what the technology is actually for was the most striking thing about the conversation.

The unlock isn’t the robot. It’s what surrounds it.

Each company on our panel is building a different layer of the same stack. Rony built haptic feedback into orthopedic surgery, invisible forces guiding a surgeon’s hand to the exact right position. Chris is building AR visualization that lets a surgeon see the intended target overlaid directly onto the patient before a robot executes the plan. Josh is building AI that compresses the learning curve for needle-based procedures, making expert-level outcomes reproducible across skill levels and care settings.

None of them are building a replacement for the surgeon. They are building the systems that make the surgeon capable of things that weren’t previously possible: the precision, the consistency, the ability to see and plan and act at a level no unaided human hand can reach. The robot, in each case, is one component in a larger collaborative system.

Rony put it cleanest. Think of Gary Kasparov and IBM’s Watson. Either one is remarkable. Together, they beat everything. That is the combination this generation of founders is building toward.

The change agent is the patient, not the technology.

One of the most under-appreciated lessons from the first generation of surgical robotics is how adoption actually happened. It was not through converting high-volume surgeons. The high-volume surgeons were the hardest to move. What worked was winning patients directly, building demand, creating a pull that hospitals could not ignore.

That dynamic is not unique to robotics. It played out the same way in continuous glucose monitoring, in clear aligner orthodontics, in nearly every healthcare technology that moved at speed. The technology enables. The patient activates. Companies that understand that sequence do not have to fight institutional inertia from the inside.

The frontier of surgery

The current generation of surgical robotics is impressive. It is also, by the assessment of the people who built it, still early. As the conversation framed it, we are still driving the Ford Model A. A generation from now, patients will look back in wonder at how primitive our approach to surgery was.

The next meaningful unlock is working at the cellular and tissue level. Imagine instruments that can navigate around critical structures rather than cutting through them, preserving function that today’s tools sacrifice in the name of access. Sensors and optics capable of diagnosing tissue at a cellular resolution, in real time, at the point of intervention. Systems that can identify and treat a tumor at the microscopic level rather than excising the surrounding region wholesale. The difference between what we do today and what that future looks like is roughly the same distance between a swig of whiskey and a leather strap, and today’s same-day outpatient surgery.

The components to get there — lab-on-chip, advanced photonics, refined microactuators — are being developed in adjacent industries. Mobile computing, autonomous vehicles, and defense are pulling the underlying technologies toward the threshold surgical robotics needs. The convergence is not guaranteed to happen on any particular timeline. But the direction is not in question.

The builders in this space are not betting on technology replacing the surgeon. They are betting on technology making the surgeon into something we do not quite have a word for yet. That is the category we find interesting.