I’ve always been a tinkerer, a builder. From my early days coding in my dorm room to building and selling two companies in Silicon Valley, my passion has always been at the intersection of a real-world problem and a technological solution. It’s what led me to create RemoteTeam, a platform to manage distributed teams, which was eventually acquired by Gusto. It’s the same fire that fueled MovieLaLa, a movie discovery app we sold to Gfycat. This obsession with practical innovation is also why I’ve put my money where my mouth is, investing in over 200 startups, including foundational AI companies like Anthropic, OpenAI, and Scale AI. So, when the opportunity arose to speak with a leading robotic surgeon, I didn’t hesitate. I had to know: what does the operating room of tomorrow look like, and how much of it will be run by the AI I’m seeing transform every other industry?
Our meeting took place in a setting that felt less like a hospital and more like a scene from a sci-fi movie. The surgeon, Dr. Evans, had a calm, focused energy that I’ve seen in the best founders I’ve backed. I got straight to the point. “What’s the biggest thing people get wrong about robotic surgery?”
“That the robot is the one calling the shots,” he said, a small smile playing on his lips. “It’s not. I’m the surgeon. The robot is an extension of my hands, a tool of incredible precision, but a tool nonetheless.”
He described how the da Vinci system, the most common surgical robot, translates his hand movements into micro-movements inside the patient. It filters out any tremor, allowing for a level of delicacy that’s simply not possible with human hands alone. He likened it to the difference between trying to paint a miniature with a house-painting brush versus a fine-tipped artist’s brush. The intent is the same, but the execution is worlds apart. This resonated with me deeply. In the world of software, we're constantly building abstractions to make our work more precise and powerful. A high-level programming language is a tool that lets us express complex logic without getting bogged down in the minutiae of machine code. The surgical robot is the same idea, but for the physical world.
The Humanoid in the OR
My mind immediately jumped to the Tesla Optimus and other humanoid robots. I’ve seen the demos, I’ve invested in the space. I’m a believer in the long-term potential of general-purpose robots. “So, what’s stopping us from having a Tesla Bot perform an appendectomy?” I asked.
He took a long pause, a look of deep concentration on his face. “Theoretically, it’s possible. But the gap between theory and practice is a chasm. Surgery is a domain of infinite variables. Every human body is a unique landscape. Tissues don’t always behave as expected. A blood vessel might be in a slightly different location. An AI would need to not just recognize these anomalies, but to reason about them, to improvise, to make a judgment call based on incomplete information. That’s not a data problem, it’s a wisdom problem.”
We got into a fascinating discussion about the role of AI in this. I’ve seen how drone AI can navigate a dense forest at high speed, making thousands of micro-decisions every second. Couldn’t that same technology be applied here? “The stakes are just different,” he countered. “When a drone hits a tree, you lose a piece of hardware. When a surgical robot makes a mistake, you can lose a life. The margin for error is zero.”
I pushed back a little. “But what about the sheer volume of data? We could train an AI on millions of hours of surgical footage. It could learn from the best surgeons in the world, identify the most efficient techniques, and even discover new ones.”
He conceded the point. “You’re right, and we’re already seeing the beginnings of that. AI is being used to analyze surgical videos to assess skill and provide feedback. It can act as a co-pilot, highlighting potential risks or suggesting a better approach. But it’s a guide, not the pilot. The human surgeon is still the one with their hands on the controls, the one who has to make the final call.” This is the same dynamic I see in the world of AI-powered coding assistants. They can write boilerplate code, suggest optimizations, and even catch bugs, but they can't design a complex software architecture from scratch. They lack the context, the understanding of the business goals, the ability to make trade-offs. They are powerful tools, but they are not yet creators.
More Than a Steady Hand
This is what so many people miss about high-stakes professions. It’s not just about technical execution. It’s about judgment, intuition, and grace under pressure. Dr. Evans shared a powerful story about a young woman with a particularly nasty tumor. It was wrapped around a major artery, a situation where a millimeter in the wrong direction could have catastrophic consequences.
“The robot gave me the precision to dissect the tumor away from the artery, something that would have been incredibly risky just a decade ago,” he explained. “But it was my twenty years of experience that guided my hands. It was the memory of a dozen other difficult cases that allowed me to anticipate the challenges and navigate the complexities. The robot was the scalpel, but I was the surgeon.”
It reminded me so much of the early days at RemoteTeam. We had a solid product, but when the pandemic hit and the world went remote overnight, our platform was put to the ultimate test. It wasn’t our code that got us through that period, it was our team. It was the countless hours we’d spent debating our product roadmap, the all-nighters we’d pulled to fix a critical bug, the shared sense of purpose that allowed us to adapt and overcome. That’s the human element you can’t code. It’s the same in a startup as it is in an operating room. I've seen brilliant engineers build technically perfect products that completely miss the mark because they don't understand the user. I've also seen less-than-perfect products succeed wildly because the team had a deep, intuitive understanding of the customer's needs. That's the wisdom that comes from experience, not from data.
The Augmented Surgeon
So, what’s the real future here? It’s not a future of robot surgeons, but of augmented surgeons. It’s a future where technology enhances human skill, rather than replacing it. Here’s what that looks like in practice:
- Augmented Reality Overlays: Imagine a surgeon looking at a patient’s liver and seeing a real-time 3D map of the blood vessels and tumors projected directly onto it. This isn’t science fiction; it’s happening now. Companies are developing systems that give surgeons x-ray vision, allowing them to see what’s underneath the surface with incredible detail. This is a game-changer. It's like giving a developer a debugger that can see into the future. It allows you to anticipate problems before they happen and to make much more informed decisions.
- AI-Powered Navigation: Think of it like GPS for surgery. The AI can create a detailed map of the surgical site and provide real-time guidance to the surgeon, helping them to navigate complex anatomy and avoid critical structures. It can warn them if they’re getting too close to a nerve or a major blood vessel. This is another area where I see huge potential. I've invested in companies that are using AI to analyze medical images and identify tumors that are invisible to the human eye. The same technology can be used to guide a surgeon's hand with superhuman precision.
- Advanced Surgical Simulation: The days of “see one, do one, teach one” are numbered. The next generation of surgeons will train on hyper-realistic simulators that can replicate the look and feel of real surgery. They’ll be able to practice complex procedures hundreds of times before they ever touch a real patient, dramatically reducing the learning curve and improving patient safety. This is something I'm particularly excited about. I believe that simulation will be a key part of the future of education in many fields, not just medicine. It's a much more efficient and effective way to learn than the traditional classroom model.
I walked away from my conversation with Dr. Evans more excited than ever. The same relentless drive for innovation that I’ve dedicated my life to in Silicon Valley is transforming medicine in profound ways. We’re on the cusp of a new era in surgery, one that will be safer, less invasive, and more effective than ever before.
This is what I look for as an investor. It’s the core thesis of my book, “Becoming Top 1%.” I’m not interested in technology for technology’s sake. I’m interested in technology that solves real problems for real people. The companies that will win in the long run are the ones that understand that the most powerful technology is the one that empowers us, that makes us better at what we do. That’s the future I’m betting on. It’s a future where human ingenuity and technological innovation come together to create something truly extraordinary. And I, for one, can't wait to see what's next.
Frequently Asked Questions
What's the most common pushback you get on this?
People often push back by citing exceptions or edge cases. And they're usually right that exceptions exist. But building a strategy around exceptions rather than patterns is a losing game for most founders.
How has this view evolved over time?
My thinking on most topics has changed significantly over the years. Early in my career, I held many conventional views that experience proved wrong. I try to update my beliefs when the evidence changes.
Do all experts agree with this view?
No, and that's fine. The best ideas in business are often contrarian. I share my perspective based on my experience and data, but I encourage you to seek out opposing viewpoints and form your own conclusions.
What experience informs this perspective?
This perspective comes from over a decade of building companies in Silicon Valley, two successful exits (RemoteTeam to Gusto, MovieLaLa to Gfycat), and investing in 200+ startups including Anthropic, OpenAI, and Scale AI. I write about what I've lived.