Medical-surgical robotics has a stunning 40 years history, and now, shifting to high gear, there is an unprecedented rise in applications and systems. Surgical robotics is entering new domains, requiring highly sophisticated manipulation skills and decision making. The newest generation of surgical robots does not only function as an agile extension of the human eyes and hands, but also becoming a skillful and smart partner of their human counterpart. Legislation and standardization activities are gradually following the technical development, striving to establish a safe and reliable environment for Surgical Robots 4.0, which promises automated treatment delivery. However, this raises numerous safety and performance related questions.