The Hierarchical Surgical Robot Transformer (SRT-H) brings step-level autonomy to surgery by combining a language-driven high-level planner with a vision-guided low-level executor. Trained on over 16,000 demonstrations, it completed the clipping-and-cutting phase of gallbladder removal with 100% success in ex-vivo trials, adapting to variations and self-correcting without human intervention—marking a milestone toward clinically viable autonomous surgery.