NVIDIA has announced Cosmos-H-Dreams, a real-time generative AI simulator designed to accelerate development and evaluation of surgical robotic systems. The new model distills capabilities from NVIDIA's larger Cosmos-H-Surgical-Simulator into a more efficient system that runs on a single NVIDIA RTX PRO 6000 GPU, enabling interactive simulation of complex surgical scenes including deformable tissue, fine instrument interactions, and other surgical dynamics that are difficult to replicate in conventional simulators. The system uses a teacher-student distillation pipeline to reduce computational requirements while preserving critical surgical dynamics and failure modes. Cosmos-H-Dreams was trained on both successful and failed surgical demonstrations from the open-source Open-H-Embodiment dataset, enabling it to accurately simulate consequences of poor robotic actions—a key requirement for offline policy evaluation. The model supports integration with multiple surgical platforms, including the da Vinci Research Kit and Versius systems, through partnerships with CMR Surgical and Cambridge Consultants. The technology addresses a significant bottleneck in surgical robotics: the high cost and time requirements of training and evaluating systems on physical hardware. By enabling offline policy evaluation and synthetic data generation, Cosmos-H-Dreams could accelerate development cycles and reduce instrument damage and safety risks during experimental phases. The simulator is served through NVIDIA's FlashDreams inference library for optimized streaming performance.