Mid-infrared (MIR) lasers offer substantial benefits, including non-contact operation, high efficiency, and precision, making them widely utilized in clinical surgical procedures such as lesion tissue removal, tissue plasticity, and tumor interstitial photothermal therapy. Notably, carbon dioxide (CO₂) lasers, among various MIR lasers, are extensively employed in skin, ear, nose, throat, and abdominal surgeries due to their exceptionally high ablation efficiency and precision. However, the lack of stable and high-performance small-scale, flexible laser energy-delivering mediums for CO₂ lasers restricts their use in minimally invasive or noninvasive procedures, a capability present in mature silica fibers used in holmium, neodymium, and other near-infrared lasers for conducting minimally invasive interventional operations in natural cavities in vivo. Presently, CO₂ laser procedures typically rely on energy-delivering mediums such as articulated arms and hollow waveguides but this considerably hampers the application of CO₂ laser in minimally invasive surgeries. To enhance the role of CO₂ lasers in clinical medicine, we review and summarize existing medical CO₂ laser energy-delivering mediums, focusing on the advances in thermal-drawn multi-material fiber technology in CO₂ laser surgery, and explore future development trends and applications of multifunctional flexible CO₂ laser ablation robotic fibers.