In this paper a novel speech recognition methodology based on Hidden Markov Model (HMM) is proposed for embedded Automatic Positioner for Laparoscope (APL), which includes a fixed point ARM processor as the core. The APL system is designed to assist the doctor in laparoscopic surgery, by implementing the specific doctor’s vocal control to the laparoscope. Real-time respond to the voice commands asks for more efficient speech recognition algorithm for the APL. In order to reduce computation cost without significant loss in recognition accuracy, both arithmetic and algorithmic optimizations are applied in the method presented. First, depending on arithmetic optimizations most, a fixed point frontend for speech feature analysis is built according to the ARM processor’s character. Then the fast likelihood computation algorithm is used to reduce computational complexity of the HMM-based recognition algorithm. The experimental results show that, the method shortens the recognition time within 0.5s, while the accuracy higher than 99%, demonstrating its ability to achieve real-time vocal control to the APL.