The latest advancement in high-intensity focused ultrasound (HIFU) treatment technology integrates magnetic resonance imaging (MRI) guidance for precise treatment of prostate disease. As conventional electromagnetic motors are not applicable for utilization within MRI scanners, we have developed a prototype robotic system driven by pneumatic stepper motors to control the movement of the HIFU transducer within an intrarectal probe during MRI-guided HIFU treatment procedures. These pneumatic stepper motors were constructed entirely from MRI-compatible plastic materials. Assessment of the robotic system’s MRI compatibility was conducted utilizing a 3.0T MRI scanner, revealing no discernible MRI image distortion with a minor decrease in the signal-to-noise ratio (2.8%) during the motor operation. The robotic system enabled the transducer to move inside the probe with two degrees of freedom, allowing both linear and rotational motion. The positional accuracy of the transducer movement was assessed, yielding ±0.20 and ±0.22 mm accuracies in the forward and backward linear movements, respectively, and ±0.79° and ±0.74° accuracies in the clockwise and counterclockwise rotational motions, respectively. Emulation of authentic HIFU procedures involved creating a two-dimensional array of thermal lesions in a tissue-mimicking phantom, achieving positional accuracy within ±1 mm for the generated HIFU focal spots. The prototype robotic system incorporating pneumatic stepper motors fabricated entirely from MRI-compatible plastic materials has demonstrated the requisite positional accuracy necessary for effective HIFU treatment of prostate disease, indicating substantial promise for future clinical application.