Background/Objectives: Robotic-assisted surgery has revolutionised modern medicine, enabling greater precision and control, particularly in microsurgical procedures. This systematic review evaluates the current state of robotic-assisted surgery across various specialties, focusing on four major robotic systems: Symani, Da Vinci, ZEUS, and MUSA. Methods: The review systematically analyses the effectiveness of these systems in performing vascular, lymphatic, and nervous anastomoses, comparing key metrics such as procedure time, success rates, and learning curves against manual techniques. It includes 48 studies, highlighting the technological capabilities and limitations of these systems in direct comparisons. Results: Results indicate that while robotic procedures often take longer than manual methods, significant improvements in efficiency are observed as surgeons gain experience. Conclusions: Overall, this study provides insights into the future potential of robotic-assisted surgery and highlights areas that require further research. It ultimately aims to promote the application of robotic systems in cranial neurosurgery, with a particular focus on advancing neurovascular techniques, such as microsuturing for bypass procedures.