This systematic review evaluates the applications and future prospects of intraoperative ultrasound-guided robotic surgery (RIIOUS). The study adhered to PRISMA guidelines and searched multiple databases up to October 2023. Twenty studies met the inclusion criteria, primarily focusing on general surgery (53%) and oncological surgery (42%). The majority of studies (53%) were related to locating tumor lesions and defining resection margins, while others assessed the feasibility of robotic ultrasound-guided surgery (15%), compared robotic and laparoscopic ultrasound probes (10.5%), and evaluated specific aspects such as hepatic tissue consistency (5%) and splenic artery blood flow visualization (5%). The review highlights the advantages of robotic instrumentation in RIOUS, including ergonomics, dexterity, and precision, which enhance surgical decision-making and potentially reduce procedure times. Despite the limited evidence and small cohort sizes, the studies consistently report satisfactory performance of RIOUS. The review emphasizes the need for increased adoption of robotic surgical procedures and training in intraoperative ultrasound for broader clinical application. Future research should focus on large-scale randomized controlled trials to further validate the utility of RIOUS in oncological outcomes.This systematic review evaluates the applications and future prospects of intraoperative ultrasound-guided robotic surgery (RIIOUS). The study adhered to PRISMA guidelines and searched multiple databases up to October 2023. Twenty studies met the inclusion criteria, primarily focusing on general surgery (53%) and oncological surgery (42%). The majority of studies (53%) were related to locating tumor lesions and defining resection margins, while others assessed the feasibility of robotic ultrasound-guided surgery (15%), compared robotic and laparoscopic ultrasound probes (10.5%), and evaluated specific aspects such as hepatic tissue consistency (5%) and splenic artery blood flow visualization (5%). The review highlights the advantages of robotic instrumentation in RIOUS, including ergonomics, dexterity, and precision, which enhance surgical decision-making and potentially reduce procedure times. Despite the limited evidence and small cohort sizes, the studies consistently report satisfactory performance of RIOUS. The review emphasizes the need for increased adoption of robotic surgical procedures and training in intraoperative ultrasound for broader clinical application. Future research should focus on large-scale randomized controlled trials to further validate the utility of RIOUS in oncological outcomes.