Purpose <p>Pelvic cancer resections increase the risk of pelvic dead space, which increases the risk of postoperative complications. Robot-assisted pelvic reconstruction surgeries are a novel approach that may be beneficial, but it is unclear what impact it has on surgical outcomes in pelvic reconstruction with rectus abdominis muscle flaps. The aim of the study was to systematically review the surgical outcomes of robot-assisted pelvic reconstruction using rectus abdominis muscle flaps in patients with any pelvic cancers.</p> Method <p>A systematic search of the literature was conducted in PubMed, Web of Science, Cochrane Library, and Embase following the PRISMA guidelines, and the final search on all databases was performed on the 13th of May 2024. Studies reporting surgical outcomes of robot-assisted pelvic reconstruction with rectus abdominis muscle flaps were eligible based on predefined criteria. Two reviewers independently screened the literature, extracted data, and assessed risk of bias of included studies.</p> Results <p>Five studies, including 143 patients in total, met the inclusion criteria, comprising two retrospective cohort studies and three case series. Of these, 36 patients underwent robot-assisted pelvic reconstruction using rectus abdominis flaps. All studies reported wound complications, which were lower in the robot-assisted groups compared to open surgery groups. One study reported shorter length of stay. Two studies reported better visualization and avoidance of excessive blood loss when performing robot-assisted surgery.</p> Conclusions <p>Early reports indicate that robot-assisted surgery with flaps in pelvic reconstruction could improve postoperative outcomes. Further research should investigate the potential benefits through larger and controlled patient groups.</p>