Background: Robotic-assisted follicular unit excision (FUE) was introduced to mitigate surgeon fatigue and improve graft harvesting in hair restoration surgery.(1) However, debate persists regarding whether robotic systems offer superior clinical outcomes compared to manual techniques. This systematic review evaluates the comparative efficacy of robotic systems versus manual FUE, specifically focusing on donor management, graft quality, and surgical efficiency. Methods: A systematic review was conducted of Pubmed, Embase, and MEDLINE to identify peer-reviewed clinical studies comparing robotic and manual FUE. Inclusion criteria encompassed research involving patients with androgenetic alopecia in the form of Randomised control trials, cohort studies, case-control studies, cross-sectional, and case series/studies. Quality was assessed with the Newcastle-Ottowa scale. A qualitative synthesis of study findings was undertaken. Results: Five relevant studies were identified meeting eligibility criteria. Analysis revealed robotic harvesting has achieved parity with manual transection rates, but has a lower efficiency due to increased graft discard and 'empty' sites. Conversely, robotic systems utilising advanced selection algorithms significantly improved hair-per-graft yield compared to random extraction. Furthermore, robotic capabilities have successfully expanded beyond extraction to include consistent recipient site creation and feasible graft implantation. Conclusion: Current robotic systems are safe and effective, offering ergonomic benefits and precision. However, they do not yet statistically outperform manual harvest efficiency in skilled surgeons, the gold standard for graft conservation. While technology supports a more automated workflow, manual oversight remains essential to minimise graft loss and ensure optimal clinical outcomes. References: 1.Avram M, & Watkins S. Robotic Hair Transplantation. 2020. Facial Plastic Surgery Clinics of North America. 28(2): 189-196