Accurate pedicle screw placement is a critical determinant of safety and success in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Screw malposition may result in neural injury, facet joint violation, and suboptimal clinical outcomes. Fluoroscopy-assisted (FA) techniques remain widely used but rely on two-dimensional imaging and repeated radiation exposure, and their accuracy may vary depending on the surgeon’s experience. Robotic-assisted (RA) systems have been introduced to enhance three-dimensional surgical planning, improve screw trajectory precision, and optimize operative outcomes. This meta-analysis aimed to compare RA-MIS-TLIF and FA-MIS-TLIF in patients with lumbar spondylolisthesis. A systematic search of PubMed, ScienceDirect, ProQuest, Cochrane Library, and Google Scholar identified comparative studies evaluating RA-MIS-TLIF versus FA-MIS-TLIF. Nine studies involving 783 patients (RA: 311; FA: 472) and 2,176 pedicle screws (RA: 1,010; FA: 1,166) met the inclusion criteria. Random-effects meta-analysis was performed using standardized mean differences (SMD) for continuous variables and risk ratios (RR) for dichotomous outcomes. RA-MIS-TLIF significantly reduced estimated blood loss compared with FA-MIS-TLIF (SMD −1.93, 95% CI −3.08 to −0.78) and improved pedicle screw placement accuracy (RR 1.20, 95% CI 1.11–1.29). The incidence of facet joint violation was also significantly lower in the robotic group (RR 0.26, 95% CI 0.19–0.37). Operative time was longer for RA procedures (SMD 1.12, 95% CI 0.20–2.04), while hospitalization showed a trend toward reduction (SMD −0.87, 95% CI −1.74 to 0.00). Overall complication rates (RR 0.85, 95% CI 0.49–1.49) and fusion rates (RR 1.03, 95% CI 0.94–1.13) were comparable between techniques. Clinically, RA-MIS-TLIF demonstrated greater improvement in postoperative back pain (SMD −2.34, 95% CI −4.33 to −0.34) and leg pain (SMD −3.64, 95% CI −6.05 to −1.22), with a trend toward improved functional recovery based on the Oswestry Disability Index. Overall, RA-MIS-TLIF enhances surgical precision, reduces blood loss and facet joint injury, and improves postoperative pain outcomes, although operative time is increased. These findings suggest that robotic technology represents an advancement in minimally invasive spine surgery.