Purpose: Free flap transfer remains the gold standard for reconstructing extensive defects following head and neck cancer resection. While success rates generally exceed 95%, technical challenges persist when encountering small-caliber or sclerotic vessels. To overcome these limitations and further enhance surgical precision, we have been developing a specialized robotic system for microsurgical vessel anastomosis. We hereby introduce our ongoing research. Methods and Results: The first-generation prototype, completed in 2018, established proof-of-concept by anastomosing 1.0 mm artificial vessels. This was followed by the second-generation prototype in 2021, which introduced a robotic arm and shoulder assembly to expand the range of motion, eventually achieving successful anastomosis of 0.8 mm rat femoral arteries and 0.3 mm artificial vessels by 2023. The latest master-slave system, finalized in March 2025, incorporates several features. Its highly accurate motion-scaling technology, featuring up to a 1:20 ratio, allow for pinpoint needle tip control while effectively neutralizing physiological hand tremors. This precision is complemented by a high-definition 3D exoscope that provides a magnified surgical field. Furthermore, the system employs custom-designed ultra-fine forceps optimized for the delicate handling of 11-0 monofilament sutures. In usability testing conducted on chicken wing vessels (diameters <0.8 mm), the mean time for a single suture was significantly reduced compared to previous prototypes, with a 100% patency rate immediately post-anastomosis. Evaluation of the vessel intima revealed uniform pitch and bite with minimal endothelial trauma. Conclusion: Our novel robotic system facilitates the anastomosis of ultra-small vessels that are traditionally considered at the limit of human capability. This system is poised to improve outcomes in complex head and neck reconstruction using free flaps.