Liver puncture is an indispensable procedure in the diagnosis and treatment of liver diseases. However, traditional manual puncture typically relies on the extensive experience and judgment of physicians. Liver puncture robots, with their advantages of high stability, precision, and safety, can to some extent compensate for the shortcomings of traditional manual puncture. Based on the different imaging modalities, liver puncture robots are categorized into those guided by ultrasound, CT, and MRI, and the advantages and disadvantages of these three imaging guidance methods are analyzed. Spatial positioning methods play a crucial role in improving the accuracy of puncture during surgery. Therefore, the spatial positioning methods under image guidance are introduced. Finally, the current research status of image-guided liver puncture robots and positioning methods is summarized, and future research directions are discussed.