Traditional thermal processes for preparing surimi-based products include water bath heating (WB), steaming, broiling, and deep-fat frying. However, these methods have many limitations, such as low thermal efficiency, high time consumption, and large sewage production. Microwave heating (MH) is a promising alternative to traditional heating methods that rely on a heat transfer medium, owing to several advantages, such as environmental friendliness, time saving, and energy efficiency. Recent studies have demonstrated that MH can enhance the gelling properties of surimi gels, and industrial microwave production of surimi seafood has been realized. The effects of MH on surimi gel quality and improving mechanisms are summarized in this review from the perspectives of protein structural responses under microwave fields and interactions between the components of surimi. Moreover, the microwave energy absorption, mass and heat transfer processes of surimi materials, industrial applications, and equipment development are discussed, along with future research directions. Microwave processing is an effective method to promote the green manufacturing of surimi-based products with high gelling quality, nutritional and organoleptic characteristics. The mechanism of improvement is primarily involved in the key component interactions under microwave field, the side chain oxidation modification and lipid oxidation products-induced crosslinking can promote the aggregation of myosin, the potential regulation of endogenous enzyme activity by microwaves also determine the structure of gel network. Continuous tunnel and pipeline MH systems were established to fabricate surimi gels of various shapes, promoting the green upgrading and sustainable processing of the aquatic products industry.