Abstract

• Intraoperative ultrasound (IOUS) is a fundamental tool used in modern hepatic surgery, which can precisely define the liver anatomy and accurately identify target lesions.

• IOUS is one of the key factors to spare hepatic parenchyma without compromising the oncological endpoints.

• IOUS should be performed by the first surgeon with the aim of gathering information that might impact the surgical strategy.

• IOUS is an important tool for staging malignancies, determining resectability, and planning the most adequate procedure.

• Contrast-enhanced IOUS (CEIOUS) is useful in the differential diagnosis of new lesions eventually detected with basic IOUS and can increase its overall sensitivity.