Intraoperative ultrasound in patients with hepatocellular carcinoma: from daily practice to future trends

Starting from the end of the 1970s, intraoperative ultrasound was introduced and developed to stage liver disease and guide the surgical interventions in patients with hepatocellular carcinoma. Without intraoperative ultrasound, it would probably be impossible to correctly define the hepatic segments as well as the limits of a tumor, also because of the existing wide variations in the anatomy. More importantly, intraoperative ultrasound allows for three-dimensional reconstruction of the relationships between the tumor, hepatic veins, and Glissonian pedicles. Such reconstruction is essential for planning the surgical strategy, which should be individualized in each patient with the aim to spare functional liver parenchyma. This work focuses on the role of intraoperative ultrasound to stage liver disease and to plan surgical resection, describing the most recent technical achievements.