Intraoperative ultrasound in surgery for hepatocellular carcinoma

Imaging-guided therapeutic procedures have modified the approach to HCC both introducing new treatment modalities and also changing the policy of hepatectomies. Indeed, with intraoperative ultrasonography (IOUS) it is possible to achieve better knowledge about tumor location and staging, also with the aid of contrast-enhanced IOUS. However, IOUS also allows to minimise the rate of major hepatectomies maintaining treatment radicality and widening the indication at surgery. Indeed, precise definition of tumor-vessel relationship, intrahepatic vessel distribution and color-Doppler analysis allows performing hepatectomies otherwise not possible. This so-called "radical but conservative" policy has allowed us a safe surgical approach with minimal mortality and major morbidity and effective local treatment with no tumor relapses at the site of the resection. Techniques for safe and radical IOUS-guided liver resections for HCC are here discussed.