Intraoperative Ultrasound in Hepatic Oncology Surgery: A Narrative Review of Its Impact on Surgical Strategy and
Cosmin Nicolescu1,2, Catalin Dumitru Cosma1,2, Marian Botoncea1,2
1Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540139 Targu Mures, Romania.
Abstract:
Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major intraoperative challenges. This structured narrative review aimed to evaluate the contemporary role of IOUS in hepatic oncology surgery, with particular emphasis on contrast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver surgery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, international guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparoscopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchymal-sparing resections contribute to the preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparoscopic ultrasound remains essential for lesion localization and vascular mapping. Recent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally integrated precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for precision-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future.
