Operative ultrasound, which permits direct We have divided the material into three placement of the probe on the organ to be principal sections: hepatic surgery, biliary studied during surgery, has been in existence surgery, and the surgery of portal hyperten­ for over 20 years. Early experiences with its sion. Our experience with operative ultra­ use in urologic [15] and biliary surgery [7, 8, sound in pancreatic disease is not adequate 9] were limited by technical difficulties but for discussion in this manual, although many the evolution of B-mode, real-time ultra­ useful applications have been suggested. sound has made possible the broad applica­ Each chapter includes an anatomical review tion of ultrasound in the operating room. and a presentation of the basic sonographic The goal of operative ultrasound is to signs to clarify the diagnosis and therapy of provide the surgeon with information about a pathologic conditions. Emphasis has been solid organ which is not obvious from its ex­ placed on the practical applications of opera­ ternal morphology. What is the nature of the tive ultrasound. lesion? What is its precise localization within With most of the ultrasound images (all the organ? What vascular and anatomical are presented on a black background) two constraints limit its surgical treatment? Mod­ schematic diagrams are shown: ern ultrasound technology, which produces The first indicates the position of the probe an image faithful to the true anatomy, per­ on anterior and lateral projections.