Aktuelle Evidenz zum intraoperativen Ultraschall

Intraoperative ultrasound (IOUS), also potentially as contrast-enhanced (CE)-IOUS, is a versatile tool for surgical decision-making. It enhances intraoperative orientation, enables precise resection guidance and helps prevent complications and follow-up procedures; however, in Germany, IOUS is currently only selectively used, often in nonsurgical disciplines. While this is reasonable in certain scenarios, it reaches its limits when imaging directly influences surgical actions. The clinical benefits of IOUS are well-documented in several specialties, particularly liver surgery, neurosurgery and surgical senology. Nevertheless, a systematic integration into surgical training, clinical practice, and guidelines is still lacking. In visceral surgery only a few surgeons have their own IOUS experience. In other fields, such as vascular or transplantation surgery, its use is already standard, although this has not been confirmed by randomized studies. The German Society for Ultrasound in Medicine (DEGUM), as the leading professional society for ultrasound in medicine, advocates a broader and structured integration of IOUS into surgical medicine. It provides practical modular training formats, promotes scientific projects and works with guidelines to make existing evidence visible and future evidence usable. The goal is to establish IOUS as a fixed component of quality-assured surgical care both interdisciplinary and cooperative but with independent sonographic expertise on the surgical side. Therefore, DEGUM recommends the use of IOUS for control and guidance during tumor resections, for navigation in anatomically unclear situations, for assessment of vascular anastomoses or organ perfusion and for extended diagnostics, particularly in liver surgery, potentially with the supplementary use of contrast-enhanced ultrasound.