In the last 3 years 21 cirrhotic patients with hepatocellular carcinoma were operated. All patients fulfilled the criteria of localized tumor and good liver function and underwent a laparotomy with the aim of resecting the tumor. Intraoperative ultrasound examination was essential to localize a non visible and non palpable tumor in 2 cases and it was useful to detect other nodules in 3 of the 16 patients who underwent a hepatic resection of the tumor. In 5 patients resection was considered not indicated. Therefore, the initial therapeutic approach of tumoral resection was changed in 23.8% of patients. Also, intraoperative ultrasonography was essential for performing a guided resection of hepatocellular carcinomas in cirrhotic liver with the aim of preserving as much liver parenchyma as possible.