We performed intrahepatic cholangiotomy and lithotomy on six hepatolithiasis patients from both proximal (hepatic hilus) and distal sites under intraoperative ultrasonic guidance. A rapid increase in the frequency of hepatectomy procedures has occurred in the last three years in our hospital, 26 of 34 cases. Hepatectomy should be avoided, however, for patients with stones in both lobes and poor functional reserve of the liver. These factors imply surgical procedure difficult. Operative cholangiography and cholangioscopy do not provide informations of the duct distal to the occlusion site. On the other hand, ultrasonography is a useful tool to assist in the complete removal of stones, and it becomes main intraoperative procedure for hepatolithiasis.