Introduction: This study evaluates the role of intraoperative ultrasound in hepatobiliary surgery in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a prospective cohort analysis. Materials and Methods: A prospective cohort study was conducted on 260 patients from March 2017 to September 2023 at a tertiary care center. Patients were divided into IOUS-assisted (n=130) and Preoperative imaging only (n=130) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The IOUS-assisted group demonstrated significantly improved primary outcomes compared to Preoperative imaging only (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.