Image-guided surgery has become the standard of care in neurosurgery1,2 with the first systems reported in the mid 1990s. Studies support improved accuracy and reduced OR times. These outcomes have led to lower morbidity and shortened inpatient hospital stays.3,4 Herline et al. described the first use of image guidance for liver surgery in 1999.5 The paradigm of image-guided surgery is largely unchanged since these early systems: a sensor is used to track the position and orientation of the surgeon’s tool. The anatomy of interest is mapped to high-resolution preoperative images using a process called registration. Registration and tool tracking enable the surgeon to see the surgical tool superimposed on the preoperative patient image on a navigational display, as the instrument is manipulated (Fig. 1). This review will describe the state of image-guided liver surgery and discuss future applications for MIS liver surgery.