Preoperative imaging is crucial for patients diagnosed with renal cell carcinoma presenting with thrombus. These individuals frequently exhibit a hypercoagulable state, raising the risk of thrombus progression or the formation of a new bland thrombus post-imaging and pre-surgery. Intraoperative ultrasound, employed under direct visualization, offers real-time, dynamic detection of thrombi, potentially influencing surgical decisions. This short review explores the utility of intraoperative ultrasound in robot-assisted thrombectomy for renal cell carcinoma, detailing its primary applications and added value in mitigating surgical risks for urologists.