Objective: We aimed at evaluating the impact of ultrasound‐guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. Design and Methods: Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H−) per operative US‐guided hook‐wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery‐related adverse events data were collected. Results: Mean operative time was significantly shorter in H+ group versus H− group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H−, p = 0.1). No significant between group difference in surgery‐related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). Conclusion: US‐guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H−. [ABSTRACT FROM AUTHOR]