ArticleSurgical endoscopy2026
Impact of intestinal blood flow assessment with indocyanine green fluorescence method and fluorescent ureteral navigation on surgeons' mental workload during laparoscopic colorectal surgery.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnastomotic leakage and ureteral injury are serious complications in colorectal surgery, negatively impacting both short- and long-term outcomes. Indocyanine green (ICG) fluorescence has gained attention for intraoperative intestinal perfusion assessment and ureteral navigation. This study evaluated whether these ICG fluorescence-based techniques reduce surgeons' mental workload.
methodsWe retrospectively assessed surgeons' workload using the NASA Task Load Index (TLX) during laparoscopic colorectal surgeries performed between January and December 2022. Anastomotic blood flow was assessed either using the ICG fluorescence method (n = 158) or the conventional method (n = 29). Moreover, patients undergoing left-sided colorectal surgery were divided into two groups based on the use of fluorescent ureteral navigation (n = 29) versus nonfluorescent navigation (n = 72).
resultsSurgeons using ICG fluorescence for blood flow assessment reported significantly lower TLX scores across all domains, including weighted workload (WWL): 12.3 (IQR: 10.5-17.3) vs. 46.8 (IQR: 21.6-54.4), P < 0.0001. Similarly, fluorescent ureteral navigation was associated with significantly lower frustration (20 [12.5-35] vs. 30 [20-55], P = 0.0093) and WWL (20.3 [17.2-36.5] vs. 29 [19.0-43.9], P = 0.0412) compared with the nonfluorescent group. Among surgeons not certified by the Japan Society for Endoscopic Surgery, fluorescent guidance resulted in lower frustration and WWL (P = 0.0053 and P = 0.0092, respectively). No significant differences were observed among certified surgeon.
conclusionICG fluorescence-based techniques for anastomotic perfusion and ureteral navigation effectively reduce mental workload for surgeons, especially for those without endoscopic surgical certification. These methods may serve as supportive tools in promoting safe and ergonomic colorectal surgery.
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