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Background <p>Anastomotic 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.</p> Methods <p>We 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).</p> Results <p>Surgeons 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), <i>P</i> &lt; 0.0001. Similarly, fluorescent ureteral navigation was associated with significantly lower frustration (20 [12.5–35] vs. 30 [20–55], <i>P</i> = 0.0093) and WWL (20.3 [17.2–36.5] vs. 29 [19.0–43.9], <i>P</i> = 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 (<i>P</i> = 0.0053 and <i>P</i> = 0.0092, respectively). No significant differences were observed among certified surgeon.</p> Conclusion <p>ICG 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.</p>

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Impact of intestinal blood flow assessment with indocyanine green fluorescence method and fluorescent ureteral navigation on surgeons’ mental workload during laparoscopic colorectal surgery

  • 期刊论文

  • 发表日期：

    2025年11月5日

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  • Shunsuke Nakashima,
  • Shunjin Ryu,
  • Yuta Imaizumi,
  • Hyuga Kawakubo,
  • Daiki Suzuki,
  • Hironari Kawai,
  • Takehiro Kobayashi,
  • Keisuke Goto,
  • Atsuko Okamoto,
  • Teppei Kamada,
  • Junji Takahashi,
  • Yasunobu Kobayashi,
  • Yasuhiro Takano,
  • Yasuhiro Takeda,
  • Ryusuke Ito,
  • Ken Eto

摘要

Background

Anastomotic 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.

Methods

We 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).

Results

Surgeons 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.

Conclusion

ICG 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.