Awareness, Utilization, and Barriers to Fluorescence Ureteral Navigation in Japan: A Nationwide Survey Study.

BACKGROUND/AIM: Fluorescence ureteral navigation (FUN) using near-infrared devices (e.g., NIRC™ and IRIS) can assist in the visualization of ureters and the prevention of iatrogenic injury during complex colorectal procedures. However, its adoption in Japan remains limited.

PATIENTS AND

METHODS

A nationwide anonymous web-based survey was conducted among surgeons in Japan from May 1 to June 30, 2025 to assess awareness, usage, and barriers related to FUN. A total of 124 valid responses were collected.

RESULTS

The majority of the respondents specialized in lower gastrointestinal surgery (66.1%), and 63.7% had more than 11 years of clinical experience. Among the respondents, 74.2% were aware of FUN, but only 25.8% had used it. Notably, 96.0% of respondents felt that there were cases in which they would like to use FUN, and 89.5% perceived FUN as educationally valuable for junior surgeons. The most desired indications included locally advanced rectal or sigmoid cancer (84.7%), recurrent cancer (77.4%), and diverticulitis (59.7%). Among respondents who were aware of FUN, 42.9% reported having encountered cases for which they wanted to use FUN but could not. The main barriers included difficulty coordinating with urologists (53.8%), high device cost (28.2%), and a lack of compatible fluorescence imaging systems (23.1%). Psychological concerns, such as hesitancy due to the perceived burden on urology departments (51.6%) and scheduling complexity (42.7%), were also notable. Only 7.3% of surgeons had experience inserting ureteral catheters, although 35.5% had assisted with the procedure.

CONCLUSION

This nationwide survey highlights the strong clinical and educational demand for FUN among Japanese surgeons as well as persistent logistical and institutional barriers. Facilitating surgeon-led implementation through improved access to devices, structured training, and interdisciplinary collaboration may support broader clinical adoption.