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

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.

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.

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.

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.