Intraoperative endoscopy in colorectal surgery in Spain: Results of a national survey

Anastomotic leakage remains one of the most feared complications in colorectal surgery. Intraoperative colonoscopy (IOC) enables direct assessment of anastomotic integrity and allows immediate therapeutic intervention. The aim of this study is to describe the implementation of intraoperative endoscopy in colorectal surgery in Spain, analysing available resources, training, utilization patterns, and impact on intraoperative decision-making.

Observational, descriptive, cross-sectional study based on an online survey distributed through the Asociación Española de Cirugía. The questionnaire, validated by a panel of experts, comprised 26 questions grouped into five domains: professional profile, infrastructure, technique and protocols, perceived outcomes, and training. The survey was active for 46 days. Descriptive statistical analysis was performed using absolute frequencies and percentages.

A total of 122 complete responses were obtained from 92 hospitals across 16 autonomous communities (completion rate: 31.7%). Flexible endoscopy was used by 55.7% of respondents, and 36.1% performed IOC routinely. Surgeons performed the procedures in 61.5% of cases. IOC was also used for localisation of lesions by 54.9% of respondents. In 61.8% of surgeons, the surgical approach was modified in up to 20% of patients. Indocyanine green fluorescence angiography was available in 85.2% of centres. Overall, 86.1% considered IOC a fundamental tool, and complications were virtually absent.

IOC is highly regarded in Spain, yet its systematic integration remains heterogeneous. Deficits in structured training, therapeutic methods, and equipment persist. A joint effort from scientific societies, hospital management, and surgical teams is required to ensure uniform implementation and improve anastomotic safety.