Association of Institution-wide Fluorescent Ureteral Navigation Implementation With Minimally Invasive Surgery Completion in Rectal Cancer

Background/Aim: Fluorescent ureteral navigation (FUN) enables real-time ureter visualization during pelvic surgery, but whether institution-wide implementation supports minimally invasive surgery (MIS) is unclear. Patients and Methods: We retrospectively compared consecutive rectal and anal canal cancer operations before (January 2017–January 2020; n=122) and after (February 2020–August 2025; n=289) implementation of a standardized catheter-based FUN workflow. After implementation, FUN was planned in 98 patients (33.9%) and used as intraoperative rescue in 3 additional patients. Results: Propensity score matching yielded 117 pairs. Among 106 matched pairs in which MIS was initiated in both eras, conversion to open surgery occurred in 7 patients (6.6%) before implementation and none after implementation (p=0.016). MIS completion among all matched cases increased from 84.6% to 100% (p<0.001). Major complications were similar (11.1% vs. 10.3%). Exploratory Firth-penalized logistic regression yielded an adjusted odds ratio of 41.4 for MIS completion in the postimplementation era (95% CI=2.78-617.41; p=0.007). Conclusion: Institution-wide FUN implementation was associated with higher MIS completion without an apparent increase in major complications despite an increasingly complex case mix.