TY - JOUR
T1 - Video-based assessment tool for workflow analysis in minimally invasive colorectal surgery
T2 - expert consensus-based development and multicentre validation of ColoWorkflow
AU - Jain, Pooja P.
AU - Mascagni, Pietro
AU - Massimiani, Giuseppe
AU - Banik, Nabani
AU - Goglia, Marta
AU - Arboit, Lorenzo
AU - Baby, Britty
AU - Balla, Andrea
AU - Baldari, Ludovica
AU - Silecchia, Gianfranco
AU - Fiorillo, Claudio
AU - Alfieri, Sergio
AU - Morales-Conde, Salvador
AU - Keller, Deborah S.
AU - Boni, Luigi
AU - Padoy, Nicolas
AU - The CompSurg Colorectal Experts Group
AU - Adamina, M.
AU - Anania, G.
AU - Arezzo, A.
AU - Vannucci, M.
AU - Bemelman, W. A.
AU - Bianchi, P. P.
AU - Bracale, U.
AU - Brucchi, F.
AU - Cahill, R.
AU - Cassinotti, E.
AU - Chand, M.
AU - D’Ugo, D.
AU - Quero, G.
AU - de Nardi, P.
AU - Espin-Basany, E.
AU - Harji, D.
AU - Khan, J.
AU - Lapergola, A.
AU - Laracca, G. G.
AU - Montroni, I.
AU - Rausa, E.
AU - Okamoto, N.
AU - Ortenzi, M.
AU - Parvaiz, A.
AU - Pernazza, G.
AU - Rausei, S.
AU - Rizzo, G.
AU - Tondolo, V.
AU - Spolverato, G.
AU - Sylla, P.
AU - Torkington, J.
AU - Adamina, M.
AU - Anania, G.
AU - Arezzo, A.
AU - Vannucci, M.
AU - Bemelman, W. A.
AU - Bianchi, P. P.
AU - Bracale, U.
AU - Brucchi, F.
AU - Cahill, R.
AU - Cassinotti, E.
AU - Chand, M.
AU - D’Ugo, D.
AU - Quero, G.
AU - de Nardi, P.
AU - Espin-Basany, E.
AU - Harji, D.
AU - Khan, J.
AU - Lapergola, A.
AU - Laracca, G. G.
AU - Montroni, I.
AU - Rausa, E.
AU - Okamoto, N.
AU - Ortenzi, M.
AU - Parvaiz, A.
AU - Pernazza, G.
AU - Rausei, S.
AU - Rizzo, G.
AU - Tondolo, V.
AU - Spolverato, G.
AU - Sylla, P.
AU - Torkington, J.
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2026/6/1
Y1 - 2026/6/1
N2 - Background: Minimally invasive colorectal surgery is characterized by significant procedural variability, a difficult learning curve, and complications that affect patient outcomes. Video-based assessment offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. This mixed-methods study aimed to develop and validate a video-based assessment tool for workflow analysis across minimally invasive colorectal procedures. Methods: An international steering committee panel of seven members coordinated a three-round modified Delphi process. Experts in colorectal surgery and video-based assessment were invited to reach consensus (≥ 70% agreement) on the phases and steps that describe workflows across colorectal surgery procedural videos. The resulting framework informed the development of ColoWorkflow. Four independent raters then applied ColoWorkflow to a multicentre video data set of laparoscopic and robotic colorectal procedures. Applicability and inter-rater reliability were evaluated. Results: Of 66 invited experts, 41 (62%) from 11 countries completed round 1, 40 (98%) completed round 2, 20 attended the final online consensus meeting, and all (40 of 40) approved the final workflow descriptors. Consensus was achieved on nine procedure-agnostic phases (port placement and abdomen exploration; vascular dissection and ligation, mesocolon/mesorectum dissection, additional lymphadenectomy; colon and/or rectum mobilization; colorectal transection; anastomosis; completion of operation; preplanned additional procedures; unplanned procedures; extracorporeal procedures) and 34 procedure-specific steps that describe colorectal surgery workflows. ColoWorkflow was developed and applied to 54 colorectal surgery videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres in four countries. The tool demonstrated broad applicability, as all phase and step labels, except one, were represented in at least one video. Inter-rater reliability was moderate, with a mean Cohen’s κ value of 0.72 for phases and 0.67 for steps. Most discrepancies arose at phase transitions and step boundary definitions. Conclusion: Based on this preliminary work, ColoWorkflow is a promising tool for workflow analysis across minimally invasive colorectal procedures. Its adoption may help standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.
AB - Background: Minimally invasive colorectal surgery is characterized by significant procedural variability, a difficult learning curve, and complications that affect patient outcomes. Video-based assessment offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. This mixed-methods study aimed to develop and validate a video-based assessment tool for workflow analysis across minimally invasive colorectal procedures. Methods: An international steering committee panel of seven members coordinated a three-round modified Delphi process. Experts in colorectal surgery and video-based assessment were invited to reach consensus (≥ 70% agreement) on the phases and steps that describe workflows across colorectal surgery procedural videos. The resulting framework informed the development of ColoWorkflow. Four independent raters then applied ColoWorkflow to a multicentre video data set of laparoscopic and robotic colorectal procedures. Applicability and inter-rater reliability were evaluated. Results: Of 66 invited experts, 41 (62%) from 11 countries completed round 1, 40 (98%) completed round 2, 20 attended the final online consensus meeting, and all (40 of 40) approved the final workflow descriptors. Consensus was achieved on nine procedure-agnostic phases (port placement and abdomen exploration; vascular dissection and ligation, mesocolon/mesorectum dissection, additional lymphadenectomy; colon and/or rectum mobilization; colorectal transection; anastomosis; completion of operation; preplanned additional procedures; unplanned procedures; extracorporeal procedures) and 34 procedure-specific steps that describe colorectal surgery workflows. ColoWorkflow was developed and applied to 54 colorectal surgery videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres in four countries. The tool demonstrated broad applicability, as all phase and step labels, except one, were represented in at least one video. Inter-rater reliability was moderate, with a mean Cohen’s κ value of 0.72 for phases and 0.67 for steps. Most discrepancies arose at phase transitions and step boundary definitions. Conclusion: Based on this preliminary work, ColoWorkflow is a promising tool for workflow analysis across minimally invasive colorectal procedures. Its adoption may help standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.
KW - artificial intelligence
KW - laparoscopic surgery
KW - lower gastrointestinal tract
KW - quality improvement
KW - robotic surgery
KW - surgical data science
UR - https://www.scopus.com/pages/publications/105038688511
U2 - 10.1093/bjsopen/zrag038
DO - 10.1093/bjsopen/zrag038
M3 - Article
C2 - 42121322
SN - 2474-9842
VL - 10
JO - BJS open
JF - BJS open
IS - 3
M1 - zrag038
ER -