Minimally invasive colorectal surgery is characterized by procedural variability, a difficult learning curve, and complications that impact quality and outcomes. Video-based assessment (VBA) offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. However, existing tools for workflow analysis remain difficult to standardize and implement. This study aims to develop and validate a VBA tool for workflow analysis across minimally invasive colorectal procedures. A Delphi process was conducted to achieve consensus on generalizable workflow descriptors. The resulting framework informed the development of a new VBA tool, ColoWorkflow. Independent raters then applied ColoWorkflow to a multicentre video dataset of laparoscopic and robotic colorectal surgery (CRS). Applicability and inter-rater reliability were evaluated. Consensus was achieved for 10 procedure-agnostic phases and 34 procedure-specific steps describing CRS workflows. ColoWorkflow was developed and applied to 54 colorectal operative videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres. The tool demonstrated broad applicability, with all but one label utilized. Inter-rater reliability was moderate, with mean Cohen's K of 0.71 for phases and 0.66 for steps. Most discrepancies arose at phase transitions and step boundary definitions. ColoWorkflow is the first consensus-based, validated VBA tool for comprehensive workflow analysis in minimally invasive CRS. It establishes a reproducible framework for video-based performance assessment, enabling benchmarking across institutions and supporting the development of artificial intelligence-driven workflow recognition. Its adoption may standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.

翻译：微创结直肠手术具有操作变异性大、学习曲线陡峭以及并发症影响手术质量和结局的特点。基于视频的评估为生成数据驱动的见解提供了机会，有助于减少变异性、优化培训并提升手术表现。然而，现有用于工作流分析的工具仍难以标准化和实施。本研究旨在开发并验证一种适用于各类微创结直肠手术工作流分析的VBA工具。研究通过德尔菲法就通用工作流描述符达成共识。基于此共识框架，开发了新的VBA工具ColoWorkflow。随后，独立评估者将ColoWorkflow应用于一个包含腹腔镜和机器人结直肠手术的多中心视频数据集，并评估了其适用性及评估者间信度。研究就描述CRS工作流的10个与术式无关的阶段和34个术式特异性步骤达成共识。ColoWorkflow被开发并应用于来自五个中心的54个结直肠手术视频（左半结肠切除术、右半结肠切除术、乙状结肠切除术、直肠乙状结肠切除术及全结直肠切除术）。该工具展现出广泛的适用性，除一个标签外其余均被使用。评估者间信度中等，阶段的平均Cohen's K值为0.71，步骤的平均Cohen's K值为0.66。大多数差异出现在阶段转换和步骤边界定义处。ColoWorkflow是首个基于共识、经过验证的、用于微创CRS全面工作流分析的VBA工具。它建立了一个可复现的基于视频的表现评估框架，能够实现跨机构基准测试，并支持人工智能驱动的工作流识别技术的发展。该工具的采用有望标准化培训、加速能力获取，并推动基于数据的外科质量改进。