Purpose: To evaluate video‑assisted anal fistula treatment (VAAFT) as a colorectal innovation through a single integrated programme, linking implementation performance, patient outcomes and provider costs to inform responsible adoption. Methodology: Mixed‑methods, multi‑study evaluation: (1) retrospective benchmark of established sphincter‑sparing surgery (104 cases, 2014–2023), (2) prospective implementation assessment across a public–private network (adoption, reach, penetration, fidelity, safety), (3) prospective 12‑month VAAFT cohort with patient‑reported outcomes, and (4) micro‑costing with volume‑sensitive capital amortisation and recurrence‑linked sensitivity analyses. Results: Benchmark recurrence was ~36–38% after LIFT/ERAF with preserved continence; day‑surgery throughput was higher for LIFT (94%) than ERAF (56%). VAAFT implementation achieved surgeon adoption 5/6, patient acceptance 22/22, and procedural fidelity 84.6%, with no 30‑day unplanned contacts. In 22 VAAFT patients, day surgery was 91%, continence was preserved, 12‑month healing was 64%, and quality of life improved in 64% (median score 29 to 0 at 12 months, p<0.001). Median operating time was 45 min and improved after the first case for most surgeons. VAAFT costs were volume‑sensitive: public $2,608 (10 uses) to $1,577 (100 uses) per procedure; private $8,534 to $6,905, approaching LIFT at scale. Conclusion: An Australian public–private network can implement VAAFT safely with high patient acceptance, rapid skills acquisition, preserved continence, and meaningful quality‑of‑life improvement. When assessed as a system intervention—not just a technique—VAAFT’s value depends on structured rollout, volume, and ambulatory pathways. This framework supports scalable, data‑driven adoption and sets priorities for longer‑term durability studies.