Minimally invasive surgery in the Federal Republic of Germany

In the Federal Republic of Germany 67 experts were questioned concerning the diffusion of 10 procedures in minimally invasive surgery (MIS). Most of the ten procedures have potential economic advantages and benefits for the patient. Informants state that more randomized controlled trials are needed. Extra-corporeal shock wave lithotripsy, percutaneous transluminal coronary balloon angioplasty, sclerosing of sites of upper gastrointestinal bleeding (including esophageal varices), and arthroscopic meniscectomy are well-established; laparoscopic cholecystectomy made a breakthrough in 1990. The diffusion process of the others is promising. Main obstacles to further diffusion are high investment and maintenance costs, long delivery time for special instruments, lack of systematic training in MIS, performance regulations, and conservatism. Investigations into total costs are necessary. Since the present financing of hospital services through per diem payment is detrimental to the diffusion of MIS, lump-sum payments could remove barriers to diffusion. New methods of interlinking hospital and out-patient care should be tested.