FUTURE OF ENDOSCOPIC SURGERY - GERMAN HEA LTH LAW AND MINIMAL ACCESS SURGERY IN AN UNIVERSITY HOSPITAL

The future development of endoscopic surgery depends on a medical and economical benefit. Medical advantages are demonstrated under professi onal conditions of practice in a retrospective study: endoscopical rep air of the groin (TEP n = 44) vs. conventional Shouldice- (n = 17) and Lichtenstein tn = 19) method. laparoscopical hemifundoplication (n = 7) vs. traditional Nissen-Rosetti procedure (n = 3) and also resection of the sigmoid (lap. n = 26) vs. open surgery (n = 12). The overall h ospital slay is shortend dramatically (primary hernia of the groin 8.8 (Shouldice) and 7.3, (Lichtenstein) vs, 3.1 days (TEP), (hemi-) fundo plication I 1.1 (open) vs. 5.0 days (lap.): resection of sigmoid 19.0 (open) vs. 17.0 days (lap.)) At the same time quality of care is held or improved. Comparison of real cost analysis revealed a better econom ical result (593-970 DM lower cost for TEP. 1.256 DM lower costs for l ap, hemifundoplication, and 1.918 DM in case of lap, resection of sigm oid) for minimal-access-surgery (MAS), although particular costs for t he endoscopic surgical procedure are increasing up to 100 %, especiall y at the beginning (learning curve), The German payment-system does no t regard the special conditions of MAS, There is no case-related payme nt for MAS due to the lower overall costs. Therefore the financial res ult is worse than for conventional treatment.