DIFFUSION OF LAPAROSCOPIC TECHNOLOGIES IN DENMARK

It has been predicted that minimally invasive therapy will have dramat ic consequences for the specialty of general surgery, as demonstrated by the diffusion of laparoscopic cholecystectomy. To investigate the d eterminants of the diffusion in Denmark of five laparoscopic technolog ies (cholecystectomy, appendicectomy, surgery for colon cancer, surger y for inguinal hernia and fundoplication), questionnaires on seventeen factors' influence on the adoption (stimulating or impeding) were sen t to fifty-nine hospitals. Fifty hospitals (85%) responded. Overall, 9 8% adopted laparoscopic cholecystectomy in Denmark between 1991 and 19 95, whereas the remainder of the technologies were adopted by 7-65% of hospitals performing these operations. Large and specialized hospital s were the earliest adopters. The factors, nature of technology (minim ally invasive versus conventional), training (appropriate training cou rses), competition (between specialties and between hospitals) and med ia attention have stimulated the diffusion, whereas three budget facto rs (budget for investment, budget for operation and public regulation) usually had an impeding effect. Stimulating factors prevail for all l aparoscopic technologies indicating that some guidance of the adoption and use of new health technologies might be necessary. In Denmark, on e of the suggested health policies to secure timely guidance is the es tablishment of an early warning system. (C) 1998 Elsevier Science Irel and Ltd. All rights reserved.