Minimally Invasive Surgery - The European Perspective -- MEDICA - World Forum for Medicine

Surgical interventional techniques have undergone a sea change with developments in minimally invasive techniques. What could be explained as laborious, painful and highly complicated procedure can now be performed with less pain, less complexities and smaller incisions all owing to the advancements in the field of minimally invasive techniques Patient benefit and surgeons ease are satisfied by the use of this technique.

Quantification of the extent of penetration of minimally invasive techniques on a pro rata basis is not viable because the extent of uptake of minimally invasive surgical techniques is limited to a few surgical specialties currently. Procedures like cholecystectomy have been performed laparoscopically for over a decade now and almost 90% of cholecystectomic procedures are performed using this technique.

If one were to consider the overall growth of the European surgical instruments market, it would not be difficult to deduce that the rate of growth is very sluggish. Estimated to be around $7500 million in 2003 this market is anticipated to register a growth of about 3% per annum in the future. However, the market for minimally invasive surgical procedures in Europe is looking forward to achieving a growth rate of about 5.9%. The market is expected to see a higher growth rate owing to its increased uptake, which in turn could be attributed to the rise in frequency of minimally invasive techniques.

The reasons for this increase can be attributed to the following factors.

§ Ageing population

§ Need for healthcare facilities for this increasing population (age group 30-60) whose medical requirements are more

§ Patient friendly techniques are being developed that shall ensure the well being of the patient as as reduced hospitalization requirements.

An analysis of the total European healthcare situation will lead to the following observations

§ An increasing trend towards reduction of hospital stays

§ Increase in number of surgeries performed

§ Reduction in number of hospitals

Minimally invasive surgery has a very high rate of growth in terms of patient acceptance. The generation of people who are most often referred to as the baby boomers, now belong to the 30-50 age group and this forms a sizeable portion of the population in Europe. Owing to advancements in communication and the coming to age of the Internet, this generation is well informed about the developments in the field of healthcare, resulting in the acceptance of newer technology. Awareness among people about the positive effects of adoption of minimally invasive surgery has helped in the propagation of this technique.

However, the university education system till date does not include the training of upcoming surgeons in the use of minimal interventional techniques like laparoscopy. In order to perform a minimally invasive surgery, the surgeon requires adequate experience as the surgeon should have an understanding of wielding the instruments and guiding it through small ports on the body wall in order to perform the surgery. Because of the lack of experience, the penetration time for minimally invasive surgical techniques to penetrate in to a broader specialty area has been stunted.

Trends over geographic regions in Europe suggest that the larger markets like France and Germany, which have traditionally been the forerunners in the field of medical devices, have begun to adopt more minimally invasive techniques. Upcoming markets like Spain and Scandinavia are also showing greater uptake owing to increased surgeon interest. Moreover sensing the potential these countries have in the offing, the medical device companies are beginning to pump more resources into these markets and are making an endeavor to increase the awareness among surgeons, thereby building a strong customer base.

The factor that could be considered detrimental to the uptake of minimally invasive surgical devices would be the higher capital costs associated with the installation of the system. However, despite cost containment initiatives, the healthcare authorities in Europe have generally accepted the long-term cost effectiveness of adopting minimally invasive surgery.

Minimally invasive surgery is supported by several instruments such as trocars, cannula, laparoscopes (inclusive of hysteroscopes, resectoscopes, arthroscopes etc) and various kinds of surgical instruments like graspers, forceps and finally the ligation instruments comprising of clip appliers and clips. What could aptly be described as a distending market, the minimally invasive surgical devices market in Europe is estimated to be around $779 million. This market is anticipated to grow at a rate of 5.9%. The countries that are expected to show the maximum growth rates are France, UK, Spain and Italy, owing to a conducive growth environment contributed by government support and greater awareness among the surgeon community. The ‘giant' German market is on a slow growth path owing to the macroeconomic environment in the country, which encourages cost containment, and to receding healthcare expenditure.

Clinical procedures that are expected to register a greater growth in the years to come in terms of the usage of minimally invasive techniques are hysterectomies, appendectomies, colonprocedures, gastric bypass surgeries, prostatectomies, sterilization and hernia repairs.

The major players in this market are Karl Storz and Olympus in the reusable devices segment and Ethicon Endosurgery and Tyco Healthcare in the disposables segment. There are over 30 players in the market vying to get a sizeable market share in this potentially rich market.

The imminent challenges that stare the market in the face are

§ Pricing pressures

§ Competitive landscape becoming ‘crowded' with a higher number of market players

§ Increased tendency to rationalize medical expenditure affecting the health of medical devices companies

In order to emerge fromthis quagmire, companies must invest in technology development and innovation that will cater to the customer requirements. Miniaturisation of instruments is the future of minimally invasive surgeryThis opens the door to traditionally untapped areas like paediatrics, where there are requirements for very small instruments.

Minimally invasive surgery might be sharing ‘today' with open surgery, but ‘tomorrow' is definitely going to be ruled by minimally invasive techniques that ensure patient wellbeing and comfort .

For further information please contact:

Katja Feick
Corporate Communications
+44 (0) 207 915 7856