In previous years, conventional, open surgical procedures in the European Union (EU) countries of France, Germany, Italy, Spain, and the United Kingdom (U.K.) were common practice for most indications.  However, technological advancements in minimally invasive or laparoscopic surgery have been evolving and are expected to drive the trend away from open and invasive surgical procedures in the EU.  Key factors include acceptance of innovative technologies, the aging population, patient demand for improved quality of life, and surgical procedures receiving reimbursement code listing. 

European open and laparoscopic surgical procedure volumes forecasts presented in this dynamic report from Medtech Insight cover the years 2005 through 2011.  Surgical procedures include those from cardiovascular and peripheral vascular surgery; obstetrics and gynecologic surgery; ophthalmic surgery; orthopedic and arthroscopic surgery; otorhinolaryngologic surgery; spine surgery; urologic surgery; and the general surgical areas of adrenalectomy and appendectomy, breast surgery, cholecystectomy, esophagogastric and gastroduodenal surgery, herniorrhaphy, liver biopsy and tumor excision, and splenectomy. 

Topics covered by this report include an overview of European healthcare technology assessment agencies; regulatory policies for medical devices, technological advancements in minimally invasive surgery, and trends in healthcare funding and reimbursement in the EU countries of France, Germany, Italy, Spain, and the U.K. 

TABLE OF CONTENTS AND LIST OF EXHIBITS

EXECUTIVE SUMMARY

i.   Trends Toward Minimally Invasive Surgery

ii.   Trends in Healthcare Funding and Reimbursement Practices

iii.  Cardiovascular and Peripheral Vascular Surgery

a.  Coronary Artery Bypass Graft Surgery and Percutaneous Transluminal Coronary Angioplasty

b.  Transmyocardial and Percutaneous Transmyocardial Revascularization

c.  Atherectomy and Thrombolysis

iv.  General Surgery

a.  Adrenalectomy and Appendectomy

b.  Breast Surgery

c.  Cholecystectomy and Colectomy

d.  Esophagogastric and Gastroduodenal Surgery

e.  Inguinal Hernia Repair

f.   Liver Biopsy and Tumor Excision

g.  Splenectomy

v.  Neurosurgery

vi.  Obstetrics and Gynecologic Surgery

a.  Cesarean Section, Dilation and Curettage, and Endometrial Ablation

b.  Hysterectomy and Myomectomy

c.  Oophorectomy, Salpingectomy, and Tubal Ligation

vii. Ophthalmic Surgery

a.  Cataract Extraction and Intraocular Lens Implantation

b.  Strabismus and Vision Correction

viii. Orthopedic and Arthroscopic Surgery

a.  Joint Replacement

b.  Arthroscopy

ix.  Otorhinolaryngologic Surgery

x.  Spine Surgery

a.  Spinal Disc and Bone Removal

b.  Spinal Fusion and Fixation

xi.  Urologic Surgery

a.  Bladder Neck Hypermobility Correction and Intrinsic Sphincter Deficiency Correction

b.  Nephrectomy, Kidney Transplantation, and Stone Management

c.  Prostatectomy and Transurethral Resection of the Prostate

Exhibit ES-1:  Cardiovascular and Peripheral Vascular Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-2:  General Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-3:  Neurosurgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-4:  Obstetrics and Gynecologic Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-5:  Ophthalmic Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-6:  Orthopedic and Arthroscopic Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-7:  Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit ES-8:  Spine Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit ES-9:  Urologic Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

1. EUROPEAN MARKET OVERVIEW

1.1 The European Union

1.1.1 A Common Currency

1.1.2 Regulatory Policies for Medical Devices

1.1.2.1 European Medical Device Directive

1.1.2.2 Product Classification

1.1.2.3 Conformité Européene Marking

1.1.3 Health Technology Assessment Agencies

1.1.4 Factors Affecting European Surgical Procedure Volumes

1.1.4.1 Aging of the Population

1.1.4.2 Technological Advancements in Minimally Invasive Surgery

1.1.4.3 Improvements in Surgical Instrumentation

1.1.4.4 Robot-Assisted Surgery

1.1.5 Traditional versus Nontraditional Healthcare Delivery

1.1.5.1 Outpatient Surgery Centers

1.1.5.2 Long-Term and Rehabilitative Care Facilities

1.1.5.3 Community-Based Healthcare and Homecare Agencies

1.1.6 Trends in Healthcare Funding and Reimbursement in European Union Countries

1.1.6.1 Public Healthcare versus Private Healthcare

1.1.7 Healthcare Reform

1.2 Selected European National Healthcare Profiles, by Country

1.2.1 France

1.2.1.1 Healthcare Organization and Reform

1.2.1.2 Hospital Services

1.2.1.3 Medical Device Reimbursement

1.2.2 Germany

1.2.2.1 Healthcare Organization and Reform

1.2.2.2 Hospital Services

1.2.2.3 Medical Device Reimbursement

1.2.3 Italy

1.2.3.1 Healthcare Organization and Reform

1.2.3.2 Hospital Services

1.2.3.3 Medical Device Reimbursement

1.2.4 Spain

1.2.4.1 Healthcare Organization and Reform

1.2.4.2 Hospital Services

1.2.4.3 Medical Device Reimbursement

1.2.5 United Kingdom

1.2.5.1 Healthcare Organization and Reform

1.2.5.2 Hospital Services

1.2.5.3 Medical Device Reimbursement

Exhibit 1-1:    European Union, Population Statistics and Projections, 2005 and 2010

Exhibit 1-2:    2005, France, Selected National Healthcare Statistics

Exhibit 1-3:    2005, Germany, Selected National Healthcare Statistics

Exhibit 1-4:    2005, Italy, Selected National Healthcare Statistics

Exhibit 1-5:    2005, Spain, Selected National Healthcare Statistics

Exhibit 1-6:    2005, United Kingdom, Selected National Healthcare Statistics

2. CARDIOVASCULAR AND PERIPHERAL VASCULAR SURGERY

2.1 Cardiac Device Implantation

2.1.1 Ventricular Assist Devices

2.1.2 Implantable Cardioverter Defibrillators

2.1.3 Pacemakers

2.1.4 Procedure Volumes Forecast

2.2 Coronary Artery Surgery

2.2.1 Coronary Artery Bypass Graft Surgery

2.2.1.1 Open versus Minimally Invasive Approaches

2.2.2 Percutaneous Transluminal Coronary Angioplasty

2.2.2.1 Stent Placement

2.2.3 Transmyocardial Revascularization

2.2.3.1 Percutaneous Transmyocardial Revascularization

2.2.4 Procedure Volumes Forecast

2.3 Heart Defect Correction

2.3.1 Heart Valve Repair and Replacement

2.3.2 Congenital Heart Defect Repair

2.3.3 Procedure Volumes Forecast

2.4 Heart and Heart-Lung Transplantation

2.4.1 Heart-Lung Transplantation

2.4.2 Procedure Volumes Forecast

2.5 Peripheral Vascular Intervention

2.5.1 Aneurysm Repair and Peripheral Vascular Grafting and Stent-Grafting

2.5.1.1 Carotid Artery Stenting

2.5.2 Femoropopliteal Bypass

2.5.3 Carotid Endarterectomy

2.5.4 Percutaneous Transluminal Peripheral Angioplasty

2.5.5 Procedure Volumes Forecast

2.6 Minimally Invasive Cardiovascular Intervention

2.6.1 Atherectomy

2.6.2 Thrombolysis

2.6.3 Thrombectomy

2.6.4 Procedure Volumes Forecast

Exhibit 2-1:    Cardiac Device Implantation, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 2-2:    Coronary Artery Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 2-3:    Heart Defect Correction, Procedure Volumes Forecast, by Country and Type,2005-2011

Exhibit 2-4:    Heart and Heart-Lung Transplantation, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 2-5:    Peripheral Vascular Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 2-6:    Minimally Invasive Cardiovascular Intervention, Procedure Volumes Forecast, by Country and Type, 2005-2011

3. GENERAL SURGERY

3.1 Adrenalectomy

3.1.1 Procedure Volumes Forecast

3.2 Appendectomy

3.2.1 Procedure Volumes Forecast

3.3 Breast Procedures

3.3.1 Breast Augmentation and Reduction

3.3.2 Breast Biopsy

3.3.2.1 Open Biopsy

3.3.2.2 Needle Biopsy

3.3.3 Lumpectomy

3.3.4 Mastectomy

3.3.4.1 Simple Mastectomy

3.3.4.2 Modified Radical Mastectomy

3.3.4.3 Radical Mastectomy

3.3.4.4 Partial Mastectomy

3.3.5 Procedure Volumes Forecast

3.4 Cholecystectomy

3.4.1 Open Cholecystectomy

3.4.2 Laparoscopic Cholecystectomy

3.4.3 Procedure Volumes Forecast

3.5 Colectomy

3.5.1 Procedure Volumes Forecast

3.6 Esophagogastric and Gastroduodenal Procedures

3.6.1 Bariatric Procedures

3.6.2 Nissen Fundoplication

3.6.3 Peptic Ulcer Repair

3.6.4 Procedure Volumes Forecast

3.7 Inguinal Herniorrhaphy

3.7.1 Procedure Volumes Forecast

3.8 Liver Biopsy and Tumor Excision

3.8.1 Procedure Volumes Forecast

3.9 Splenectomy

3.9.1 Procedure Volumes Forecast

Exhibit 3-1:    Adrenalectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-2:    Appendectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-3:    Breast Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-4:    Cholecystectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-5:    Colectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-6:    Esophagogastric and Gastroduodenal Surgery, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-7:    Inguinal Herniorrhaphy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-8:    Liver Biopsy and Tumor Excision, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 3-9:    Splenectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

4. NEUROSURGERY

4.1 Craniotomy

4.1.1 Brain Tumors

4.1.2 Cerebral Aneurysms

4.1.3 Head Trauma

4.2 Cerebrospinal Fluid Shunting

4.2.1 Procedure Volumes Forecast

4.3 Intracranial Pressure Monitoring

4.3.1 Procedure Volumes Forecast

4.4 Stereotaxis

4.4.1 Procedure Volumes Forecast

Exhibit 4-1:    Cerebrospinal Fluid Shunting, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 4-2:    Intracranial Pressure Monitoring, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 4-3:    Stereotaxis, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 4-4:    Neurosurgery, Procedure Volumes Forecast, by Country, 2005-2011

5. OBSTETRICS AND GYNECOLOGIC SURGERY

5.1 Cesarean Section

5.1.1 Procedure Volumes Forecast

5.2 Dilation and Curettage

5.2.1 Procedure Volumes Forecast

5.3 Endometrial Ablation

5.3.1 Procedure Volumes Forecast

5.4 Exploration and Adhesiolysis

5.4.1 Procedure Volumes Forecast

5.5 Hysterectomy

5.5.1 Procedure Volumes Forecast

5.6 Myomectomy

5.6.1 Procedure Volumes Forecast

5.7 Oophorectomy

5.7.1 Procedure Volumes Forecast

5.8 Salpingectomy

5.8.1 Procedure Volumes Forecast

5.9 Tubal Ligation

5.9.1 Procedure Volumes Forecast

Exhibit 5-1:    Cesarean Section Delivery, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 5-2:    Dilation and Curettage, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 5-3:    Endometrial Ablation, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 5-4:    Exploration and Adhesiolysis, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 5-5:    Hysterectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 5-6:    Myomectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 5-7:    Oophorectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 5-8:    Salpingectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 5-9:    Tubal Ligation, Procedure Volumes Forecast, by Country, 2005-2011

6. OPHTHALMIC SURGERY

6.1 Cataract Extraction and Intraocular Lens Implantation

6.1.1 Procedure Volumes Forecast

6.2 Strabismus Correction

6.2.1 Procedure Volumes Forecast

6.3 Vision Correction

6.3.1 Astigmatic, Hexagonal, and Radial Keratotomy

6.3.2 Automated Lamellar Keratoplasty

6.3.3 Corneal Ring Implantation

6.3.4 Corneal Transplantation

6.3.5 Laser-Assisted In Situ Keratomileusis

6.3.6 Laser Epithelial Keratomileusis

6.3.7 Photorefractive Keratotomy

6.3.8 Procedure Volumes Forecast

Exhibit 6-1:    Cataract Extraction and Intraocular Lens Implantation, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 6-2:    Strabismus Correction, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 6-3:    Vision Correction, Procedure Volumes Forecast, by Country and Type, 2005-2011

7. ORTHOPEDIC AND ARTHROSCOPIC SURGERY

7.1 Fracture Management

7.1.1 Procedure Volumes Forecast

7.2 Joint Replacement

7.2.1 Hip Replacement

7.2.2 Knee Replacement

7.2.3 Shoulder Replacement

7.2.4 Small Joint Replacement

7.2.5 Procedure Volumes Forecast

7.3 Arthroscopic Surgery

7.3.1 Articular Surface Repair

7.3.2 Ligament Repair

7.3.2.1 Anterior Cruciate Ligament Reconstruction

7.3.2.2 Posterior Cruciate Ligament Reconstruction

7.3.2.3 Acromioclavicular Joint Separation Repair

7.3.3 Loose Body Removal

7.3.4 Meniscal Repair

7.3.4.1 Inside-Out

7.3.4.2 Outside-In

7.3.4.3 All-Inside

7.3.5 Tendon Repair

7.3.5.1 Carpal Tunnel Release

7.3.5.2 Rotor Cuff Reconstruction

7.3.6 Procedure Volumes Forecast

Exhibit 7-1:    Fracture Management, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 7-2:    France, Joint Replacement, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-3:    Germany, Joint Replacement, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-4:    Italy, Joint Replacement, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-5:    Spain, Joint Replacement, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-6:    United Kingdom, Joint Replacement, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-7:    Joint Replacement, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 7-8:    France, Arthroscopic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-9:    Germany, Arthroscopic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-10:  Italy, Arthroscopic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-11:  Spain, Arthroscopic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-12:  United Kingdom, Arthroscopic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 7-13:  Arthroscopic Surgery, Procedure Volumes Forecast, by Country, 2005-2011

8. OTORHINOLARYNGOLOGIC SURGERY

8.1 Adenoidectomy

8.2 Myringotomy with Tympanostomy Tube Replacement

8.3 Rhinoplasty

8.4 Septoplasty

8.5 Tonsillectomy

8.6 Tracheostomy

8.7 Procedure Volumes Forecast

Exhibit 8-1:    France, Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 8-2:    Germany, Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 8-3:    Italy, Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 8-4:    Spain, Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 8-5:    United Kingdom, Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Type, 2005-2011

Exhibit 8-6:    Otorhinolaryngologic Surgery, Procedure Volumes Forecast, by Country, 2005-2011

9. SPINE SURGERY

9.1 Artificial Disc Implantation

9.1.1 Procedure Volumes Forecast

9.2 Disc and Bone Removal

9.2.1 Discectomy

9.2.2 Laminectomy and Laminotomy

9.2.3 Procedure Volumes Forecast

9.3 Spinal Fusion

9.3.1 Cervical Fusion

9.3.1.1 Procedure Volumes Forecast

9.3.2 Lumbar Fusion

9.3.2.1 Procedure Volumes Forecast

9.3.3 Thoracic Fusion

9.3.3.1 Procedure Volumes Forecast

9.3.4 Minimally Invasive Spinal Fixation

9.3.4.1 Procedure Volumes Forecast

Exhibit 9-1:    Artificial Disc Implantation, Procedure Volumes Forecast, by Country, 2005-2011

Exhibit 9-2:    Disc and Bone Removal, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 9-3:    Cervical Fusion, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 9-4:    Lumbar Fusion, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 9-5:    Thoracic Fusion, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 9-6:    Minimally Invasive Spinal Fixation, Procedure Volumes Forecast, by Country, 2005-2011

10. UROLOGIC SURGERY

10.1 Bladder Neck Hypermobility Correction

10.1.1 Burch Colposuspension

10.1.2 Marshall-Marchetti-Krantz Procedure

10.1.3 Transvaginal Needle Bladder Neck Suspension

10.1.4 Procedure Volumes Forecast

10.2 Intrinsic Sphincter Deficiency Correction

10.2.1 Pubovaginal Sling

10.2.2 Tension-Free Vaginal Tape

10.2.3 Procedure Volumes Forecast

10.3 Nephrectomy and Kidney Transplantation

10.3.1 Procedure Volumes Forecast

10.4 Kidney Stone Management

10.4.1 Procedure Volumes Forecast

10.5 Prostatectomy

10.5.1 Transurethral Resection of the Prostate

10.5.1.1 Transurethral Microwave Therapy

10.5.1.2 Interstitial Laser Coagulation

10.5.1.3 Transurethral Needle Ablation

10.5.1.4 High-Intensity Focused Ultrasound

10.5.2 Procedure Volumes Forecast

10.6 Prostatic Urethral Stenting

10.6.1 Procedure Volumes Forecast

Exhibit 10-1:  Bladder Neck Hypermobility Correction, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 10-2:  Intrinsic Sphincter Deficiency Correction, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 10-3:  Nephrectomy and Kidney Transplantation, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 10-4:  Kidney Stone Management, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 10-5:  Prostatectomy, Procedure Volumes Forecast, by Country and Type, 2005-2011

Exhibit 10-6:  Prostatic Urethral Stenting, Procedure Volumes Forecast, by Country and Type, 2005-2011

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