MISS Regulations in Turkey

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Tolgay Satana


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Citation: T. Satana : MISS Regulations in Turkey. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

It would not be wrong to say that the emergence of minimal invasive surgery and its introduction to our country date back to our master, Hippocrates, who lived in these lands. However, subsequent advancements in this geographic area resulted in the evolution, development, and appropriation of Hippocrates and his principles throughout western civilization. We generally tend to emulate the rules and regulations from abroad even when it is not necessary just like we import knowledge when we should develop it ourselves. This time, we tried to do the opposite by using Asclepius�s healing baton against Poseidon�s wind. What was the situation in the World? The International Musculoskeletal Laser Society (IMLAS) had published successful studies on spinal endoscopy, an innovative area of surgery. Sahap Atik, the prominent figure in laser joint surgery in our country, helped us kick off the MISS journey, starting with use of laser in spinal endoscopy. The introduction of MISS got under way immediately as part of the Osteo meetings, the studies on Bone and Joint Decay and Osteoporosis of which, was arranged by the Turkish Joint Diseases Foundation, or TEVAK. In addition to the great success achieved with the Osteo Congress, MISS was now being discussed as a subject matter. It was in 2005 when the Journal of Joint Diseases and Related, in parallel with relocation of the IMLAS meeting to Turkey, was published as a special report, hence breaking new ground throughout the world and in Turkey. We succeeded in introducing the Minimal Invasive concept. Now, it was time characteristics. Characterization began to occur in the minds of fellows who resort to classical surgery techniques as we tried to explain that minimal invasive surgery did not mean downsizing incisions but rather working in a less traumatic manner. At this stage it was necessary to move from the introduction stage to the characterization stage. We were supposed to engrave the defined processes into the minds by ensuring they corresponded to the originals. We started with those dealing with spinal surgery. Azmi Hamzaoglu, the foremost figure in modern spinal surgery in Turkey, helped us go through introductory stage very rapidly due to his position as the Chair of the Association. We embarked on our studies, under Mr. Hamzaoglu�s leadership. Tolgay Satana simultaneously performed the first Percutaneous Endoscopic Lumbar Discectomy. Tolgay Satana introduced the surgery to the public with the first televised broadcast. We took part in this time, with IMLAS, the studies of the ISMISS Association, which specializes on the Spine. We presented our limited experience at the ISMISS meetings and at other local meetings. We were able to practice on only private patients, not even in the universities and public hospitals despite our readiness to bring the device from outside. An application was submitted to the new chair of the Spinal Association, Ufuk Aydinli. In the meantime, we made another application to TTB. Now the characterization stage was completed too. For the new initiatives were referred to the wise men committee of the bureaucracy. Our individual application in 2005 was not successful because we were not a legal entity and was thus forgotten. So, we had to become an association, but it was impossible to achieve that without first forming a society. Patients approached the operation decisions with doubt. The surgeons practicing classical surgery mercilessly used the phrase �charlatan.� A discussion carried out in the e-mail groups under the leadership of Ufuk Aydinli gave us the chance to categorize MISS operations. The operations then were explained to a distinguished group of attendants at the Bursa AO meeting. It bore a result: Drafts, brought up by Neurosurgery and Spinal Association, were being discussed now. But the split in the Spinal Association�s new governing body interrupted this process. ISMISS had better come to Turkey and contribute to the formation of a new society. Contacts were made with Spinal Association, Neurosurgery Association, Physical Treatment and Pain Association. The first ISMISS meeting was held subsequent to harvesting the necessary support. The world�s leading authorities defined the initiatives at this gathering. Scientific conclusions showed surgery served the public interest. But the training part of the meeting was obstructed and participant satisfaction waned because the cadaver course was not conducted. While the persons responsible for this situation were removed a new association was set up, and formation of a society is still in the works. But the association was comprised of those who did not practice MISS techniques or those who did so only to a limited extent. Moreover, it maintained the division regarding the management of the Spinal Association. Thus, the ones blocking the first ISMISS meeting took the lead. Rather than working for the needs of the country, the newly established association preferred to exchange correspondence with outside institutions that did not recognize ISMISS�s national representation. The ISMISS meeting was immediately relocated from Ankara to Istanbul. It won Istanbul University�s backing. Favorable conditions were provided thanks to the cadaver courses. When the only existing textbook on MISS needed to be translated into Turkish, the members of this group failed to do so and thus the association failed to serve the public interest. In addition, the year 2008 passed without any regulatory demands and the global crisis had a deep impact on the second ISMISS meeting. It was apparent that ISMISS had to launch a new cooperation. An offer of combined efforts made at the first ISMISS get-together was reiterated to the governing body of Turkish Society of Orthopaedics and Traumatology (TOTBID). Nevertheless, as TOTBID stated it did not recognize ISMISS and so another association was established. The first thing International Society for Minimal Intervention in Spinal Surgery (ISMISS � Turkish OMID), did was to apply to the Turkish Medical Association (TTB) with an official statement, which said that the use of MISS was not defined and that this did not serve the public interest. After classification, OMID informed the other concerned associations and the Ministry of Health. OMID evaluates the past amendments to the laws related to the individual applications. The Ministry of Health formed the Social Security Institution (SGK) system by implementing the general health system. This system analyzes classifications that are not compatible with the TTB�s private practice application manual by referring to the medical practice regulation (SUT). All the MISS applications can be shown as IDET and Nucleotomy in the SUT and TTB manuals. Endoscopy applications can be priced by adding 600 units to classical surgery for TTB. This is contrary to MISS�s cost reduction goal. It makes it difficult for the insurance companies to support the initiative. In fact, MISS is the most low-cost system within the insurance, hospital and doctor triangle. OMID is working to improve this situation.

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