Tokura: building the infrastructure for ambulatory surgery in Germany

a system under pressure

Germany has one of the most expensive healthcare systems in the world, and yet patients wait far too long for routine procedures. The structural reason is straightforward: 63% of all surgeries in Germany still happen inpatient, roughly twice the rate of comparable countries like the US, the Netherlands, and Denmark. That means 16.5 million surgeries a year are performed in hospitals where patients stay overnight, at significantly higher cost and with longer waiting times than necessary.

The case for change is well established. Around 4 million of those procedures could safely move to same-day ambulatory settings. The regulatory framework is moving too: Germany's 2024 hospital reform legislation is actively shifting financial incentives to make outpatient surgery more attractive for surgeons and less financially viable for hospitals when performed inpatient. The policy intent is clear. What has been missing is the infrastructure to deliver on it.

Germany currently has only around 200 ambulatory surgery centers. By most estimates, the system needs over 2,000 modern, high-throughput facilities to fully absorb the potential outpatient volume. The gap between political will and operational reality is the opportunity Tokura is built to close.

our investment

We are delighted to co-lead Tokura's seed round alongside Heal Capital, with additional participation from better ventures, including Nicole Strüngmann, Katrin Pucknat, and Guido Kruse. The capital will go toward building Tokura's first flagship center in Berlin and developing the proprietary Tokura OS.

We backed Tokura because the founding team combines the execution DNA needed to build a scaled operations business with a clinical advisory board that provides exactly the depth and credibility the model requires. The regulatory shift is already underway, surgeon demand is real, and no scaled, tech-enabled, multi-specialty platform exists yet. Tokura is positioned to be the first.

the problem is execution, not intent

Outpatient surgery fails not because of a lack of demand, but because the systems to support it have never been built. Hospitals are structured around inpatient care and struggle to run ambulatory units economically. Doctor practices are fragmented and lack the capital, staff, and infrastructure to take on surgical volume at scale. Existing surgery centers are mostly small, undercapitalized, and digitally underdeveloped.

Surgeons willing to shift outpatient face a fragmented landscape: no guaranteed OR access, no dedicated support staff, no end-to-end workflow, and a significant administrative burden on top of their clinical work. The result is that many simply do not make the move, even when the economics and patient outcomes would support it.

Tokura builds the missing layer

Tokura positions itself as the operational backbone for outpatient surgery in Germany. The company takes a fully integrated approach: purpose-built ambulatory surgery centers paired with a proprietary technology platform, the Tokura OS, that orchestrates the entire surgical journey from scheduling and pre-operative preparation through to documentation, billing, and aftercare.

The model is designed to be built around both the surgeon and the patient. Tokura aims to handle operations, staffing, sterilization, compliance, logistics, and administrative workflows, so surgeons can focus entirely on care and patients benefit from a smoother, faster experience. The platform is designed to deliver 50% less administrative time, three times higher throughput, and 30% better profitability for surgeons compared to existing alternatives.

Tokura also offers a partnership model: hospitals and practices looking to develop their own outpatient capacity can build and operate ambulatory centers together with Tokura, drawing on its operational expertise, digital infrastructure, and standardized playbook.

a founding team built for this

Tokura was founded by Dr. Daniel Kreter and David Rizor, two operators who built and scaled Taxfix together over six years. Kreter has 15 years of startup and scale-up experience, including early roles at Zalando and a decade running complex, regulated operations. Rizor led strategy and corporate development at Taxfix, overseeing financing rounds totaling over €300 million.

They are supported by a medical advisory board with deep operational experience: PD Dr. med. Clemens Gwinner, senior attending at Charité Berlin and team physician for 1. FC Union Berlin; Dr. med. Dominik Schlarb, dermatologic surgeon at University Hospital Münster; and Dr. med. Michael Krämer, former head of anesthesia at Charité and founder of an ambulatory surgery center in Berlin.

what comes next

With this funding, Tokura will open its first center in Berlin, prove the model with high-throughput, multi-specialty ambulatory surgery, and develop the Tokura OS for rollout across additional sites. The longer-term vision is to become the operating system for outpatient surgery in Germany, first as a center operator, then as a platform licensed to hospitals, practices, and international providers.

We are proud to back Daniel, David, and the full Tokura team on their mission to deliver one million surgeries a year ambulatory.