Acylgermanes provide an outstanding photo-induced reactivity at highly useful absorption wavelengths. This encouraged multidisciplinary research groups to utilize them as highly effective and non-toxic photoinitiators for, particularly medical applications. In this minireview, we present the most recent breakthroughs to synthesize acylgermanes. We also outline mechanistic aspects of photo-induced reactions of several acylgermane derivatives based on fundamental spectroscopic insights. These studies may aid future developments for tailor-made photoinitiators.