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We investigated the outcome of endoscopic carpal tunnel release (ECTR) for patients with carpal tunnel syndrome (CTS) in comparison with the results of preoperative nerve conduction studies. The compound muscle action potential (CMAP) of the abductor pollicis brevis muscle (APB) and the second lumbrical muscle (L2) was recorded following median nerve stimulation at the wrist. A total of 38 hands in 35 patients were classified into four categories. Hands with a similarly prolonged distal motor latency for the APB and L2 were classified as type 1 (n=25), while those with a more prolonged distal motor latency for the APB than for the L2 (>0.7 ms) were classified as type 2 (n=10). Hands with a CMAP for the APB, but not L2, were classified as type 3 (n=1), and hands with no CMAP for either the APB or L2 were classified as type 4 (n=2). After ECTR, all of the type 1 and 2 hands were improved. Patients with type 3 and type 4 hands did not show satisfactory improvement, which may have been due to anatomical variation of the recurrent motor branch of the median nerve.Résumé Nous avons examiné la réaction à des opéra-tions de libération du canal carpien endoscopique (LCCE) chez des patients souffrant d'un syndrome du canal carpien (SCC), en utilisant les résultats d'une etude de conduction des nerfs (ECN) préopératoire. La ré-action des potentiels de l'action des muscles composés (PAMC) de l'abducteur pollicis brevis (APB) et du second muscle lombrical (L2) fut enregistrée suivant une stimulation du nerf médian au poignet. Un total de 38 mains de 35 patients fut divisé en quatre catégories. Les mains avec SCC présentant une latence motrice distale prolongée similaire dans APB et L2, furent classées en tant que type 1 (25 mains). Celles avec SCC présentant une latence motrice distale plus prolongée dans APB que dans le L2 (>0.7 ms), furent classées en tant que type 2 (10 mains), celles avec SCC dont les PAMC de APB seuls furent mis en lumiére, furent classées en tant type que 3 (1 main), et celles avec SCC dont les PAMC à la fois de APB et L2 ne furent pas mis en lumière, furent classées en tant que type 4 (2 mains). Après la LCCE, toutes les mains des types 1 et 2 furent bien améliorées. Patients de types SCC 3 et 4 n'ont pas pré-senté une amélioration satisfaisante, par suite probablement d'une variation anatomique d'une branche motrice récurrente. IntroductionIt has been reported that endoscopic carpal tunnel release (ECTR) gives mostly satisfactory results in the treatment of carpal tunnel syndrome (CTS). There are some unsatisfactory results, however. We classified CTS according to the degree of involvement of the recurrent motor branch of the median nerve, based on nerve conduction velocity (NCV) studies, and report the results and the indications for ECTR in patients with CTS. Patients and methodsWe studied 38 hands in 35 patients, with symptoms of carpal tunnel syndrome by ECTR. There were five men and 30 women with a mean age of 66 years (31-83 years). The mean follow-up period was 8 months (3-32 months).W...

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Aim: To present the use of an additional trocar (AT) in the lower thorax during thoracoscopic pulmonary lobectomy (TPL) in children with congenital pulmonary airway malformation.Methods: For a lower lobe TPL (LL), an AT is inserted in the 10th intercostal space (IS) in the posterior axillary line after trocars for a 5-mm 30° scope, and the surgeon's left and right hands are inserted conventionally in the 6th, 4th, and 8th IS in the anterior axillary line, respectively. For an upper lobe TPL (UL), the AT is inserted in the 9th IS, and trocars are inserted in the 5th, 3rd, and 7th IS, respectively. By switching between trocars (6th↔8th for the scope, 4th↔6th for the left hand, and 8th↔10th for the right hand during LL and 5th↔7th, 3rd↔5th, and 7th↔9th during UL, respectively), vital anatomic landmarks (pulmonary veins, bronchi, and feeding arteries) can be viewed posteriorly. The value of AT was assessed from blood loss, operative time, duration of chest tube insertion, requirement for post-operative analgesia, and incidence of perioperative complications.Results: On comparing AT+ (n = 28) and AT– (n = 27), mean intraoperative blood loss (5.6 vs. 13.0 ml), operative time (3.9 vs. 5.1 h), and duration of chest tube insertion (2.2 vs. 3.4 days) were significantly decreased with AT (p < 0.05, respectively). Differences in post-operative analgesia were not significant. There were three complications requiring conversion to open/mini-thoracotomy: AT– (n = 2; bleeding), AT+: (n = 1; erroneous stapling).Conclusions: An AT and switching facilitated posterior dissection during TPL in children with congenital pulmonary airway malformation enhancing safety and efficiency.

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