A Novel Supraretinacular Endoscopic Carpal Tunnel Release: Instrumentation and Technique (Cadaveric Study)

Abstract

Purpose: Endoscopic carpal tunnel release has been shown to be associated with a shorter return to work compared with open carpal tunnel release in the treatment of carpal tunnel syndrome. Unfortunately, it may be associated with a higher risk for median nerve injury when the carpal tunnel is used as a portal for instrumentation. The purpose of this study was to assess safety in using a newly designed retractor through a supraretinacular approach. Methods: We used 8 wrists (4 left and 4 right wrists) from 4 fresh-frozen cadavers for this study. Supraretinacular endoscopic carpal tunnel release using the supraretinacular retractor was performed by a single investigator, followed by exploration of the carpal tunnel and the structures surrounding it. Surgeries were performed using a new surgical instrument consisting of an arch-shaped blade and handle. It includes a retainer adapted to receive a 2.4-or 2.7-mm endoscope and to retain it at the apex of the arch, which can be moved in and out to visualize the entire transverse carpal ligament. The space below the blade is also used as a portal to insert scissors and instrumentation to cut the transverse carpal ligament. Results: All 8 carpal tunnels were completely released with no injury to the median nerve, superficial palmar arch, flexor tendon, or violation into Guyon canal. Mean distance of the flexor retinaculum division to the recurrent motor branch, palmar cutaneous branch, and superficial palmar arch was 6.87 ± 2.80, 7.13 ± 5.33, and 9.13 ± 4.42 mm, respectively. All specimens had an extraligamentous recurrent motor branch. Conclusions: The retractor and described technique were safe and effective in this cadaveric study. Further clinical trials are necessary before it can be adopted as a safe and reliable technique. Type of study/level of evidence: Therapeutic IV.

A Novel Supraretinacular Endoscopic Carpal Tunnel Release: Surgical Technique, Clinical Efficacy and Safety (A Series of 48 Consecutive Cases)

“…Previously, we designed a smaller instrumentation and a technique to release the transverse carpal ligament through a similar approach. 7 In that study, we described a new technique using the supraretinacular approach and found that by abiding to a safe zone, we could perform ECTR without causing any injuries to vital structures in the wrist—namely, the median nerve, superficial palmar arch, and flexor tendons—or violation of the Guyon canal.…”

Retinaculotomía endoscópica de doble portal en el síndrome del túnel carpiano

“…No obstante, estos procedimientos endoscópicos pueden generar eventuales lesiones neurológicas en caso de variantes anatómicas, así como dañar mecanorreceptores en la región palmar de la muñeca, por lo que no parecen representar una alternativa superior frente a las vigentes técnicas infrarretinaculares. [30][31][32] conclusIones La retinaculotomía endoscópica del túnel carpiano mediante la técnica de dos portales de Chow es una intervención quirúrgica reglada, eficaz y segura para el tratamiento del STC. La tasa de complicaciones es mínima cuando la intervención está en manos de un equipo quirúrgico cohesionado, liderado por un primer cirujano experimentado.…”

Endoscopic Carpal Tunnel Release Without Invading the Tunnel: A New Transretinacular Technique

“…Another critical aspect is the need to insert devices into the CT, thereby increasing the pressure on the median nerve, already damaged from chronic compression. Supraretinacular approaches, as proposed by some authors,16–19 would prevent such transient deficit of nerve function, but the use of relatively bulky devices may disrupt the subtle volar anatomy more than necessary and contribute to higher incidence of pillar pain.…”