Early major complications of endoscopic carpal tunnel release: A review of 1200 cases

Abstract

RW Tse, LN Hurst, TA Al-Yafi. Early major complications of endoscopic carpal tunnel release: A review of 1200 cases. Can J Plast Surg 2003;11(3):131-134. Although the early benefits of endoscopic carpal tunnel release have been demonstrated, there is great controversy regarding the risks and safety of the technique. The present study reports early major complications in a series of 1278 consecutive cases performed by a single surgeon over a seven-year period. All procedures were performed under local anaesthesia on an outpatient basis using the Agee single portal technique. Mean follow-up was three months. No vascular, tendon or permanent nerve injuries were documented. Recurrent or persistent symptoms occurred in 7% of patients for which 20 of 89 underwent subsequent open carpal tunnel release. No nerve injuries were found on re-exploration. Other complications were consistent with previously reported incidences. This is the largest reported case series by a single surgeon and represents an accumulation of surgical experience at the upper end of the learning curve. Endoscopic carpal tunnel release is a safe procedure in this experienced single surgeon series. Complications majeures précoces de la libéra-tion endoscopique du nerf médian au niveau du canal carpien Bien que les bénéfices précoces de la libération endoscopique du nerf médian au niveau du canal carpien soient démontrés, il existe une grande controverse au sujet des risques et de l'innocuité de la technique. La présente étude fait état de complications majeures précoces dans une série de 1 278 cas consécutifs opérés par un seul chirurgien en l'espace de sept ans. Toutes les interventions ont été exécutées sous anesthésie locale en clinique externe au moyen de la technique portale unique d'Agee. Le suivi moyen était de trois mois. Aucune lésion vasculaire, tendineuse ou nerveuse permanente n'a été documentée. Des symptômes récurrents ou persistants se sont manifestés chez 7 % des patients, et 20 de ces 89 patients ont subi une libération ouverte du nerf médian au niveau du canal carpien. Aucune lésion nerveuse n'a été découverte au moment de la deuxième exploration. D'autres complications étaient compatibles avec des incidences déclarées auparavant. C'est la plus grande série de cas à être déclarée par un seul chirurgien, et elle représente une accumulation d'expérience clinique dans le haut de la courbe d'apprentissage. La libération endoscopique du nerf médian au niveau du canal carpien est une intervention sûre dans le cadre de cette série effectuée par un seul chirurgien expérimenté.

‘INSIGHT-PRECISION’: a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome

“…36,38 Its reported incidence has been inconsistent, varying from 5% to as high as 61%. 8,36,[39][40][41][42] Several authors report a decreased incidence of postoperative pillar pain with endoscopic or limited-open carpal tunnel-release techniques 2,4,10,18,26 but others have found no difference 13,36 and one study reports a higher incidence of pillar pain with an endoscopic technique. 43 Its aetiology remains unclear, with different theories falling into four categories: 38 ligamentous or muscular, alteration to the structure of the carpal arch, neurogenic and oedematous.…”

“…The present study showed an incidence of postoperative persistent cicatricial pain of 0.64% (one case) and pillar pain at one month of 2.55% (four cases), which compares favourably with other reports (Table 5). 8,9,39,40,42,[44][45][46][47][48] After endoscopic carpal tunnel release was first reported by Okutsu in 1987 7,49 and in 1989 by Okutsu 6 and Chow, 11 several devices and surgical techniques emerged with the common goal of creating a small incision to decrease the incidence of the well-recognized complications of open carpal tunnel release, 1,2,5,13,18,19,[25][26][27] and improve patients' quality of life. A steep learning curve 10,45 increased the technical difficulties, 13,21,28,32,33,50 and potentially devastating complications have been reported with endoscopic techniques.…”