Initial Outcomes of a Novel High-Visibility Endoscopic Carpal Tunnel Release Technique

Abstract

Background A large variety of endoscopic carpal tunnel release methods have been described in efforts to shorten recovery time, reduce scar discomfort, and allow earlier return to work. The majority of existing techniques are the modifications of the Agee, Chow, and Menon techniques, all of which require dedicated equipment that can increase facility and surgical fees for the patient and institution. We present a novel high-visibility endoscopic carpal tunnel release technique that uses common hand surgery instruments available in all surgical units, without requiring disposable or custom devices. Description of Technique The cases were performed under local anesthesia using routine reusable instruments and a conventional 2.5-mm 30-degree small joint arthroscope. Following proximal dissection, a clear, colorless, plastic shield was created from a standard syringe that offered a 360-degree vision of the carpal tunnel and protection of the median nerve. Release of the transverse carpal ligament was performed under full arthroscopic vision using Metzenbaum dissection scissors. Methods This pilot study analyses the first nine cases in eight patients who were operated on using this technique, with a minimum of 6 months of follow-up. Results No peri- or postoperative complications were encountered. All patients demonstrated significant improvements in the Disabilities of the Arm, Shoulder, and Hand score, the Boston Carpal Tunnel Questionnaire score, and a visual analog score for pain. Conclusion The high-visibility endoscopic carpal tunnel release technique is safe and effective, and offers a viable cost-reducing alternative to the existing endoscopic methods for carpal tunnel syndrome. Future comparative trials are required to validate these findings in a larger series. Level of Evidence This is a Level IV study.

Endoscopic carpal surgery in carpal tunnel syndrome: A systematic review

“…Two studies were RCT studies by Kempton et al 18 and Truelove et al 19 . Seven studies were prospective studies, the most prevalent research design, including studies by Degeorge et al, 20 Li et al, 21 Trung et al, 22 Grandizio et al, 23 Ng et al, 24 , 25 and Rooij et al 26 Only five retrospective studies were identified, by Satteson et al, 27 Hein et al, 28 Liu and Wu, 29 Wellington et al, 30 and Tarfusser et al 31 …”

“…A 2018 retrospective study conducted in the United States between 2011 and 2016 by Satteson et al had the largest sample size with 522 patients and 897 wrists using endoscopic surgery, whereas a retrospective review by Liu and Wu 29 in China had the smallest sample size of eight patients. A prospective study in Vietnam by Trung et al 22 had the largest sample size of 150 patients.…”

“…Eleven studies included information on the tools used for diagnosis, including clinical and neurological evaluation Liu and Wu, 29 electrodiagnostic study results (EMG), and NCS. The parameters varied depending on the objectives of the study.…”

“…Tarfusser et al 31 using another single-portal via transretinacular technique stated that all patients reported rapid recovery, pain subsidence, and return to daily activity within a few days, although one patient did not experience measurable improvement of grip strength or sensory function, but only disappearance of pain and discomfort at 2 weeks after surgery. Liu and Wu 29 used a new plastic shield portal technique and reported that DASH, BCTQ, and VAS were statistically significantly decreased compared to preoperation.…”

“…Van Rooij et al 26 following Fechner et al (2013) 44 used a single-portal technique, claiming that it will can better prevent accidental injury to the median nerve . Liu and Wu 29 used a new technique using a plastic shield created from a standard syringe that offers a 360° view of the carpal tunnel and provides protection for the median nerve in single-portal endoscopic techniques. Another single-portal method using a transretinacular technique was demonstrated in a study by Tarfusser et al 31 A two-portal endoscope method was used by Li et al 21 via the Chow technique, a transbursal approach, while both of Ng et al's 24,25 studies used the portal to divide the flexor retinaculum with a retrograde hook knife.…”