Endoscopic Carpal Tunnel Release

What is Endoscopic Carpal Tunnel Release?

The endoscopic carpal tunnel release (ECTR), which is also known as "keyhole surgery", is a newer minimally-invasive procedure that has been available since the 1990's. This outpatient surgical procedure is usually performed in an operating room and has an operative time that ranges from 15 to 60 minutes. The procedure is usually performed under monitored anesthesia care (MAC) along with local anesthetic. This procedure requires special equipment. The single-port technique only requires a small incision at the wrist through which a tiny camera (endoscope) and instrumentation is placed. The two-port technique requires two small incisions at the wrist and palm for the camera and instruments.

Fig 6. Endoscopic carpal tunnel release procedural representation illustrating placement of the MicroAire SmartRelease® ECTR system. The trigger-system released blade is positioned beneath the transverse carpal tunnel ligament and will cut and divide the ligament from below.

Dr. Nguyen uses the single-port MicroAire SmartRelease® ECTR endoscopic carpal tunnel release system (MicroAire website). A tiny incision is made at the base of the wrist though which the endoscope can be placed. As opposed to the open carpal tunnel release that visualizes the transverse carpal tunnel ligament from above, the endoscope allows visualization and identification of the transverse carpal ligament from below. A special disposable retractable blade is positioned under endoscope visualization directly beneath the transverse carpal ligament. Under direct endoscopic visualization, a trigger-system releases and elevates a small retractable blade which is used to cut the carpal ligament from below.(see video below) The carpal tunnel is released and visualized the entire time with the endoscopic camera. The small incision on the wrist is closed with a couple sutures and bandages are placed.

Video 1. Visual representation of the endoscopic carpal tunnel release using the MicroAire® ECTR system. The small wrist incision allows introduction of the endoscope which allows direct visualization of the transverse carpal tunnel ligament above. The ligament can then be cut using the disposable trigger-released blade to successfully release the carpal tunnel and the compressed median nerve.

Postoperatively, patients are instructed move as much as they can tolerate from a pain standpoint. Clinical studies have demonstrated that patients recover and return to work significantly faster following endoscopic release compared to the open release. The incision for endoscopic repair is smaller and contained to the wrist, which has less cutaneous (skin) innervation compared to the adjacent skin of the more sensitive palm. There is also less dissection and disruption of soft tissues with the endoscopic approach, and clinical studies have shown that patients experience significantly less pain (at 3 months). The smaller incision has the added advantage of leaving a smaller scar after healing.

There is a slightly longer recovery time with the open release.  A longer scar remains from longer incision. The combination of the larger incision and soft tissue disruption from open dissection results in the open carpal tunnel release being associated with more pain postoperatively. There may be a slightly less, but not significant, chance of complications, secondary to the ability for direct surgical visualization with the open procedure.

Continue to "Endoscopic vs Open Repair"

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Additional Information

Please see the provided Additional Links and Resources about Carpal Tunnel Syndrome for additional information and references.