Endoscopic carpal tunnel release surgery uses a thin tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist. The endoscope lets the doctor see structures in the wrist, such as the transverse carpal ligament, without opening the entire area with a large incision.
The cutting tools used in endoscopic surgery are very small. They are also inserted through the small incision in the wrist.
During endoscopic carpal tunnel release surgery, the transverse carpal ligament is cut. This releases pressure on the median nerve, relieving carpal tunnel syndrome symptoms.
The small incisions in the palm are closed with stitches. The gap where the ligament was cut will eventually fill with scar tissue.
Both endoscopic and open carpal tunnel release procedures allow successful release of the transverse carpal ligament to treat carpal tunnel syndrome and most patients are able to return to their same jobs following treatment. Recurrence of carpal tunnel syndrome with either is rare and most patients recover completely. Both can be performed as outpatient procedures. There are no long-term differences in the outcomes of the two approaches. Long-term satisfaction rates are also similar between the two procedures.
There are differences that have been identified in studies between the two techniques. Studies have shown that endoscopic surgery may allow a faster functional recovery with a faster recovery (pinch-grip and grip-strength) in the first 3 months after surgery, but with similar results to the open approach thereafter. Endoscopic surgery has also been shown to allow a faster return to work. Patients undergoing endoscopic surgery have also been shown to have significantly less pain and tenderness on the scar and/or palm in the short-term postoperative period (at 3 months). Additionally, the smaller single incision made with the endoscopic technique results in a smaller scar. The decreased pain seen with the endoscopic technique is likely due to the incision not involving the palm, which is more innervated and sensitive than the wrist, and because there is less dissection and soft tissue destruction required to gain access to the transverse carpal ligament. As with any minimally-invasive procedure, there is a small risk with the endoscopic approach of having to intraoperatively convert to an open approach when visibility is impaired.
Written by Dr. David Yakin, M.D.