Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE

Introduction. The standard open technique for carpal tunnel surgery has wound problems and complications significantly more than minimally invasive surgery using the Wongsiri technique with MiniSURE Kit® (Surgical Innovation Healthcare Co., Ltd, Bangkok, Thailand) and in particular, the open technique surgery requires a longer time for return to work. CTR surgery with endoscopic devices improves the results with fewer wound problems when compared with the commonly used open technique; however, nerve complications and injury are more prevalent with endoscopic surgery than with the open technique. The Wongsiri technique produces good results with new medical devices such as the MiniSURE View, for improved vision and line-of-sight, and the MiniSURE Cut for improved and complete cutting via the supraretinacular technique that may reduce the nerve problems associated with endoscopic tooling in the carpal tunnel. Purpose. To evaluate the results of the operation and postoperative outcomes of the Wongsiri technique with a MiniSURE Kit®. Methods. 20 patients underwent carpal tunnel release using the Wongsiri technique and a MiniSURE Kit® with a five-step surgery: MIS starts when the surgeon makes a 1.5–1.8 cm incision, creates a working space, inserts the visual tube of MiniSURE View, inserts the freer, and then cuts the transverse carpal ligament by using the MiniSURE Cut. Results. All 20 successes of the Wongsiri technique and MiniSURE Kit® surgery occurred within 6.8 minutes operative time and a 12 mm wound size. A single outlier, in one case (6.7%), the patient experienced pillar pain which abated within one month. Patients can return to work in 7.3 days. Conclusions. The Wongsiri technique with the MiniSURE Kit® demonstrated good outcomes similar to the endoscope. By contrast with the endoscopic surgery, the Wongsiri technique with the MiniSURE Kit® reduced preop, operating, and postop time, many resources, and significant costs and resulted in no nerve problems or complications.

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Minimally invasive carpal tunnel surgery in leprosy

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626198 ◽

2014 ◽

Vol 33 (01) ◽

pp. 42-44

Author(s):

José Marcos Pondé ◽

Clarissa Ramos ◽

Lazaro Santos ◽

João Pedro Magalhaes ◽

Ana Flavia Cavalcanti

Keyword(s):

Developing Countries ◽

Cost Effectiveness ◽

Minimally Invasive ◽

Median Nerve ◽

Local Anesthesia ◽

Carpal Tunnel ◽

Surgical Approach ◽

Carpal Tunnel Release ◽

Nerve Involvement ◽

Carpal Tunnel Surgery

Abstract Objective: Evaluate carpal tunnel release in leprosy. Methods: The authors operated upon 60 patients with median nerve involvement by leprosy between February 2008 and February 2012. The outpatients were under local anesthesia submitted to carpal tunnel release. Results: All the patients showed post-operative improvement in pain and sensation. Conclusion: The surgical approach is a cost effectiveness procedure adequate to developing countries.

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Comparative Analysis of Efficacy of Endoscopic versus Open Carpal Tunnel Release

Pakistan Journal of Surgery and Medicine ◽

10.37978/pjsm.v1i2.181 ◽

2020 ◽

Vol 1 (2) ◽

pp. 113-117

Author(s):

Ali Niyaf ◽

Kiran Niraula ◽

Aishath Sofia Shareef ◽

Mohamed Sajuan Mushrif

Keyword(s):

Carpal Tunnel Syndrome ◽

Return To Work ◽

Carpal Tunnel ◽

Endoscopic Surgery ◽

Open Surgery ◽

Carpal Tunnel Release ◽

Operative Duration ◽

Chronic Regional Pain Syndrome ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction. Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.

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Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.967 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Tahsin Gürpınar ◽

Barış Polat ◽

Ayşe Esin Polat ◽

Engin Carkçı ◽

Ahmet Sinan Kalyenci ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Return To Work ◽

Carpal Tunnel ◽

Daily Life ◽

Carpal Tunnel Release ◽

Incision Length ◽

Early Return ◽

Carpal Tunnel Surgery ◽

Prospective Comparative Study ◽

Tunnel Syndrome

Objective: This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques. Methods: This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared. Results: The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05). Conclusion: ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length. doi: https://doi.org/10.12669/pjms.35.6.967 How to cite this:Gurpinar T, Polat B, Polat AE, Carkci E, Kalyenci AS, Ozturkmen Y. Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study. Pak J Med Sci. 2019;35(6):1532-1537. doi: https://doi.org/10.12669/pjms.35.6.967 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Effectiveness of Surgical Treatment in Carpal Tunnel Syndrome Mini-Incision Using MIS-CTS Kits: A Cadaveric Study

Advances in Orthopedics ◽

10.1155/2020/8278054 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Wongthawat Liawrungrueang ◽

Sunton Wongsiri

Keyword(s):

Carpal Tunnel Syndrome ◽

Minimally Invasive ◽

Median Nerve ◽

Carpal Tunnel ◽

Fibrous Tissue ◽

Surgical Techniques ◽

New Device ◽

Working Space ◽

Carpal Tunnel Surgery ◽

Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is caused by the compression of the median nerves in the wrist. Patients have pain and numbness in the hands. According to the records of Songklanagarind Hospital from 2015 to 2018, of 800 patients, 196 or 24.5% were treated with surgery. The novel tool of minimally invasive surgery for carpal tunnel syndrome (MIS-CTS) was developed to improve effectiveness and safety. Purpose. This study was performed to the effectiveness of visualization during surgery and the complete release of the transverse carpal ligament (TCL) and also the safety of using the MIS-CTS kits. Methods. Twenty fresh cadaveric forearms had surgery. Surgical techniques were (1) incision 15–18 mm at palmar hand; (2) the scissors and the navigator were inserted to create working space underneath the palmar aponeurosis; (3) the visual enhancer was inserted. The visual enhancer improves the visual field by shielding the soft tissue around the operative field; (4) the TCL was cut at the distal TCL by surgery scalpel, and then a flexible freer was used to detach the fibrous tissue from the median nerve and the TCL; and (5) the TCL cutting blade was pushed straight to cut the TCL completely from distal to proximal. TCL length was observed until the complete release. The median nerve and the recurrent branch of the median nerve were observed. Results. All TCL were cut completely. All median nerves, recurrent branches of the median nerve, and superficial palmar arches could be observed during the operation, and none were injured. This technique showed effectiveness and safety for minimally invasive carpal tunnel surgery. Conclusions. The study found that the new device, MIS-CTS kits, along with this technique is effective for CTS release in terms of minimally invasive open carpal tunnel surgery.

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A Prospective Evaluation of the Effect of Supervised Hand Therapy After Carpal Tunnel Surgery

Hand ◽

10.1177/1558944718812155 ◽

2018 ◽

Vol 15 (3) ◽

pp. 315-321

Author(s):

Joseph A. Gil ◽

Barrett Weiss ◽

Justin Kleiner ◽

Edward Akelman ◽

Arnold-Peter C. Weiss

Keyword(s):

Return To Work ◽

Carpal Tunnel ◽

Standard Therapy ◽

Carpal Tunnel Release ◽

Hand Therapy ◽

Postoperative Rehabilitation ◽

Treatment Groups ◽

Carpal Tunnel Surgery ◽

Significant Difference

Background: The objective of this investigation is to examine the effect of postoperative therapy after routine carpal tunnel release. Our hypothesis was that supervised hand therapy does not improve outcomes after routine carpal tunnel release. Methods: Patients with carpal tunnel syndrome were randomly assigned to one of 3 groups based on the last digit of their medical record numbers to one of 3 groups: standard 6-week postoperative rehabilitation (standard therapy), expedited one-session postoperative rehabilitation group (expedited therapy), and no postoperative rehabilitation group (no therapy). The primary outcome measures were Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and return to work. The outcome questionnaire was completed preoperatively, at the 2-week follow-up visit, and monthly to 6 months after surgery. Results: All 3 treatment groups had similar mean QuickDASH scores preoperatively. At 1- to 6-month follow-up, all 3 groups had similar QuickDASH scores at each visit, and all showed a significant decline from baseline (preoperative) QuickDASH score. Overall, QuickDASH score decreased significantly from a preoperative visit mean of 42.7 to a final postoperative (visit 8) mean of 6.69. There was no significant difference in the mean QuickDASH score among all 3 groups at 6-month follow-up. There was no significance in the time of return to work among the 3 groups (standard therapy, 21.8 days; expedited therapy, 20.9 days; no therapy, 16.6 days). Conclusions: This investigation adds evidence that supervised hand therapy does not improve the outcomes of routine carpal tunnel surgery as measured by QuickDASH and return to work.

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The Influence of Illness Perception and Mental Health on Return to Work After Carpal Tunnel Release Surgery

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2021.04.002 ◽

2021 ◽

Vol 46 (9) ◽

pp. 748-757

Author(s):

Miguel C. Jansen ◽

Mark J.W. van der Oest ◽

Nicoline P. de Haas ◽

Ruud W. Selles, PhD ◽

J. Michiel Zuidam, MD, PhD ◽

...

Keyword(s):

Mental Health ◽

Return To Work ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Illness Perception ◽

Carpal Tunnel Release Surgery

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Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome

Journal of Orthopaedic Surgery ◽

10.1177/2309499021993407 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199340

Author(s):

Kotaro Sato ◽

Kenya Murakami ◽

Yoshikuni Mimata ◽

Gaku Takahashi ◽

Minoru Doita

Keyword(s):

Learning Curve ◽

Median Nerve ◽

Carpal Tunnel ◽

Open Surgery ◽

Carpal Tunnel Release ◽

Safe Alternative ◽

Endoscopic Carpal Tunnel Release ◽

Flexor Retinaculum ◽

Carpal Tunnel Surgery ◽

Conversion Rates

Purpose: Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. Methods: We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly’s grading system. Patients’ mean follow-up period was 12.7 months. Results: Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly’s grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. Conclusions: We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.

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Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

10.21203/rs.2.22968/v1 ◽

2020 ◽

Author(s):

Yueying Li ◽

Wenqi Luo ◽

Guangzhi Wu ◽

Shusen Cui ◽

Xiaossong Gu ◽

...

Keyword(s):

Return To Work ◽

Randomized Controlled Trials ◽

Nerve Injury ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Endoscopic Carpal Tunnel Release ◽

Satisfaction Rates

Abstract Background Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial. MethodsWe comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR. Results Twenty-eight studies were included in our meta-analysis. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, -7.25 days; 95% CI, -14.31 to -0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). There were no significant differences between the two methods in terms of permanent nerve injury (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28). Conclusions Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions than OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

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