Commentary on Ecker et al. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series

2015 ◽  
Vol 40 (2) ◽  
pp. 199-199 ◽  
Author(s):  
R. Adani
Keyword(s):  
Surgical Technique ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Endoscopic Carpal Tunnel Release ◽  
Prospective Case Series

Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series

2014 ◽  
Vol 40 (2) ◽  
pp. 193-198 ◽  
Author(s):  
J. Ecker ◽  
N. Perera ◽  
J. Ebert
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Level Of Evidence ◽  
Motor Branch ◽  
Endoscopic Techniques ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Prospective Case Series

Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques. Level of evidence: IV.

scholarly journals Early Major Complications of Endoscopic Carpal Tunnel Release: A Review of 1200 Cases

2003 ◽  
Vol 11 (3) ◽  
pp. 131-134 ◽  
Author(s):  
Raymond W Tse ◽  
Lawrence N Hurst ◽  
Tawfeik A Al-Yafi
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Outpatient Basis ◽  
Safe Procedure ◽  
Nerve Injuries ◽  
Persistent Symptoms ◽  
Endoscopic Carpal Tunnel Release ◽  
Major Complications ◽  
Open Carpal Tunnel Release

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.

Experiences with Endoscopic Carpal Tunnel Release

Swiss Surgery ◽  
2002 ◽  
Vol 8 (4) ◽  
pp. 181-185
Author(s):  
Buchli ◽  
Scharplatz
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoskopische Karpaltunnelspaltung

Im Spital Thusis wurden zwischen 1994 und 2000 122 Patienten wegen eines Karpaltunnelsyndroms operiert. Wir wollten wissen, ob die endoskopische Karpaltunnelspaltung in einem Regionalspital mit genügend hoher Sicherheit angewandt wurde und ob die Ergebnisse mit der offenen Karpaltunnelspaltung vergleichbar sind. In einer retrospektiven Studie konnten wir 82 Patienten mittels Fragebogen über das Operationsergebnis befragen. 39 Patienten wurden offen operiert, 26 mittels der Zweipfortentechnik nach Chow und 17 mittels Einpfortentechnik nach Agee. Schwere irreversible Komplikationen wurden nicht beobachtet. Bezüglich der Operationsergebnisse zeigten sich keine signifikanten Unterschiede in den drei Gruppen. Von den 39 offenen Karpaltunnelspaltungen klagten neun Patienten über Restbeschwerden, wobei es zu einer Reoperation wegen einer Thenarastverletzung kam. Bei den 26 endoskopischen Karpaltunnelspaltungen in Zweipfortentechnik traten bei acht Patienten Restbeschwerden auf, wobei eine Reoperation wegen exzessiver Vernarbung durchgeführt werden musste. Bei den 17 Operationen nach Agee hatten fünf Patienten Restbeschwerden, es musste jedoch keiner reoperiert werden. Die Studie zeigt, dass mit den drei unterschiedlichen Operationsverfahren bezüglich Sicherheit und Therapieerfolg vergleichbare Resultate erreicht wurden. Vorteile wegen dem atraumatischeren Zugang der endoskopischen Techniken konnten wir jedoch nicht objektivieren.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Ian Wellington ◽  
Antonio Cusano ◽  
Joel V. Ferreira ◽  
Anthony Parrino
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Postanesthesia Care Unit ◽  
Complication Rates ◽  
Endoscopic Carpal Tunnel Release ◽  
Average Operating ◽  
Wide Awake ◽  
No Tourniquet ◽  
Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

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