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Safety modification for Agee Endoscopic Carpal Tunnel Release technique

Esteban Marten, MD Michael Hendel, PhD Louis Ross,MS Mark Hendrickson, MD
Cleveland Clinic
2010-04-05

Presenter: Esteban Marten

Affidavit:

Director Name:

Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Hand

PURPOSE

Endoscopic median nerve decompression at the carpal tunnel (ECTR) has become a commonly used technique by many hand surgeons, but some still doubt its safety. A prospective trial has shown potential benefit in elderly patients' psychological acceptance of the surgery while maintaining comparable functional improvements and safety margins.1
We describe novel modifications to the ECTR which, in our experience, enhance the surgeon's ability to perform the procedure with a safety margin that rivals traditional open surgery. We believe our methods allow surgeons less experienced in endoscopy to perform this procedure safely and shorten the learning curve.

METHODS

A single surgeon's 3 year experience is retrospectively reviewed. The modified endoscopic approach involved use of orbital retractors to enhance visualization of the carpal tunnel. A professional quality video of the procedure is presented.

RESULTS

795 consecutive carpal tunnel releases were performed over a 3 year period. 721 were modified ECTRs and 74 were OCTRs (open carpal tunnel release) were performed. There were no median nerve injuries. We measured length of surgery and functional outcome.

CONCLUSIONS

The safety of endoscopic carpal tunnel decompression can be enhanced by applying some simple technical modifications. We believe these can allow even hand surgeons inexperience in endoscopy to consistently achieve the safety margins and functional results obtained with traditional open decompression. Our approach also shortens the learning curve and does not add significant costs.

1 Schwartz MS, Chan TP. Carpal tunnel syndrome: Age as an important factor. Muscle and Nerve 1998; 15: 829.

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