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Commentary & Perspective | ||||||||
Commentary & Perspective on If standard open carpal tunnel release predictably leads to resolution of the signs and symptoms of carpal tunnel syndrome with minimum risk and little postoperative morbidity in nearly all patients, why should surgical techniques employing smaller incisions, more involved instrumentation, and a greater potential for complications be employed?1 In this issue of The Journal, Trumble et al. attempt to answer this question in their report of the results of a prospective, randomized multicenter study. The results of this study support the use of single-portal endoscopic carpal tunnel release for several reasons. Neither the surgical time nor the surgical costs were increased in the endoscopic group in comparison with the open release group; there was no difference in the prevalence of complications between the two groups2, yet patients treated with single-portal endoscopic release had better outcomes in terms of function, symptom severity, scar sensitivity, dexterity, and patient satisfaction during the first two to three postoperative months, as evaluated by blinded observers using accepted objective and subjective measures. Finally, patients who were treated with single-portal endoscopic release returned to work, on average, three weeks earlier than did the patients treated with an open release. At first glance, therefore, these findings in this well-designed, well-controlled study seem to support the widespread use of endoscopic carpal tunnel release for the treatment of this condition. Caution must be exercised, however, before general use of this technique can be advocated. All three surgeons who co-authored this study are experienced in endoscopic techniques for surgery of the hand and wrist. Their excellent results might not be replicated by orthopaedic surgeons who are less familiar with variations in the anatomy of the hand3. Incomplete release of the transverse carpal ligament or injury to neurovascular structures might occur, with disastrous results. I would recommend that the surgeon not familiar with the techniques of endoscopic carpal tunnel release receive instruction either at a "hands-on" technical course or from a hand surgeon adept at this technique before offering it to patients. Whether the benefits of shorter recovery time, decreased scar sensitivity, and earlier return to work outweigh the potential risks of neurovascular injury or incomplete decompression4 is a question that can be answered only by the individual operating surgeon, on the basis of his or her own degree of knowledge, skill, and confidence. This study does offer support to those surgeons who are confident that they can perform this procedure in a safe, reliable manner. Trumble et al. do stop short, however, of advocating the widespread use of single-portal endoscopic carpal tunnel release for the treatment of carpal tunnel syndrome. *The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated. References 1. Gerritsen AA, Uitdehaag BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg. 2001;88:1285-95. | ||||||||
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