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Endoscopic Carpal Tunnel Release Surgery

Endoscopic Carpal Tunnel Release Surgery refers to a method of performing Carpal Tunnel Release Surgery using an endoscope or an arthroscopic device. Typically this method uses either one or two smaller incisions compared to the traditional open method of carpal tunnel release surgery. Surgery, either open or endoscopic is a way to treat Carpal Tunnel Syndrome. The surgeon uses the endoscope to release the transverse carpal ligament which is a part of the carpal tunnel found in the wrist.

The use of an endoscope to release the carpal tunnel was first described in1989 by Okutsu et al., in an article entitled Endoscopic Management of Carpal Tunnel Syndrome, Arthroscopy, 5(1):11-18 (1989). Here a flexible clear plastic tube was used with a standard endoscope to identify the transverse carpal ligament and released it withac retrograde knife.

Many variations of the endoscopic or arthroscopic methds have been described each with its own unique apparatus and surgical protocol.

The two more common and popular devices were referred to early on as the Chow device and the 3M Agee device. The Chow device is a two-portal device while the 3M Agee endoscopic carpal tunnel release system is a single portal device. The Chow device was produced by Dyonics and early papers documented its success. It was heralded by its corporate manufacturer as a breakthrough in carpal tunnel surgery. The Agee 3M device used a single portal or incision in the area of the wrist crease. Both methods are still in use today although other manufacturers have either bought, redesigned or adopted the technology that provided the basis for these new methods to be used. The Chow two portal or two incision device has had other manifestations and the Agee device was bought by Microaire and both are still in use today. Additonal modifications in technique for a maller or limited incison have been accompanied by many variations of knives, rasps and tubes through which these intruments and the imaging arthroscope or endoscope are passed. Such as this patent application . http://www.google.com/patents?hl=en&lr=&vid=USPAT5282816&id=qAUcAAAAEBAJ&oi=fnd&dq=Arthroscopy,+1989%3B+5:1:11-18. In addition several years later a distal portal or single incision in the distal palm was advocated by others. Some of these methods utilize an endoscope tp visualize the undersurface of the transverse carpal ligment while others simply rely on instrumetationthat allow for a smaller incison but with instrumentation that aids in giuding the surgeons knife via retraction.

Many studies have been done to determine whether the perceived benfits of a limited endoscopic ro arthroscopic release are truly significant. Brown et al did prospective, randomized, multicenter study and found no significant differences between the two groups with regard to the secondary quantitative outcome measurements. However the open technique resulted in more tenderness of the scar than did the endoscopic method.

References

Okutsu, I., Ninomiya, S., Takatori, Y., and Ugawa, Y. “Endoscopic management of carpal tunnel syndrome.” Arthroscopy, 1989; 5:1:11-18.

Chow, J. C. Y., "Endoscopic Release of the Carpal Ligament: A New Technique for Carpal Tunnel Syndrome", The Journal of Arthroscopic and Related Surgery, vol. 5(1), pp. 19-24

Chow, J. C. Y., "A Breakthrough in Carpal Tunnel Release", Dec., 1990. (Dyonics Brochure)

Agee, J. M., "The Agee Surgical Technique and User's Guide" 1990

External Links

[1]Video from youtube showing endoscopic carpal tunnel release surgery using a single proximal portal or one proximal incision method

[2]Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods RA Brown, RH Gelberman, JG Seiler, SO Abrahamsson, AJ Weiland, JR Urbaniak, DA Schoenfeld and D Furcolo