Single portal endoscopic carpal tunnel release: modification of Menon's technique and data from 65 cases

Abstract

The purpose of our study is to make a follow-up evaluation of endoscopic carpal tunnel release under focal anesthesia using the Wolf single portal system. A total of 65 patients with a mean age of 50 years undergoing 79 procedures were retrospectively studied. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were recorded. Follow-up was conducted at 1, 5, 12, and 24 weeks and at 1 year postoperatively. Wound pain, analysis of satisfaction, Levine functional status scales, and surgical complications were included. No patients sustained iatrogenic neurovascular injury or hematoma formation. The average Levine functional severity score decreased from 2.82 points preoperatively to 1.2 points at the most recent survey. One case recurred at 1 year after the surgery and subsequently underwent open release. Surgery using the Wolf single portal system under focal anesthesia is a safe and efficacious option for endoscopic carpal tunnel release.

Fig. 1

a. Instruments of the Wolf single portal system included a 2.7-mm 25° endoscope (S), handle, 5.7/7.0-mm slotted cannula (C), angular knife assembly (N), and a right angle probe. b. Set-up of the Wolf single portal system with the assistant’s hand (H) holding the retractor (R), which is aiming at the radial border of the ring finger and serves as guidance for advancement of releasing knife (N)

Fig. 2

Intraoperative photograph illustrates the endoscopic view of the carpal tunnel with transverse carpal ligament (T) visible at the top before release. The median nerve is beneath the endoscope cannula (C)

Fig. 3

a. Intraoperative photograph. The transverse carpal ligament (T) is released by antegrade cutting with an angular blade (N). b. Intraoperative photograph. Complete release of the transverse carpal ligament (T) is confirmed under direct video monitoring