Endoscopic Carpal Tunnel Release

A Retrospective 5 year Review

Dr Steve Carter

Vincent Pallotti Hospital

Martin Singer Hand Unit

Introduction

• Carpal tunnel Syndrome is the most common compression neuropathy of the upper extremity

• USA 350 000 Carpal Tunnel Releases per year

• Open Carpal Tunnel Release ( OCTR ) remains the Gold Standard

Introduction

• Endoscopic Carpal tunnel Release (ECTR) has been used for the last two Decades (Chow)

• Potential benefits include improved grip and pinch strength, an earlier return to work and lower risk of scar tendernes

• Robert Strauch Cochrane Meta Analysis 1859 handsClin Orthop Relat Res. 2015 Mar; 473(3): 1120-1132

• ECTR gives you the ability to do Bilateral with benefits to the patient and potential cost saving

Aims

• Retrospectively audit a 5 year period ( 2011-2016 ) of consecutive ECTR

• Assess the rate of intraoperative failure and conversion to open release

• Review Major and Minor complications

• Cost Effectiveness of Bilateral ECTR

Methods

Inclusion Criteria

• Females• Medical Aid Provider

Exclusion Criteria

• Males• Elderly >75 years• Inflammatory conditions• Previous wrist Pathology

Equipment

• Micro-Aire Single portal release system• Standard Arthroscopic tower• General Anaesthesia ( Bilateral )• Hot Water

Overall cohort

• 72 females (between 2011 and 2016)• Median age of the cohort at time of surgery: 47 years (17-74)• Total 98 ECTR• During the same period 384 OCTR ( 25% ECTR )• Bilateral: 26/72 (36%)• Unilateral: 46/72 (64%)

- Right hand: 33

- Left hand: 13

ResultsEndoscopic surgery Reverted to open surgery P value

Number of patients 67 (93%) 5 (7%)

Median age in years (range)

47 (17-74) 54 (35-62) P=0.62

UnilateralBilateral release

4423

32

P=0.57

Hand involved•Right•Left •Bilateral

311224

212

P=0.80

Results

• No Major complications, no Median nerve injury• No RSD• No Pillar pain or other scar related issues • Minor complications: 2 patients had a transient parasthesia of

the common digital nerve to middle and ring fingers which settled spontaneously over 3 months

• No patient required redo surgery for recurrent Carpal Tunnel Syndrome or inadequate release

• 7% conversion to open• 278 patients 4,3% conversion to open

Klena J C, et al. J.Hand SurgAm.2011 Jan;36(1):61-4

Cost analysis

• Theatre Costs• Open Carpal Tunnel Release costs R4622• Unilateral Endoscopic Release costs R7715• Bilateral Endoscopic Release costs R 9935• No theatre cost saving in doing two OCTR and doing a

Bilateral ECTR• Cost saving with doing Bilateral ECTR would be a single

admission and a single Anaesthetic fee as opposed to two admissions and two Anaesthetics For Bilateral OCTR

Summary

• Endoscopic Carpal Tunnel release is a reliable effective procedure

• There is a low complication rate• Allows you the ability to do Bilateral ECTR• Low 7% conversion to Open Release • No significant theatre cost saving comparing Bilateral ECTR to

two OCTR• Subjectively Allows you to offer your patient a less invasive

procedure • Bilateral procedures and a single Anaesthetic