Our experience in first 100 cases of endoscopic carpal tunnel release: An Indian perspective
Abstract Purpose This study was done to determine the role of endoscopic carpal tunnel release in the treatment of carpal tunnel syndrome and also to note the conversion rates of endoscopic to open release, causes for conversion and to analyse the learning curve of the operating surgeon for endoscopic procedure. Methods A total of 100 consecutive idiopathic carpal tunnel cases were included who had undergone preoperative ultrasonography (USG) for assessment of carpal tunnel morphology. All patients were primarily scheduled for a standard single portal endoscopic release after excluding the contraindications for endoscopic carpal tunnel release (ECTR). The conversion rate of endoscopic to open carpal tunnel release (OCTR) was analysed and reasons for conversion were established by an independent observer. Results Out of 100 patients, 74 (74%) underwent endoscopic release and 26(26%) underwent mini-open release. The conversion rates from endoscopy to open was noted to be 26%. Distal edge not being visualized in 14 cases (53%) was the most common cause for conversion followed by tight canal hindering the insertion of the scope in four cases (15.3%). In the first fifty cases in our study, 20 cases were converted to open release which amounted to 40% conversion rate, but in the next 50 subset of patients the conversion rates had dropped to 13.3%. Conclusion Endoscopic carpal tunnel release can be accepted as the treatment of choice for the surgical decompression of carpal tunnel owing to decreased postoperative complications. One of the major limitations of the ECTR is the slow learning curve of a surgeon. Difficulty to visualise the distal edge of TCL was most common cause for conversion. With increasing experience of a surgeon in endoscopic release, the conversion rates would decrease. Level of study: level 4, decision analysis
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