Feasibility and limitations of the endoscopic instrumentation to release carpal ligament

In the authors' experience, endoscopic carpal tunnel release (ECTR) is a reasonably safe and effective technique for carpal tunnel release. The authors have achieved excellent to good results in 90% of patients with a 1.2% complication rate. Patients preferred ECTR to open surgery. However, ECTR is technically more demanding and complications may occur even with considerable experience; the single tendon injury the authors have had occurred on the 35th patient. More importantly, in 8 procedures the authors could not predict that ECTR could not be performed. They believe this recognition is crucial to good results; if they had persisted with ECTR in those 8 patients, the complication rate may have been higher and the success rate lower. The surgical error rate was far higher during cadaver operations and the authors feel that they learned a great deal during this experience. They strongly believe that ECTR is not a technique that can be adequately learned in a weekend seminar. Reported complications of ECTR have increased as more surgeons use this method to release the carpal ligament. More data should be gathered before ECTR can become the standard practice of surgical release of the carpal ligament.