Limited Open Carpal Tunnel Syndrome Using the Safeguard System:

Mini-open transverse flexor crease incision versus limited longitudinal palmar incision carpal tunnel release: A short term outcome study

OBJECTIVE

To compare the outcome of carpal tunnel release using the limited longitudinal palmar incision technique and mini open transverse flexor crease incision technique.

MATERIALS AND METHODSL

Between October 2017 and September 2019, we performed Carpal Tunnel release procedures on 122 consecutive patients with unilateral idiopathic CTS. Patients in Group A (64 patients) had a palmar mini open longitudinal incision at wrist. Patients in Group B (58 patients) had a small flexor crease transverse incision. In the non palmar transverse incision group, we used a blunt ended facelift scissors to cut the flexor retinaculum after placing a dural retractor between the retinaculum and median nerve. The preoperative and postoperative (2 weeks,6 weeks,3 months, 6 months and 1 year) patient statuses were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores, VAS, grip strength and return to work days.

RESULTS

The BCTSQ symptom severity scale and functional status scale showed significant improvement following surgery in Group B compared to Group A at 2 weeks,6 weeks and 3 months (p < 0.05). At 6 months and 1 year follow up, both the symptom severity and functional status scale were comparable in both the groups. Grip strength, pillar pain and scar tenderness showed significant improvement in transverse flexor incision group compared to longitudinal palmar incision group at 6 weeks and 3 months and were comparable later on.

CONCLUSION

We conclude that the mini open transverse flexor crease incision technique using the conventional instruments is simple, safe and cost-effective mode of treatment of idiopathic CTS when compared to the limited palmar incision technique. Though the long term outcomes are comparable in both groups, the flexor crease transverse incision group patients had better pain relief, better cosmesis and shorter recovery period than the palmar incision group.

Effectiveness of Surgical Treatment in Carpal Tunnel Syndrome Mini-Incision Using MIS-CTS Kits: A Cadaveric Study

Introduction. Carpal tunnel syndrome (CTS) is caused by the compression of the median nerves in the wrist. Patients have pain and numbness in the hands. According to the records of Songklanagarind Hospital from 2015 to 2018, of 800 patients, 196 or 24.5% were treated with surgery. The novel tool of minimally invasive surgery for carpal tunnel syndrome (MIS-CTS) was developed to improve effectiveness and safety.

Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE

INTRODUCTION

The standard open technique for carpal tunnel surgery has wound problems and complications significantly more than minimally invasive surgery using the Wongsiri technique with MiniSURE Kit® (Surgical Innovation Healthcare Co., Ltd, Bangkok, Thailand) and in particular, the open technique surgery requires a longer time for return to work. CTR surgery with endoscopic devices improves the results with fewer wound problems when compared with the commonly used open technique; however, nerve complications and injury are more prevalent with endoscopic surgery than with the open technique. The Wongsiri technique produces good results with new medical devices such as the MiniSURE View, for improved vision and line-of-sight, and the MiniSURE Cut for improved and complete cutting via the supraretinacular technique that may reduce the nerve problems associated with endoscopic tooling in the carpal tunnel.

PURPOSE

To evaluate the results of the operation and postoperative outcomes of the Wongsiri technique with a MiniSURE Kit®.

METHODS

20 patients underwent carpal tunnel release using the Wongsiri technique and a MiniSURE Kit® with a five-step surgery: MIS starts when the surgeon makes a 1.5-1.8 cm incision, creates a working space, inserts the visual tube of MiniSURE View, inserts the freer, and then cuts the transverse carpal ligament by using the MiniSURE Cut.

RESULTS

All 20 successes of the Wongsiri technique and MiniSURE Kit® surgery occurred within 6.8 minutes operative time and a 12 mm wound size. A single outlier, in one case (6.7%), the patient experienced pillar pain which abated within one month. Patients can return to work in 7.3 days.

CONCLUSIONS

The Wongsiri technique with the MiniSURE Kit® demonstrated good outcomes similar to the endoscope. By contrast with the endoscopic surgery, the Wongsiri technique with the MiniSURE Kit® reduced preop, operating, and postop time, many resources, and significant costs and resulted in no nerve problems or complications.

Minimally invasive carpal tunnel release

We prospectively compared the safety and effectiveness of mini-incision (group A) and a limited open technique (group B) for carpal tunnel release (CTR) in 185 consecutive patients operated between November 1999 and May 2001, with a 5-year minimum follow-up. Patients in Group A had a minimally invasive approach (<2 cm incision), performed using the KnifeLight (Stryker, Kalamazoo, Michigan) instrument. Patients in Group B had a limited longitudinal incision (3-4 cm). Patient status was evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire, administered preoperatively and at 19, 30, and 60 postoperative months. Mini-incision CTR showed advantages over standard technique in early recovery, pillar pain, and recurrence rate. The recovery period after mini-incision is shorter than after standard procedure.