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

Aesthetic and Functional Outcomes of Open Carpal Tunnel Release and Thread Carpal Tunnel Release: A Randomized Clinical Trial

Background and Objectives  Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods  This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results  Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain ( p  < 0.001) and lower scar length ( p  < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion  The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome.

Minimally invasive carpal tunnel release: A clinical case study and surgical technique

Introduction and importance

Carpal tunnel syndrome (CTS) is the most prevalent type of median nerve entrapment neuropathy. CTR surgery with a single limited incision is becoming more widely accepted. A better recovery, less pillar pain, less scarring, and an earlier return to work are the key benefits of single limited incision. This study provides an inquiry report on the surgical method, surgical advice, and outcomes of single limited incision minimally invasive carpal tunnel release for CTS.

Case presentation

A 60-year-old female developed carpal tunnel syndrome (CTS). Patient received minimally invasive carpal tunnel release using single limited incision following the failure non operative treatment and the patient was able to return to work with excellent 1-year outcomes. The patient was extremely satisfied with this operative technique.

Clinical discussion

This case highlights a successful outcome of a minimal invasive surgery in CTS. Visual efficiency during surgery and full transverse carpal ligament release are both improved with this technique which requires only a single limited incision. The transverse carpal ligament is totally released with this approach. During the operation, median nerves and superficial palmar arches are not injured.

Conclusion

This technique has been shown to be effective and safe for minimal invasive surgery. This technique could be of interest to surgeons performing minimal invasive surgery who treat CTS.

A Preliminary Report on Augmented Reality Assisted Carpal Tunnel Release

Augmented reality (AR) refers to the use of technology to enhance a real-world environment by computer generated visual, auditory, haptic, somatosensory and/or olfactory stimuli. We developed an augmented reality-assisted surgery (ARAS) for carpal tunnel syndrome (CTS). It generates a virtual image of the operative field that the surgeon can view. This enhances the operative experience. We report the use of ARAS in performing limited open carpal tunnel release. Level of Evidence: Level V (Therapeutic).

Hand Surgery in Thailand

Modern hand surgery in Thailand started after the end of World War II. It is divided into 4 phases. In the initial phase (1950-1965), the surgery of the hand was mainly performed by general surgeons. In 1965-1975, which was the second phase, many plastic surgeons and orthopaedic surgeons graduated from foreign countries and came back to Thailand. They played a vital role in the treatment of the surgery of the hand and set up hand units in many centers. They also contributed to the establishment of the "Thai Society for Surgery of the Hand," which still continues to operate. In the third phase (1975-2000), there was a dramatic development of microsurgery because of the rapid economic expansion. There were many replantation, free tissue transfers, and brachial plexus surgeries in traffic and factory-related accidents. The first hand-fellow training program began in 1993. In the fourth phase (since 2000), the number of hand injuries from factory-related accidents began declining. But the injury from traffic accidents had been increasing both in severity and number. Moreover, the diseases of hand that relate to aging and degeneration had been on the rise. Thai hand surgeons have been using several state-of-the-art technologies such as arthroscopic and endoscopic surgery. They are continuing to invent innovations, generating international publications, and frequently being invited as speakers in foreign countries.