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Wongsiri S, Sarasombath P, Liawrungrueang W. Minimally invasive carpal tunnel release: A clinical case study and surgical technique. Ann Med Surg (Lond) 2022; 84:104950. [PMID: 36582854 PMCID: PMC9793183 DOI: 10.1016/j.amsu.2022.104950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Sunton Wongsiri
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Peem Sarasombath
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wongthawat Liawrungrueang
- Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand
- Corresponding author.
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Ma T, Wang D, Hu Y, Zhao X, Wang W, Song L. Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study. J Orthop Surg Res 2021; 16:462. [PMID: 34281573 PMCID: PMC8287693 DOI: 10.1186/s13018-021-02608-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/11/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose This study aimed to investigate the outcomes of a mini-transverse incision with a bush-hook versus a conventional open incision for carpal tunnel release (CTR). Methods This was a prospective study. The decision to receive either technique (mini-transverse incision with a bush-hook or conventional open incision) was primarily based on patients’ choice. Patients’ symptom severity, functional status, and symptomatic pain were measured at pre-operation, 1 month, and 3 and 6 months postoperatively, and any relevant complications were recorded. Kelly’s scale was used to evaluate the overall clinical efficacy. Results Eighty-nine patients were included in the open CTR group and 85 patients in the mini-transverse incision group. The mini-transverse incision group had a significantly smaller incision (4.4±0.6 vs 44.8±3.7 mm), shorter surgical time (7.8±1.9 vs 21.2±3.4 min), and shorter hospital stay (3.7±1.6 vs 5.9±2.0 days) than did the open CTR group. Both groups showed significant improvements from baseline levels (all P<0.001). At postoperative 1 month and 3 months, the transverse incision group showed a significantly better VAS, SSS, and FSS (all P<0.05), but the difference was non-significant at 6 months except for FSS (P=0.022). Also, mini-transverse incision showed a significantly reduced time to return to work and activities, trend to a higher rate of excellence, and good and fewer complications than did the open CTR. Conclusions The mini-transverse incision exhibited better performance in surgery-related measures, symptomatic remission, functional recovery, and postoperative morbidity, thus could be considered a promising technique alternative. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02608-x.
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Affiliation(s)
- Tianxiao Ma
- Department of Orthopaedic Surgery, The General Hospital of Jizhong Energy Xingtai Mining Group, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Dongyue Wang
- Department of Orthopaedic Surgery, The General Hospital of Jizhong Energy Xingtai Mining Group, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Yuqing Hu
- Department of Orthopaedic Surgery, The General Hospital of Jizhong Energy Xingtai Mining Group, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Xiaocui Zhao
- Department of Orthopaedic Surgery, Xiangjiang Area of the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Wei Wang
- Department of Orthopaedic Surgery, The General Hospital of Jizhong Energy Xingtai Mining Group, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China.
| | - Lihua Song
- Department of Orthopaedic Surgery, The General Hospital of Jizhong Energy Xingtai Mining Group, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China.
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Wongsiri S, Liawrungrueang W. Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE. Adv Orthop 2020; 2020:6273723. [PMID: 31969999 PMCID: PMC6969642 DOI: 10.1155/2020/6273723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/03/2019] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Sunton Wongsiri
- Department of Orthopaedic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Wongthawat Liawrungrueang
- Department of Orthopaedic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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A Novel Supraretinacular Endoscopic Carpal Tunnel Release: Instrumentation and Technique (Cadaveric Study). JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Mardanpour K, Rahbar M, Mardanpour S. Functional Outcomes of 300 Carpal Tunnel Release: 1.5 cm Longitudinal Mini-incision. Asian J Neurosurg 2019; 14:693-697. [PMID: 31497086 PMCID: PMC6702990 DOI: 10.4103/ajns.ajns_31_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective There is an opportunity for median nerve decompression by open surgery in carpal tunnel syndrome which is the most common surgical procedure in neurosurgical practice. The aim of this study is to evaluate the long-term outcomes of carpal tunnel release with 1.5 cm longitudinal mini-incision technique with regarding the effectiveness and safety. Methods For this prospective study, 300 hands for 188 patients with advanced carpal tunnel syndrome who had indication for neurolysis underwent carpal tunnel release through a 1.5 cm longitudinal mini-incision between March 2011 and 2015. There were 132 (70%) females and 56 (30%) males with a mean age of 40 ± 29.5 years (ranging from 24 to 73) and female to male: About 2.56.178 operations were performed for the right hand and 122 for the left hand. Preoperatively, all patients were evaluated with clinical examination and nerve conduction studies. The clinical effects of the patients assessed with the Global Symptom Score (GSS) and Visual Analog Patient Satisfaction Scale. Results The mean follow-up period was 18.6 ± 9.3 months (12-30 months). Postoperatively, 2% (six hands) complained of residual mild pain with tenderness of scar and only 1% (three hands) complained of median nerve damage (neuropraxy) with tingling and numbness but was temporary which improved after 1 week. Five patients (seven hands) loosed strength of their wrists, but muscle force of abductor pollicis brevis reinforced after 1 month. There is no evidence of local infection, stiffness, loss of some wrist strength, or recurrence of the disorder. Postoperative GSS scoring obviously improved than preoperative (P < 0.002). There is no patient who underwent reoperation. The mean time recovery appeared almost 2 weeks. Conclusion 1.5 cm longitudinal mini-incision method in carpal tunnel syndrome decompression showed satisfactory pain relief, wound healing, and nontender scar with good functional outcomes. The technique was performed safely without major complication.
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Affiliation(s)
- Keykhosro Mardanpour
- Department of Orthopedic, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahtab Rahbar
- Department of Pathologic, Iran University of Medical Sciences, Tehran, Iran
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Ecker J, Perera N, Ebert J. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series. J Hand Surg Eur Vol 2015; 40:193-8. [PMID: 24570345 DOI: 10.1177/1753193414524688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques.
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Affiliation(s)
- J Ecker
- Western Orthopaedic Clinic, SJOG Health Care, Subiaco, Australia
| | - N Perera
- Hand and Upper Limb Centre, Subiaco, Australia
| | - J Ebert
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, Australia
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Vasiliadis HS, Sakellaridou ME, Shrier I, Salanti G, Scholten RJPM. Open release for carpal tunnel syndrome. Hippokratia 2014. [DOI: 10.1002/14651858.cd011041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Haris S Vasiliadis
- University of Ioannina; Department of Orthopaedics; Ioannina Greece
- Sahlgrenska Academy, University of Gothenburg; Molecular Cell Biology and Regenerative Medicine; Gothenburg Sweden SE-413 45
| | | | - Ian Shrier
- Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University; Centre for Clinical Epidemiology; 3755 Cote Ste-Catherine Road Montreal Quebec Canada H3T 1E2
| | - Georgia Salanti
- University of Ioannina School of Medicine; Department of Hygiene and Epidemiology; Medical School Campus University of Ioannina Ioannina Greece 45110
| | - Rob JPM Scholten
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; Room Str. 6.126 P.O. Box 85500 Utrecht Netherlands 3508 GA
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Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: A perspective randomised study. J Plast Reconstr Aesthet Surg 2014; 67:237-43. [DOI: 10.1016/j.bjps.2013.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 04/14/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
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How to prevent injury to the palmar cutaneous branch of median nerve and ulnar nerve in a palmar incision in carpal tunnel release, a cadaveric study. Acta Neurochir (Wien) 2013; 155:1751-5. [PMID: 23828713 DOI: 10.1007/s00701-013-1764-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify palmar cutaneous branches of median nerve and ulnar nerve (PCBMN and PCBUN) and try to find a safe path at wrist and forearm in the decompression procedure of carpal tunnel syndrome. MATERIALS AND METHODS Ten formalin-fixed and five fresh-frozen cadaveric forearms were included in the study. The cross point of longitude of middle finger and distal wrist crease was defined as 0 point. Distal wrist crease (DWC) and 0 point were chosen as references for measurements. Several points on the pathway of PCBMN and PCBUN were measured. RESULTS The average distance between the origin of the PCBMN and PCBUN to the DWC was 4.95 ± 0.88 cm, 10.12 ± 1.50 cm, separately. The average distance between DWC and the point where PCBMN and PCBUN separated from their trunk was found to be 2.09 ± 0.31 cm, 2.90 ± 0.50 cm, separately. The distances between PCBMN, PCBUN and 0 point at DWC level was found to be 0.61 ± 0.12 cm, 0.47 ± 0.31 cm, separately. The diameters of two cutaneous branches were 0.10 ± 0.02 cm, 0.11 ± 0.04 cm, separately. CONCLUSION The general longitudinal palmar incision could avoid injuries to recurrent branch of median nerve and distal branches of palmar cutaneous nerve can be avoided macroscopically. The area about 5 mm ulnar and 6 mm radial to 0 point at wrist level was a relatively safe area.
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Heidarian A, Abbasi H, Hasanzadeh Hoseinabadi M, Hajialibeyg A, Kalantar Motamedi SM, Seifirad S. Comparison of Knifelight Surgery versus Conventional Open Surgery in the Treatment of Carpal Tunnel Syndrome. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:385-8. [PMID: 24349724 PMCID: PMC3838646 DOI: 10.5812/ircmj.4180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/13/2012] [Accepted: 07/08/2012] [Indexed: 12/31/2022]
Abstract
Background A variety of surgical treatment methods for carpal tunnel syndrome are introduced recently, including open surgery, endoscopic and the Knifelight. It is hypothesized that Knifelight method could decrease scar tenderness and time before return to daily activities for patients and is accompanied with less disturbance to fine sensory nerves. Objectives To compare the Knifelight instrument and open carpal tunnel release with respect to scar length, operation duration, recovery time needed before return to work and amount of pain three weeks after surgery in patients with neurophysiologically confirmed carpal tunnel syndrome. Patients and Methods Fifty nine patients with indication for carpal tunnel release randomly assigned into two groups: open (n=30) or Knifelight (n=29). The patients compared regarding scar length, operation duration, time to return to daily activities and amount of pain at three weeks after operation based on Visual Analog Scale. Results There was no significant differences regarding age and sex in the two groups. The scar length, operation duration and time before return to daily activities were significantly lower in the Knifelight group. Although the mean visual analogue scale of Knifelight group found to be lower than the other, it was not statistically significant. Conclusions The Knifelight technique is accompanied with advantages over the open surgery regarding operation time, scar length and time to return to daily activities. The pain relieve based on Visual Analog Scale was not statistically different from conventional open surgery.
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Affiliation(s)
- Amin Heidarian
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Hamidreza Abbasi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | | | - Azin Hajialibeyg
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | | | - Soroush Seifirad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Soroush Seifirad, Endocrinology and Metabolism Research Center, Shariati Hospital, Tehran, IR Iran. Tel: +98-9355799979, Fax: +98-9355799979, E-mail:
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