gms | German Medical Science

Objectives/Interrogation: The learning curve and risks of sectioning the transverse carpal ligament (CTL) by ultrasounds have never been evaluated so far. We have evaluated these parameters, on surgical criteria (quality of section and anatomical injuries), by a comparative cadaveric study between a junior surgeon and an experimented one through two section methods: ultrasound carpal tunnel release (UCTR) and endoscopic carpal tunnel release (ECTR).

Methods: We used 30 normal cadaveric wrists (5 fresh frozen, and 15 conserved). The Junior surgeon did performed 14 UCTR and 6 ECTR without any external help, against 5 for each method for the senior. We then extensively dissected each wrist to evaluate the quality of section evaluated by the percentage of section (length of sectioned ligament reported to the total CTL length). We also researched anatomical injury (tendons, vessels, nerves) caused by the section.

Results and Conclusions: The CTL was fully released in half cases for the junior surgeon in each group. The mean percentage of section was 90% with 2 injuries for ECTR and 80% with 3 injuries for UCTR (Figure 1 [Fig. 1]).

The senior surgeon did not cause any damage, the mean section was 100% in ECTR and 88% in UCTR.

There were significant differences between junior and senior surgeons in each method on surgical parameters.

The Junior surgeon showed greater fluency in ECTR around 3 wrists against 10 in UCTR, for the inexperienced surgeon (Figure 2 [Fig. 2]).

There are a longer learning curve and an increase of severe lesions by sectioning the CTL by ultrasounds than the reference method.

This study highlight the importance of cadaveric model for the trainee to acquire the method.

Anatomical knowledge are essentials to manage complications.