gms | German Medical Science

Objectives/Interrogation: The most common peripheral neuropathy is caused by the idiopathic carpal tunnel syndrome (CTS). The surgical decompression is usually performed with an open (OCTR) or endoscopic carpal tunnel release (ECTR). The ECTR is supposed to show a flat and complicated learning curve and to be technically more demanding than the OCTR. Therefore, we wanted to examine the learning curve while establishing ECTR in our clinic and monitored a total of 175 patients for complications and outcome during a 1.5 year period. Moreover, we wanted to figure out, which operative method shows the higher patient acceptance.

Methods: From April to November 2017, 52 patients with idiopathic CTS were included in a pilot study, operated in a single center by one surgeon using the one-portal ECTR-procedure. The operative time was measured and any remaining hematoma was scored at the time of stitch removal 12 days after surgery. The postoperative pain level was evaluated (VAS 0-10). Regression of the typical CTS symptoms such as nocturnal numbness and pain (NMP) was also monitored. From November 2017 to September 2018 another 123 patients were operated with ECTR and monitored identically. Finally, 8 patients who were operated bilaterally with OCTR and ECTR by the same surgeon were interviewed, which operative procedure they preferred.

Results and Conclusions: In the beginning, 30 ECTR were needed to establish a stable and representable process. In the first 30 patients, greater variabilities in the operative time from 6 to 27 min. were recorded and 2 ECTR-procedures were converted into an open surgical approach. In the first third of 52 patients (1-17), the average operative time was 11.8 min., in the second third (18-35) 8.0 min. and in the last third (36-52) 5.5 min. were needed. During the learning phase, operative revisions, due to complications, were not observed. However, there was one iatrogenic partial lesion of a three-part motoric thenar branch in an extremely obese patient (patient no. 119), that had to be reconstructed microsurgically during the same operation. By all 175 patients, the NMP disappeared post-operatively and the pain level was low (VAS 0-2). In case of a CTS, 7 of 8 patients who were operated bilaterally, wanted to be operated again with ECTR, 0 of 8 preferred OCTR and one patient was indecisive. Thus, these results do not confirm the assumed prolonged learning process. If the guidelines are respected, the ECTR is confirmed to be a save and favorable procedure with a high patient acceptance.