PROSPECTIVE COMPARISON OF MINIMAL INCISION OPEN AND 2-PORTAL ENDOSCOPIC CARPAL-TUNNEL RELEASE

Part of the groundswell for endoscopic plastic surgery initially gaine d momentum in hand surgery, with claims that endoscopic carpal tunnel release allowed less invasive surgery and a more rapid recovery due to diminished pain and scarring than was possible with traditional ''ope n'' methods. Admittedly, no ultimate difference in their efficacy as r egards symptom relief had been observed. However, in our opinion, some of these conclusions may be flawed, since an ''open'' method employin g the most minimal possible incisions was not necessarily used. Theref ore, a more apropos study should compare an acceptable minimally invas ive ''open'' technique versus endoscopic carpal tunnel decompression. A prospective, consecutive series of 96 patients with medically unresp onsive, confirmed carpal tunnel syndrome with no other concomitant han d pathology was selected. Fifty-three patients (71 hands) underwent '' open'' release using a minimal incision, which was comparable in compo sition to a group of 47 patients (66 hands) who had a two-portal endos copic release. Scar length (p = 0.999), need for hand therapy (p = 0.7 98), rate of complications (p = 0.359), length of time before resuming routine activities (p = 0.255), and length of time before return to w ork (p = 0.373) were not statistically different whether an ''open'' o r ''closed'' procedure had been performed. Regardless of the technique employed, individuals receiving Worker's Compensation more often requ ired hand therapy (p < 0.02) and had a significantly longer recovery p eriod (p < 0.005). A subgroup of 15 patients with bilateral carpal tun nel syndrome who had decompression using opposing methods had no signi ficant difference in preference. Our observed outcomes documented no c lear superiority for endoscopic carpal tunnel release and should justi fy the continued use of a minimally invasive ''open'' technique by exp erienced hand surgeons without fear of personal obsolescence, especial ly if materiel expense is relevant or the risk for inadvertent injury is problematic.