The endoscopic carpal tunnel repair (ECTR), which is also known as "keyhole surgery", is a newer minimally-invasive procedure that has been available since the 1990's. This outpatient surgical procedure is usually performed in an operating room and has an operative time that ranges from 15 to 60 minutes. The procedure is usually performed under monitored anesthesia care (MAC) along with local anesthetic. This procedure requires special equipment. The single-port technique only requires a small incision at the wrist through which a tiny camera (endoscope) and instrumentation is placed.
Dr. LaBrasca uses the single-port MicroAire SmartRelease® ECTR endoscopic carpal tunnel repair system. A tiny incision is made at the base of the wrist though which the endoscope can be placed. As opposed to the open carpal tunnel repair that visualizes the transverse carpal tunnel ligament from above, the endoscope allows visualization and identification of the transverse carpal ligament from below. A special disposable retractable blade is positioned under endoscope visualization directly beneath the transverse carpal ligament. Under direct endoscopic visualization, a trigger-system releases and elevates a small retractable blade which is used to cut the carpal ligament from below. The carpal tunnel is released and visualized the entire time with the endoscopic camera. The small incision on the wrist is closed with a couple sutures and bandages are placed.
Postoperatively, patients are instructed move as much as they can tolerate from a pain standpoint. Clinical studies have demonstrated that patients recover and return to work significantly faster following endoscopic repair compared to the open repair. The incision for endoscopic repair is smaller and contained to the wrist, which has less cutaneous (skin) innervation compared to the adjacent skin of the more sensitive palm. There is also less dissection and disruption of soft tissues with the endoscopic approach, and clinical studies have shown that patients experience significantly less pain (at 3 months). The smaller incision has the added advantage of leaving a smaller scar after healing.
There is a slightly longer recovery time with the open repair. A longer scar remains from longer incision. The combination of the larger incision and soft tissue disruption from open dissection results in the open carpal tunnel repair being associated with more pain postoperatively. There may be a slightly less, but not significant, chance of complications, secondary to the ability for direct surgical visualization with the open procedure.