Endoscopic carpal tunnel release surgery is a safe, effective option that individuals with pain and numbness actively seek out.

If you give a patient the choice between a one-and-a-half-centimeter incision on the crease in their wrist with a speedy recovery prognosis or a four-to-five centimeter opening on the palm of their hand that takes a little longer to heal, they`ll naturally gravitate toward that smaller incision and quicker recovery. At least that`s been the experience of Philip C. Marin, MD, a double board-certified plastic, reconstructive and hand surgeon in Pueblo, Colo., who has done more than 5,000 carpal tunnel procedures over the last 25 years. Around 95% of those cases were endoscopic carpal tunnel procedures - the one with that tiny one-and-a-half-centimeter scar - and the bulk of the patients who come to see him are there due to word of mouth.

[Most of the patients that come in have met a patient of mine who had the endoscopic technique, and they really liked the results," says Dr. Marin. [The endoscopic technique is usually what they have on their mind in the first place." Though he does explain both options to prospective surgical patients and occasionally performs open cases, Dr. Marin says it generally only occurs if there`s something inside the carpal tunnel that needs to be cleaned out or it there`s severe synovitis, something that only occurs in only a handful of approximately 250 annual carpal tunnel cases he performs.

Single vs. double port

While the endoscopic release can be performed either via a single portal (i.e., incision) approach or a dual portal approach, Dr. Marin has only ever worked with a single portal technique, whereby the surgeon makes the lone incision in the wrist crease, enters the carpal tunnel and releases the transverse carpal ligament under direct visualization using a retractable knife that`s connected to an endoscopic device. [It`s an excellent technique, it`s extremely safe and it`s a very good point of entry into the carpal tunnel," says Dr. Marin. [After doing this technique for 25 years, I believe it`s one of the safest ways to get into the palm of the hand."

Dr Marin`s word-of-mouth referrals, longevity and track record for reliable outcomes seem to support this. The typical turnaround for the surgery itself is just eight minutes and the patients receive a Bier block, also known as intravenous local anesthesia (IVRA), which is a safe and cost-efficient way to provide short-term anesthesia and analgesia during a procedure on a patient`s extremity.

Recovery-wise, Dr. Marin`s patients, whom he does not splint, are encouraged to move their fingers from the get-go and do gentle range of motion exercises. [We leave stitches in for approximately two weeks and tell patients to avoid any compression or trauma to the palm of the hand because it`ll be sore from surgery," he says. [You want to move it, but you don`t want to aggravate it."

The dual portal technique, which includes a second incision in the palm of the hand and the insertion of a camera within, puts the surgeon right there in the middle of palm. [There are deep palmar arches, and you have the carpal tunnel nerve, the median nerve branching there, so in my opinion, it`s a little bit more dangerous of a technique," says Dr. Marin. [I`ve actually never performed it."

But there are plenty of others who have. That`s the thing about carpal tunnel release surgery - surgeon preference almost always plays a major role in the technique. [You learn from your mentors," says Dr. Marin. [They have such an influence on the people who they`re training."

When conservative approaches fail

Endoscopic carpal tunnel release is such a common and reliable option that some people believe it`s the first line of treatment when patients present with symptoms. Of course, that`s rarely the case.

When patients come to Dr. Marin with typical symptoms - numbness in the radial three-and-one-half digits, weakness in the hand, object dropping and night awakening - his first approach is early management with anti-inflammatories and night splinting. [The night splinting helps because it holds your wrist in a relatively neutral position, which allows the nerve to have the most space to breathe - next to the nine tendons that are in the carpal tunnel next to it," says Dr. Marin. If that fails, sometimes he`ll do cortisone injections in the carpal tunnel. Only then, if the patient is unresponsive to conservative management, does Dr. Marin bring up the single port endoscopic carpal tunnel release in which he`s so experienced. [Patients should fail conservative management first prior to entering surgery," he says. If and when that happens, Dr. Marin is more than equipped to provide surgical relief in as safe, efficient and expedient a manner as possible.