Carpal Tunnel Syndrome: Endoscopic Carpal Tunnel Release

Carpal Tunnel Syndrome: Endoscopic Carpal Tunnel Release

This surgical video demonstrates an endoscopic carpal tunnel release for the treatment of carpal tunnel syndrome. In this procedure, the transverse carpal ligament will be cut to release pressure from the underlying tendons and median nerve within the carpal tunnel.

Here, we see a right hand with the palm facing up. The surgeon begins by marking out where the skin incision will be made along the base of the wrist. The surgeon cuts through the skin and uses surgical scissors to cut through some of the underlying soft tissue. A hook is used to move the skin out of the way and the surgeon inserts a surgical instrument into the opening made through the skin to widen the area beneath the transverse carpal ligament.

Next, the surgeon uses a scraper to remove any debris from the underside of the ligament. The patient’s wrist is then placed into slight hyperextension, or backward bending, with a towel under the wrist to better access the carpal tunnel. The surgeon inserts a carpal tunnel release instrument into the carpal tunnel through the skin incision. This instrument contains a camera and a tiny blade that will be used to cut the transverse carpal ligament.

The instrument’s camera is used to locate the underside of the transverse carpal ligament, seen here. Once the instrument is positioned at the end of the ligament, the blade is released, and the instrument is pulled back to cut through the far end of the ligament. The rest of the ligament is then cut. The surgeon inserts surgical scissors into the wrist to check that the space within the carpal tunnel is now freed up.

The surgeon will close the skin incision with sutures, and the carpal tunnel release is now complete.