Camera-guided endoscopic carpal tunnel release

Carpal tunnel syndrome is the most frequent nerve entrapment problem that can make a person visit an orthopedic surgeon.

It affects 1% of the general population.

Looking down on the palm, the carpal tunnel is a passageway in the wrist, resting on the wrist bones and capped by the transverse carpal ligament.

Tendons and the median nerve pass through the carpal tunnel.

The median nerve supplies sensation to the thumb, the index finger, the middle finger and half of the ring finger, as well as movement to the base of the thumb.

What are the possible causes of carpal tunnel syndrome?

The most common cause of carpal tunnel syndrome is excessive use of the wrist (using tools or lifting loads).

It is also linked to genetic predisposition (due to the anatomy of the area, in particular the size of the carpal tunnel), injuries and such conditions as pregnancy, diabetes, thyroid issues, and rheumatoid arthritis.

Due to the above conditions, a great amount of pressure may be applied on the median nerve, thus preventing it from functioning properly.

This results in the patient having such symptoms as numbness, tingling, a burning sensation and pain, which worsen over time.

A typical symptom is patient waking up in the middle of the night with numb fingers and having to shake their hand or leave it hanging in order to get rid of the numbness.

At an advanced stage of the condition, after ignoring the symptoms, the muscles at the base of the thumb may waste away, and the patient may lose their grip (they drop things).

What treatment is appropriate for carpal tunnel syndrome?

Treatment aims to decompress  the median nerve.

This can be achieved by the use of conservative methods or surgery.

Conservative treatment methods, whose success rates are low, include administration of pain killers, change of activity or of the equipment used, splinting, local steroid injections and physiotherapy.

Surgery is clearly more effective.

Under this method, the surgeon cuts the transverse ligament, which restricts the tunnel, thus decompressing the median nerve.

There are two surgical approaches.

The first one is conventional open surgery and the other one is endoscopic surgery.

The first one, despite its long and successful record, has a higher incidence of complications, including bleeding, painful hypertrophic scars, persistent symptoms, infections and damages to the median and ulnar nerve, as well as to nearby tissues.

Even if completely successful, the size of the surgical incision and the prolonged rehabilitation period, ranging from a few weeks to several months, entail increased suffering for patients and higher indirect treatment costs, including the income lost due to the patient’s inability to work.

What are the advantages of endoscopic carpal tunnel release?

Endoscopic carpal tunnel release has proved to be more efficient in practice as it is a camera-assisted method.

Where no camera is used, it is considered as open surgery.

In the context of endoscopic surgery, regional or total anesthesia is administered to the patient and a 2 cm long incision is made.

A cutting tool fitted with an HD 4K camera is then inserted through the incision.

Dr Dimitris Triantafyllopoulos uses the most advanced, ergonomic and safe system, which allows for better visibility in the area of the operation.

This system has better features than other endoscopic release devices and ensures several benefits, as it is able to align the surgeon’s hand with the scalpel, thus reducing the likelihood of mechanical damage and, above all, likely injuries of the median nerve.

The simple design of the instrumentation and the use of disposable scalpels, including all moving parts, are equally advantageous, thus reducing the duration of the operation.

Upon completion of the operation, the surgeon will stitch the incision and bandage the wrist or place a splint to protect the incision.

Most of the patients will stay in hospital for a few hours.

The wound must be kept clean and dry for 10-14 days.

The patient’s activity is limited only in terms of their level of comfort, as there are no restrictions at all.

The wound is checked 2 days after the operation, and a final check is carried out 2 weeks later.

Proven advantages include resumption of the patient’s day-to-day activities almost twice as fast as with open carpal tunnel release surgery.

The length of the rehabilitation period depends on how advanced the syndrome is, how intense the preoperative symptoms are and what the patient’s health condition is.

If the median nerve has been constricted for a longer period of time, thus resulting in significant loss of sensation, recovery will take longer and full rehabilitation may take up to one year.

For some patients, full recovery may even be impossible.