Endoscopic Stalk Resection of a Toe Ganglion With Color-aided Visualization

Ganglion cysts are common cystic lesions filled with a jelly-like substance and originate from a joint capsule or tendon sheath through a stalk. Ganglion cysts mostly occur in the hand region, for which surgical excision usually results in good outcomes. In contrast, toe ganglions are relatively rare, and surgical treatment is associated with a high recurrence rate because of unidentifiable ganglion stalks, requiring large skin incisions. We have treated toe ganglion cysts using endoscopy in the ganglion cyst by injecting methylene blue into the tendon sheath that connects to the ganglion stalk. The result has been favorable, without recurrence. The advantages of our technique include the following: (1) Endoscopy using a color aid can show the location of a ganglion stalk, and removing the stalk can prevent recurrence. (2) Endoscopic stalk-only resection is minimally invasive, allowing early mobilization and reducing surgical-site complications. The purpose of this Technical Note is to describe our endoscopic stalk resection technique with color-aided visualization, and we have included a video presentation.