Palmar uniportal extrabursal endoscopic carpal tunnel release

A new technique of endoscopic carpal tunnel release using a 1.5-cm longitudinal palmar incision was used in 280 cases. The incision allows identification of the superficial palmar arch as well as the median nerve and its branches. A new knife/sleeve device that attaches to a standard 4-mm endoscope was created to simplify the procedure. The flexor retinaculum is endoscopically divided proximally into the distal forearm; the "interthenar fascia" (fascia superficial to transverse carpal ligament) can be preserved. Early postoperative results include a mean overall return to work and full activity of 14 days. Postoperative pinch and grip strengths were near or at the preoperative level by 8 weeks after surgery. One third of patients required no postoperative analgesics with minimal scar, ulnar pillar, and radial pillar tenderness.