Scientific article
Results of Endoscopic Carpal Tunnel Release Relative to Surgeon Experience With the Agee Technique

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Purpose

To establish the rate of iatrogenic injury after endoscopic carpal tunnel release (ECTR) for a surgeon in the first 2 years of practice; to report the rate of conversion from ECTR to open carpal tunnel release (OCTR), the reason for conversion, and any increase in morbidity found in patients converted to OCTR; and to determine whether the conversion rate decreased with increasing surgeon experience.

Methods

We conducted a retrospective review of patients undergoing ECTR by a single surgeon in the first 2 years of practice. Data collected or calculated included symptom relief, rate of conversion to OCTR, reason for conversion, and neurovascular complications. For patients converted to OCTR, we assessed satisfaction and function using the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these results for 1 to 6 months, 7 to 12 months, and 12 to 24 months to determine whether a learning curve was present.

Results

A total of 278 patients (358 procedures) underwent ECTR. Of these, 12 patients required conversion to OCTR during the index procedure over a 2-year period. In the first 6 months of practice, 8 of 71 ECTRs were converted to OCTR compared to 1 of 72 in the second 6 months. This was a statistically significant decrease (p = .017). In year 2, 3 of 215 patients were converted to OCTR. Average Disabilities of the Arm, Shoulder, and Hand score for patients converted from ECTR to OCTR was 9. No patients required repeat surgery for recurrence of carpal tunnel symptoms. We observed no major neurovascular complications.

Conclusions

A learning curve for ECTR was present. Rates of conversion significantly diminished with increased surgeon and anesthesia experience. Patients requiring conversion showed no variation in Disabilities of the Arm, Shoulder, and Hand scores from established values after OCTR. Patients may be at a higher risk of conversion to OCTR during the learning curve time period; nevertheless, we found no increased morbidity.

Type of study/level of evidence

Prognostic III.

Section snippets

Materials and Methods

We obtained institutional review board approval for this study. We conducted a retrospective review of all patients undergoing ECTR for CTS by a single hand fellowship–trained surgeon in the first 2 years in practice from October 2007 to September 2009. The surgeon had no experience with ECTR before fellowship but was exposed to ECTR during fellowship training. Patients with prior carpal tunnel release were excluded from the study. All patients with diabetes or an underlying rheumatologic

Results

At final follow-up, all patients reported major or complete relief of symptoms, including pain and numbness. No patient required revision carpal tunnel release. A total of 12 patients required conversion to OCTR at time of index surgery over a 2-year period. In the first 6 months, 71 ECTRs were performed. Of these, 8 ECTRs were converted to OCTR. The reason for converting to OCTR included hypertrophic synovium obstructing clear visualization of the transverse carpal ligament for 4, inadequate

Discussion

There have been multiple retrospective and prospective trials showing successful relief of symptoms and pain with both OCTR and ECTR.11, 18, 19, 20, 25, 26, 27 Some have concluded that results of ECTR depend on the surgeon's level of experience.11, 25, 26, 27, 28 This study showed that a learning curve was present when looking at conversion from ECTR to OCTR. In addition, we found that patient safety was never compromised during the learning curve because the rate of nerve injuries and patient

References (30)

  • D.H. Palmer et al.

    Endoscopic carpal tunnel release: a comparison of two techniques with open release

    Arthroscopy

    (1993)
  • J.M. Agee et al.

    Endoscopic carpal tunnel release: a prospective study of complications and surgical experience

    J Hand Surg

    (1995)
  • J.C. MacDermid et al.

    Endoscopic versus open carpal tunnel release: a randomized trial

    J Hand Surg

    (2003)
  • D.S. Ruch et al.

    Endoscopic carpal tunnel release: the Agee technique

    Hand Clin

    (1996)
  • P.A. Feinstein

    Endoscopic carpal tunnel release in a community-based series

    J Hand Surg

    (1993)

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