Hand surgeons trained in surgery of the peripheral nerves of the upper extremity and are frequently called upon to operate on peripheral nerves elsewhere including the lower extremity. The authors of this study discuss the application of the “minimally invasive surgery” concept frequently utilized by hand surgeons for carpal tunnel and cubital tunnel syndromes by applying them widely to neurolysis of the upper and lower extremities. They took 12 commonly performed peripheral nerve surgeries and evaluated them in 10 patients each. “Classical” incisions were drawn on the patient and then minimally invasive incisions were also drawn as performed by the senior author. The procedures were performed with traditional instruments with the aid of a small lighted retractor. The minimally invasive incisions were found to be an average of 51% shorter than traditional incisions. None of the 120 patients had adverse effects or post-operative morbidities and all patients reportedly preferred the shorter incision when queried about which incision they would like most.
The authors conclude that the concepts learned from minimally invasive surgery in other specialties as well as already successfully adopted techniques for minimally invasive carpal tunnel and cubital tunnel surgery can be applied to a myriad of other nerve compression syndromes safely and effectively. One caution the authors provide is that when surgery is performed for exploration and diagnosis rather than in situations in which the diagnosis is already known, a traditional approach should be taken. While the authors provide universally good results with their techniques, no actual data related to recovery or resolution symptoms is provided in general or by anatomic region treated. However, as all fields migrate toward less and less invasive techniques, this paper demonstrates that the same push for less invasive methods can be developed for surgery of the peripheral nerves.