This prospective, blinded study compared the outcomes of simultaneous vs. staged endoscopic carpal tunnel releases (CTR) performed in a single center over a two-year period. Independent investigators evaluated the patients preoperatively and postoperatively, and the operations were done by 11 surgeons using the MicroAir Endoscopic CTR System. Seventy-one patients were included in the study, divided into three groups by their own choice: Group 1 (n=12): Simultaneous releases; Group 2 (n=31): Staged releases 1-3 weeks apart; Group 3 (n=28): Staged releases more than 3 weeks apart. Postoperative management was individualized by surgeon, but was consistent in approach. All patients were assessed preoperatively and at 6 months postoperatively for Tinel's and Phalen's signs, Semmes-Weintstein testing, and clinical symptom severity using the Levine-Katz Questionnaire. Postoperative evaluations included return to work data, complications, and satisfaction. The groups were fairly consistent in age, with a tendency toward younger, male patients selecting simultaneous releases that was not statistically significant. The results show that all groups exhibited a significant improvement in Semmes-Weinstein testing, grip strength, pinch strength, presence of Tinel's and Phalen's signs, mean symptom severity and functional status scores at 6 months postoperatively. There were no statistically significant differences for these data between the three groups. There was a significant difference in the return to work times for the three groups. The simultaneous group averaged 2.6 weeks, vs. 8.5 weeks for the group staged 1-3 weeks apart and 6 weeks for the group staged more than 3 weeks apart. Complications were rare and minor, with no intraoperative complications reported.
This study is the first to evaluate outcomes of simultaneous vs. staged endoscopic CTR in a prospective fashion. It supports the safety and efficacy of endoscopic CTR in a carefully selected patient population when performed by skilled surgeons experienced with the technique. It effectively compares the outcomes of simultaneous vs. staged releases in this group, with the only statistically significant difference in the groups being time off of work. There were no ill-effects of simultaneous surgery noted on patients' postoperative activities, satisfaction with the procedure, personal hygiene, or infection. The authors conclude that simultaneous endoscopic CTR offers significant savings in cost to the patient and employer in lost economic productivity, as well as a decrease in overall payer costs due to decreased surgical expenses when compared with staged releases, without an appreciable increased risk. Although not appropriate for all patients with bilateral disease, e.g. those with inordinately high demand for hand use in the immediate postoperative period, simultaneous endoscopic release does appear to offer significant patient and economic benefits to society over staged endoscopic releases.
Carpal, Tunnel, Syndrome, Endoscopic, Release, Outcome
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