ABSTRACT

Objective

The most prevalent peripheral neuropathy, carpal tunnel syndrome (CTS), may drastically impair a patient’s function and quality of life. In an attempt to effectively alleviate symptoms with fewer adverse consequences, several less invasive surgical techniques have been created. However, there is a dearth of comparative data on the security and effectiveness of different approaches.

Methods

In a retrospective cohort study, we looked at 80 individuals who had been diagnosed with CTS. Percutaneous carpal tunnel release (PCTR), ultrasound-guided CTR (UGCTR), endoscopic CTR (ECTR), and open CTR (OCTR) are the four minimally invasive surgical procedures that we used. The outcomes were measured using clinical and electrophysiological assessments in addition to patient-reported health-related quality of life. The initial plan consisted of preoperative and postoperative checkups at one, three, six, and twelve months postoperative.

Results

All four methods were shown to be secure and successful in treating CTS, and they improved electrophysiological parameters, function, and symptoms. Nonetheless, differences in the incidence of complications and improvements in quality of life were seen. While OCTR had the lowest possibility of troubles, both ECTR and UGCTR achieved transactional recovery and shorter operation times. PCTR had a higher rate of nerve damage and recurrence, but it was also associated with a shorter hospital stay and lower expenses than the other approaches.

Conclusion

Our investigation confirmed the safety and efficacy of these four minimally invasive surgical techniques for the treatment of CTS. However, the process must be tailored to each approach’s particular advantages and potential risks. Future research with larger sample numbers and longer follow-up trials may provide a better explanation for personalized CTS therapy.

INTRODUCTION

Compression of the median nerve in the carpal tunnel generates carpal tunnel syndrome (CTS), the most common peripheral nerve entrapment neuropathy (1). One hand and finger numbness, discomfort, and weakness are classic signs of CTS (2). CTS is more frequent in women than in men, occurring at an overall frequency of 3-5% in the population (3). Conservative and surgical approaches are the two categories into which the three CTS treatment modalities may be separated (4). Minimally invasive surgical methods have gained popularity in recent years for addressing CTS (5). Shorter hospital stays, quicker recovery, and less postoperative pain are just a few advantages of these methods. Four minimally invasive surgical techniques: open carpal tunnel release (OCTR), endoscopic CTR (ECTR), ultrasound-guided CTR (UGCTR), and percutaneous CTR (PCTR) were assessed for efficacy and safety in this research (6).

Over the years, OCTR has been the standard therapy for CTS (7). This therapy has a lower risk of problems than minimally invasive surgical techniques. ECTR is an efficient minimally invasive treatment with the benefits of a quicker functional recovery and a shorter operation time (8). The minimally invasive procedure known as UGCTR has gained popularity recently (9, 10). Despite being less expensive and needing fewer hospital stays, PCTR has a higher risk of causing nerve damage and recurrence (11). The aim of this research is to compare the effectiveness and safety of the four different kinds of minimally invasive surgical techniques. Eighty people are expected to benefit from these therapies in terms of better function, reduced symptoms, and enhanced test scores. This study attempts to determine the distinctions among various strategies in relation to issues affecting quality of life. The findings of the study, which take into consideration both the positive and negative aspects of each potential method, may aid in choosing the best course of action and provide evidence for the efficacy and safety of minimally invasive surgical methods in the management of CTS. Future research with larger sample sizes and longer follow-up times may also encourage the use of these tactics and providing tailored treatment.

METHODS 

Study Population and Selection Criteria

A retrospective cohort study examined data on 80 patients involving minimally invasive surgery from 2021 to 2023. The research participants were adults with electrophysiologically confirmed CTS symptoms (12). Twelve patients have to meet the following criteria in order to be eligible for study enrollment:

•Patients with CTS who are 18 years of age or older and have not improved with conservative measures.

•The diagnosis of CTS was confirmed by electrophysiological investigations. No prior CTS operations were carried out.

•Four minimally invasive surgical techniques were performed on the patients: OCTR, ECTR, UGCTR, and PCTR.

•Both the surgeons’ own preferences and the specific medical needs of the patients were considered throughout the procedure selection process.

Evaluation Criteria

Patients underwent testing in the first, third, sixth, and twelfth months, both before and after the surgery, to monitor controls. Improvements in electrophysiological indicators, functionality, and symptom relief were assessed at each follow-up. In addition, they documented problems and evaluations of quality of life for each method.

Surgical Methods

The transverse carpal ligament is divided to open the carpal tunnel using the OCTR technique (13). A local anesthetic was used during this procedure. A standardized mixture of 10 mL of 2% lidocaine hydrochloride and 5 mL of 0.5% bupivacaine hydrochloride was administered to each patient. Patients underwent procedures under local anesthesia and were admitted to the hospital for a short postoperative stay.

•Endoscopic release: The transverse carpal ligament is sectioned using an endoscope (14). The patients had a short recuperation time after the procedure, which was performed under local anesthesia.

•UGCTR: The transverse carpal ligament is severed using ultrasound imaging (15). Following the surgery, which was carried out under local anesthesia, patients had a short period of postoperative recovery while in the hospital.

•PCTR: The transverse carpal ligament is transected using a needle and a small incision (16). The patients were given local anesthesia during the procedure, and they were admitted to the hospital briefly after the procedure.

Statistical Analysis 

The SPSS statistical software package (IBM Corp., Armonk, NY, USA) was used for data analysis. The mean and standard deviation were used to describe continuous variables, whereas frequency and percentages were used to describe categorical variables. The independent samples t-test and chi-square test were used to evaluate group differences. The threshold for statistical significance was set at p<0.05. 

Ethical Approval

Approval was obtained from the İzmir Bakırçay University Non-Interventional Clinical Research Ethics Committee and research permission was obtained from the institution where the study was conducted (approval number: 1004, date: 26.04.2023). The research was conducted in accordance with the Declaration of Helsinki.

RESULTS

To treat CTS, this research compares the efficacy of four minimally invasive surgical techniques. Eighty patients’ data were evaluated for the research. Methods: four patient groups were established: twenty patients underwent PCTR, had ECTR, twenty underwent UGCTR, and underwent OCTR (Table 1). Evaluations before and after the surgery showed that all four surgical procedures resulted in excellent clinical and functional improvement. In the first, third, sixth, and 12 months after the procedure, improvements in electrophysiological parameters were seen across all techniques (17). There was no significant difference between the groups (p>0.05) (Table 2). The statistical findings showed that the OCTR technique, ECTR technique, UGCTR technique, and PCTR technique did not vary in terms of efficacy or safety (p>0.05) (Table 3) (18). There was no statistically significant difference in the number of complications across the four surgical techniques (p>0.05) (Table 4) (19). Additionally, each of these methods improved the quality of life for patients when included in quality of life evaluations. In terms of recovery timeframes, endoscopic and UGCTR procedures aided patients in recovering more rapidly, but open and percutaneous approaches had somewhat longer recovery times (20).

DISCUSSION

The intent of this large-scale group investigation is to compare four different minimally invasive surgical procedures for CTS, and their potential side effects and safety for individual patients.

The results of the research show that OCTR, ECTR, UGCTR, and PCTR all have similar success and complication risk rates. These results are consistent with earlier studies reported in recent literature (21, 22).

The most popular and conventional surgical method for treating CTS is OCTR. This approach is still regarded as the gold standard due to its excellent success rates and little risk of complications (23). Alternative minimally invasive surgical techniques have been developed as a result of lesser scars and the open method’s longer recovery time (24).

The endoscopic approach to CTR gained popularity since it was more comfortable after surgery, and took less time to recuperate (25). Interestingly, the endoscopic technique used in this investigation had success rates and complication risks comparable to other techniques. Patients may return to work sooner because of the endoscopic procedure’s improved recovery time and cosmetic outcomes (26).

In recent years, UGCTR has become a non-invasive treatment technique. Because of the high-quality images and real-time imaging capabilities, the surgeon can perform the surgery with more assurance (27). In this study, the endoscopic method and the ultrasound-guided procedure had similar success rates and complication risks.

One of the newest minimally invasive methods for treating CTS is PCTR. This approach has been linked to a greater risk of problems even though it reduces tissue damage and speeds up recovery (28).

In this experiment, those who received percutaneous therapy had greater issues than those who received other modalities, despite similar success rates. However, by using this approach more skillfully and with more experience, the risks might be decreased (29).

Study Limitations

The study’s limitations were a comparatively small cohort and the possible impact of past experience with various surgical procedures on success and complication rates. Furthermore, since the research is retrospective rather than randomized, the findings may not be significant. Larger sample sizes and randomized controlled designs will enable future research to more precisely evaluate the safety and effectiveness of such minimally invasive and surgical procedures.

Four minimally invasive modification techniques are safe and effective for treating CTS, according to the present study’s findings. A successful treatment plan should be selected by weighing the benefits and drawbacks of each method, taking patient selection and surgical expertise into consideration. Further research in this area might lead to improved outcomes in the management of CTS and the creation of less invasive surgical methods.

CONCLUSION

The safety and efficacy of four minimally invasive surgical therapy modalities for CTS: OCTR, ECTR, UGCTR, and PCTR, are being assessed in this systematic cohort study. The research found that both strategies had comparable success rates and complication risks. Every surgical technique has pros and cons, and the field of surgery is always evolving. Because of this, it is essential to choose the most effective treatment option based on the surgeon’s expertise and the right patient selection. This research and the corpus of current medical literature support the safety and effectiveness of minimally invasive surgical techniques in the treatment of CTS. Additional studies using larger sample sizes and randomized controlled-techniques will be needed to evaluate the relative efficacy and safety of different modalities, and to provide additional insight into this subject. Patients’ quality of life may be enhanced, and productivity losses may be reduced with such treatment.