SURGICAL RELEASE TECHNIQUE

There are multiple high and moderate quality studies that were identified to evaluate the difference in outcomes between a mini-open carpal tunnel release and an endoscopic carpal tunnel release. These studies consistently demonstrated no difference in long-term outcomes (e.g., patient reported outcome measures, range of motion, grip strength) between the two techniques (Oh 2017, Kang 2013, Larsen 2013, Aslani 2012, Wang 2022, Capa-Grasa 2014). We used mini-open carpal tunnel release as a term to describe a small incision in the palm that does not cross the wrist crease, which is smaller in size than more traditional open approaches.

Benefits/Harms of Implementation
There is no consistently demonstrated benefit of utilizing a mini-open carpal tunnel release or an endoscopic carpal tunnel release. Endoscopic carpal tunnel release may afford a shorter return to work however this may depend upon post operative protocols, patient occupation, and other factors. Endoscopic carpal tunnel release can be associated with greater costs, which may affect patient preference for this option. Although not included in this review, complication rates for endoscopic carpal tunnel release may be higher than previously described and should be considered (Carrol 2023).

Cost Effectiveness/Resource Utilization
Cost data regarding endoscopic and mini open carpal tunnel release vary and are based upon several factors including surgical location (e.g., office, operating room) and stakeholder perspective (e.g., societal, payer) (Barnes 2021, Zhang 2016). Prior studies evaluating the cost effectiveness of these approaches have favored mini-open carpal tunnel release when completed in the office setting, however, advances in endoscopic release in the office may need to be considered. Recent literature on higher complication rates with endoscopic release may affect future CAEs on this topic.

Acceptability
Mini-open and endoscopic release are both accepted surgical techniques for carpal tunnel release.

Feasibility
Both techniques are feasible, however each technique should be performed only by those who are trained in each technique.

Future Research
Future investigations can focus on the development of tools to help guide patients in understanding the benefits, risks, and costs associated with each technique to support a shared decision-making approach that aligns with patient preferences.