A new tool for mini-open carpal tunnel release – the PSU retractor

Abstract

Background: Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome.

Experience of carpal tunnel syndrome that operated using limited uni skin incision

“…These are hypertrophic scar formation, scar tenderness, pillar pain, loss of grip strength and sympathetic dystrophy resulting in the delay of returning to daily activities or work and emotional distress (2,5,6,14). To reduce these complications, various limited incisions or endoscopic techniques are described by authors (3,8,10,12,19,23,24,26). During the last two decades, endoscopic carpal tunnel release procedures have become popular and have been widely used by surgeons.…”

Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE

“…New endoscopic approaches via the supraretinacular area were introduced to avoid nerve problems by inserting the endoscopic tools above the transverse retinaculum carpal tunnel space from proximal to distal [26]. e author had a similar opinion to avoid nerve problems by working from a perspective outside the carpal tunnel, utilizing the BLAR area approach [8,17], but assured an incision size, which opened at the distal part, to ensure and provide safety for a critical structure of the recurrence branch of median nerve and superficial palmar arch. Additional benefits should be mentioned, as the Wongsiri technique with MiniSURE Kit ® uses little equipment, a small surgical team and no anaesthetic team, minor operation theatre, and hospital disposables and overhead, in-patient rooms and overnight observation are needed, and cost of surgery is reduced.…”

“…e Wongsiri technique for minimally invasive carpal tunnel release has been consistently performed in Songklanagarind Hospital with the purpose of minimally invasive surgery and to minimize soft tissue injury while simultaneously enhancing the surgical field above the TCL with a special retractor [8,17]. e volar hand is an enriched area with cutaneous branches of the median nerve and ulnar nerve for fine touch sensation.…”

“…Several minimally invasive (MIS) techniques compete to be the most effective CTR, and surgeons have developed and refined methods to reduce wound complication, painful and prominent scars, and nerve problems [7][8][9]. Endoscopic carpal tunnel release (ECTR) has shown better results pertaining to wound complication and return to work timeliness when compared to the standard open technique; however, the endoscopic techniques require special training, which includes a long learning curve because of the complicated technique and device, and notably incomplete release incidence may occur [10].…”

“…To enhance the visualization field and to improve efficiency in cutting in MIS, Wongsiri created a new technique (Wongsiri technique) and an innovative set of surgical tools for minimal invasive carpal tunnel release (patent pending), starting with the PSU carpal tunnel retractor in 2008 and culminating in a refinement of the original design with the MiniSURE Kit ® in 2013 [8,17]. e Wongsiri technique with a special designed retractor can improve visualization up to 48.7 mm with a minimal incision [8]. e evolution of a MIS carpal tunnel release tool is the MiniSURE Kit ® (Surgical Innovation Healthcare Co., Ltd, Bangkok, ailand), which is comprised of the MiniSURE View for enhancing visualization and the MiniSURE Cut for a complete and efficient cut of the TCL.…”