Purpose
To establish the rate of iatrogenic injury after endoscopic carpal tunnel release
(ECTR) for a surgeon in the first 2 years of practice; to report the rate of conversion
from ECTR to open carpal tunnel release (OCTR), the reason for conversion, and any
increase in morbidity found in patients converted to OCTR; and to determine whether
the conversion rate decreased with increasing surgeon experience.
Methods
We conducted a retrospective review of patients undergoing ECTR by a single surgeon
in the first 2 years of practice. Data collected or calculated included symptom relief,
rate of conversion to OCTR, reason for conversion, and neurovascular complications.
For patients converted to OCTR, we assessed satisfaction and function using the Disabilities
of the Arm, Shoulder, and Hand questionnaire. We compared these results for 1 to 6
months, 7 to 12 months, and 12 to 24 months to determine whether a learning curve
was present.
Results
A total of 278 patients (358 procedures) underwent ECTR. Of these, 12 patients required
conversion to OCTR during the index procedure over a 2-year period. In the first 6
months of practice, 8 of 71 ECTRs were converted to OCTR compared to 1 of 72 in the
second 6 months. This was a statistically significant decrease (p = .017). In year
2, 3 of 215 patients were converted to OCTR. Average Disabilities of the Arm, Shoulder,
and Hand score for patients converted from ECTR to OCTR was 9. No patients required
repeat surgery for recurrence of carpal tunnel symptoms. We observed no major neurovascular
complications.
Conclusions
A learning curve for ECTR was present. Rates of conversion significantly diminished
with increased surgeon and anesthesia experience. Patients requiring conversion showed
no variation in Disabilities of the Arm, Shoulder, and Hand scores from established
values after OCTR. Patients may be at a higher risk of conversion to OCTR during the
learning curve time period; nevertheless, we found no increased morbidity.
Type of study/level of evidence
Prognostic III.
Key words
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Article info
Publication history
Accepted:
October 18,
2010
Received:
August 24,
2010
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2011 Published by Elsevier Inc.
