Editor's Choice| Volume 48, ISSUE 1, P46-52, January 2023

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The Environmental Impact of Open Versus Endoscopic Carpal Tunnel Release

Published:February 02, 2022DOI:


      The environmental impact of common ambulatory hand surgeries has been an area of growing interest in recent years. There were 2 objectives of this study: (1) to quantify the carbon footprint of carpal tunnel surgery and its principal driving components; and (2) to compare the carbon footprints of open carpal tunnel release (oCTR) and endoscopic carpal tunnel release (eCTR).


      We performed a life cycle assessment to quantify the environmental impacts of 2 surgical procedures: oCTR and eCTR. Patients were retrospectively identified by querying the Mass General Brigham institutional billing database. Fourteen oCTR procedures and 14 eCTR procedures in 28 patients were included in the life cycle assessment. The boundaries of the life cycle assessment were the start and end times of the procedures. The environmental impacts were estimated using the carbon footprint, expressed in the equivalent mass of carbon dioxide released into the atmosphere (kgCO2-eq). The facility-related, processing-related, solid waste–related, and total kgCO2-eq were calculated.


      The average carbon footprint of carpal tunnel release was 83.1 kgCO2-eq and was dominated by processing-related and facilities-related factors. The average carbon footprint of eCTR (106.5 kgCO2-eq) was significantly greater than that of oCTR (59.6 kgCO2-eq).


      Endoscopic carpal tunnel release leaves a greater carbon footprint than oCTR, and its environmental impact is dominated by facility-related and central processing–related factors.

      Type of study/level of evidence

      Economic and Decision Analyses IV.

      Key words

      JHS Podcast

      January 2, 2023

      Perspectives - January 2023

      Dr. Eitan Melamed discusses the article "The Environmental Impact of Open versus Endoscopic Carpal Tunnel Release" by Zhang et al, that appears in the Januareu 2023 issue of The Journal of Hand Surgery.

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