Endoscopic Peripheral Nerve Surgery

• Carpal Tunnel Syndrome: This condition involves compression of the median nerve at the wrist, causing numbness, tingling, and weakness in the hand and fingers. When non-surgical treatments fail to alleviate symptoms, endoscopic release may be considered.

• Cubital Tunnel Syndrome: Compression of the ulnar nerve at the elbow causes this condition, resulting in numbness and tingling in the ring and little fingers. Persistent symptoms despite conservative management may necessitate surgical intervention.

This method uses one small incision through which both the endoscope and surgical instruments are introduced. A specialised portal system creates a working channel for the procedure. The single entry point maintains the minimally invasive nature of the surgery while allowing adequate visualisation and access to the compressed nerve. This technique is commonly used for carpal tunnel release as well as cubital tunnel release.

This approach utilises two separate small incisions: one for the endoscope and another for the surgical instruments. The dual-portal system provides improved manoeuvrability and visibility during more complex procedures.This technique may be  employed for carpall tunnel release.

• Anaesthesia Administration: Local anaesthesia may be used alone or combined with intravenous sedation, depending on the specific procedure and patient factors. The anaesthetic is injected around the surgical site to numb the area completely. For more extensive procedures, regional anaesthesia that blocks nerve signals to the entire arm or general anaesthesia may be selected.

• Incision and Portal Placement: One or two small incisions (typically 1-2 cm) are made at predetermined locations. The exact positions depend on the nerve being treated and the specific endoscopic technique selected. Through these portals, a cannula (hollow tube) is carefully inserted to create a working channel.

• Endoscope Introduction: The endoscope, a thin tube with a camera and light source, is inserted through the cannula. This provides magnified visualisation of the surgical field on a monitor. The surgeon can clearly see the compressed nerve and surrounding structures in detail.

• Nerve Decompression: Using specialised instruments inserted alongside or through a separate portal, the surgeon removes or releases structures compressing the nerve. This may include cutting tight ligaments (such as the transverse carpal ligament in carpal tunnel syndrome), removing abnormal tissue growth, or dividing constricting bands.

• Closure and Dressing: After confirming successful decompression, the endoscope and instruments are removed. The small incisions are closed with sutures, surgical tape, or adhesive. A sterile dressing is applied to protect the wound. Depending on the procedure location, a splint or soft bandage may be added to limit movement and provide support during initial healing.

Possible complications of endoscopic peripheral nerve surgery may include infection at the incision site, bleeding or haematoma formation, nerve injury resulting in increased numbness or weakness, incomplete decompression requiring revision surgery, and scar tissue formation around the nerve. Some patients may experience temporary increased pain during the healing process. Complex regional pain syndrome is an uncommon complication characterised by disproportionate pain and swelling in the hand and arm.