2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Single or Dual-Portal Endoscopic Carpal Tunnel Release: A Comparative Analysis

Stefanos Christos Papageorgiou, MD, Ioannina GREECE
Tilemachos Papageorgiou, MD, Ioannina GREECE
Ioannins Koumoulidis, MD, Ioannina GREECE
Anastasios Mavromatis, MD, Ioannina GREECE
Christos D. Papageorgiou, MD, PhD, Ioannina GREECE

Univeristy Hospital Of Ioannina , Ioannina, Epirus, GREECE

FDA Status Not Applicable

Summary

This study aims to evaluate the outcomes of ECTR and to determine whether significant differences exist between the two most common techniques: single-portal and dual-portal endoscopic approaches

Abstract

Introduction

The safety, efficacy, and benefits of endoscopic carpal tunnel release (ECTR) are well-established, with the primary advantages being reduced postoperative pain and a quicker recovery. However, a potential disadvantage is the inability to directly perform median nerve neurolysis.

Material And Methods

We present the results of 378 consecutive endoscopic carpal tunnel procedures performed between March 1995 and September 2024. Patients were prospectively followed, with outcomes including length of surgery, patient-reported symptoms and functional measures, time to return to work, and complications. A sub-group analysis was conducted to compare the single-portal and dual-portal techniques

Results

A success rate of 98.02% was achieved in this series, with no cases of permanent morbidity or median nerve injury. Two patients (0.52%) required conversion to open surgery due to unresolved preoperative symptoms. Notably, no transient postoperative nerve injuries were observed. Scar tenderness was significantly reduced with the dual-portal technique compared to the single-portal method. However, rates of pillar pain, symptom relief, and patient satisfaction did not differ significantly between the two groups.

Conclusions

Endoscopic carpal tunnel release is appealing due to its reduced postoperative morbidity and quicker return to work. However, surgeons should be aware of the associated learning curve and the slightly higher risk of transient nerve injury. The dual-portal technique appears to be safer, particularly due to the palpation step of the procedure. Our data confirm that ECTR is a safe and reliable technique and do not support the notion of a higher risk of median nerve injury with this method. For our team, the endoscopic technique remains the preferred treatment for primary idiopathic carpal tunnel syndrome.