Safety of Mini Invasive CTR with Smillie Meniscotome and Ligature Conductor Bone Gauge

Background: CTR can be achieved by open or endoscopic techniques alike. Currently, most hand surgeons use "mini open" (less then 3 cm skin incision) technique. some cut the transverse carpal ligament (tcl) with sccisors in a "semi blind" way, thereby potentially exposing the median nerve to harm. Different tools (carpaltomes) were developed in order to enhance safety but most are single use tools or expensive.

Objective: to describe a surgical technique using "on the shelf equipment": smilley meniscotome and ligature conductor/bone gauge for mini-open CTR and show that it is a safe method.

Method : A retrospective chart review. Over a 4 year period, I operated 50 patients for mini CTR utilizing a smilley knife (meniscotome) and slotted gauge to lead the meniscotome that cuts the tcl. patients were evaluated after 2 weeks for short term results and complications, focusing on reported sensory loss or symptom aggrevation (potential nerve damage).

Result : 90% of the patients were seen at 2 weeks post -surgery. only one patient reported sensory loss in median nerve territory. Thus the method was proved to be relatively safe

Conclusion: this is a safe and simple way to perform mini open CTR. It is low-cost as it is done with standard tools readily available "on the shelf" it can be alternative to release performed with scissors