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In long-term haemodialysis patients, carpal tunnel syndrome (CTS) frequently occurs as a result of amyloid deposition, originating from beta-2 microglobulin, to the flexor retinaculum, paratenons and tendons themselves, which leads to an increase in carpal canal pressure and compression of the median nerve. Surgical procedures can rectify the condition, but continuing maintenance haemodialysis sometimes causes recurrence.

We endoscopically operated 1848 hands primarily, 104 recurrent post-endoscopic procedure hands and 130 recurrent post-open procedure hands using the Universal Subcutaneous Endoscope (USE) system, then analysed clinical symptoms and electrophysiological recovery for more than six months post-operatively. The patients were satisfied with the clinical results. Optimal electrophysiological improvements were reported. There were no statistical differences between three groups, except in recovery of touch sensation, which was better in the post-endoscopic group than in the post-open group. There were no complications in this series.

Our minimally invasive endoscopic procedure, using the USE system, is safe and effective for primary and recurrent CTS in haemodialysis patients.

Some cases of carpal tunnel syndrome in macrodactyly patients have been reported. We performed endoscopic carpal canal release on two unilateral macrodactyly patients suffering from bilateral carpal tunnel syndrome. We measured carpal canal pressure before performing endoscopic surgery using the Universal Subcutaneous Endoscope system to confirm median nerve compression. We diagnosed median nerve compression in each patient due to the high preoperative carpal canal pressure. Carpal canal pressure immediately decreased to within normal range following release of both the flexor retinaculum and the distal holdfast fibres of the flexor retinaculum.

One patient recovered to within normal in terms of sensory disturbances and abductor pollicis brevis muscle strength. The other patient showed improvement in terms of sensory disturbance, however, muscle power did not recover because this patient had suffered from carpal tunnel syndrome for ten years.

Endoscopic carpal canal release and decompression surgery was effective for carpal tunnel syndrome in both macrodactyly patients.

We have analyzed postoperative long-term follow-up results of five years or more from idiopathic carpal tunnel syndrome patients that underwent our complete carpal canal release and decompression procedure that uses the Universal Subcutaneous Endoscope system. In this series, 203 hands were followed up both clinically and electrophysiologically. Final follow-up times were determined by the most recent electrophysiological measurements. Mean follow-up period was nine years. Tingling, pain (using a 3 gm needle) and touch (using a 2 gm von Frey hair) at all median nerve distribution areas recovered to normal in 92.9, 98.2, 95.2%, respectively. Abductor pollicis brevis muscle power improved from preoperative manual muscle testing of 0, 1, 2 to post-operative 4 or 5 in 82.6%. Mean detectable distal sensory latency improved from 4.3 (n = 130) to 3.1 msec (n = 200). Mean detectable distal motor latency improved from 6.2 (n = 189) to 4.1 msec (n = 200). Complication and recurrence rates were 0% and 0.5% respectively.

Characteristics of endoscopic lumbar discectomy system (ELDS) developed in Japan were introduced, and the first 50 cases were clinically evaluated. Patients included: 4 cases of double disc herniationat two levels; 1 cranially and 3 caudally migrated discs; 3 spinal canal stenosis; 1 synovial cyst; and 3 persistent ring apophysis. In 4 central disc herniation cases, 1 case was approached bilaterally and other 3 cases unilaterally. Using a step-dilator system, targeting inter-laminar space was exposed and a tubular retractor either of 16 or 18 mm diameter was inserted through the paravertebral muscle. A 30° endoscope of 3 mm diameter was installed to a tubular retractor. Partial laminectomy and resection of ligamentum flavum were performed using microsurgical instruments, followed by medial retraction of the symptomatic nerve root and incision of the herniated disc. Average surgery time was 119 minutes and estimated blood loss was 49.1 gm. Patients left their bed at 1.9 days post-operative and average hospital-stay was 11.5 days. Recovery ratio of the Japanese Orthopedic Association (JOA) score was 80.7%. Average visual analog pain scale at the first day post-operative was 2.9 cm and CRP at the 7th day was 0.4 mg/dl. Adjacent two-level discectomy was possible with one midline skin incision. Coexistence of severe lumbar spinal canal stenosis was most technically demanding pathology. ELDS provided brightened and magnified surgery field. This can be an effective assistant for minimally invasive lumbar disc surgery.

Background: Endoscopic carpal tunnel release is a common treatment for moderate to severe carpal tunnel syndrome. Recently there have been various new techniques which offer improved accuracy and decreased recovery time. In this study, orthopedic surgeons and biomedical engineers from the Faculty of Medicine and Faculty of Engineering, Prince of Songkla University, designed a wireless endoscopic carpal tunnel release with a single portal technique and tested the efficacy and safety of the new technique in a cadaveric study.

Methods: Ten fresh cadaveric forearms were used in the study. The surgical technique began with a surgical incision 15–20 mm above the wrist crease on the line between the middle finger and ring finger. The palmaris longus aponeurosis was retracted by Senn retractors. A visual enhancer was inserted to improve the internal visual field in order to see the flexor retinaculum clearly. The flexor retinaculum was cut distally to create an entry and the flexor retinaculum was cut by the scalpel. The flexor retinaculum length was observed until the release was completed. The median nerve was observed.

Results: Each flexor retinaculum was cut completely. All of the median nerves were carefully observed during the operation and none were injured. This technique showed the effectiveness and safety of minimally invasive carpal tunnel surgery.

Conclusions: The study found that the new device using this technique is effective for carpal tunnel syndrome (CTS) surgery in terms of minimally invasive endoscopic carpal tunnel surgery.