M. Lance Tavana, M.D. , an associate professor at MUSC and program director for the MUSC integrated plastic surgery residency, performs endoscopic carpal tunnel release in an outpatient facility instead of the operating room, allowing patients to get back to their passions more quickly.
So carpal tunnel release has been performed for decades. First with an open technique which is with an incision on the palm. In the late 90s, it was developed in endoscopic technique which is a technique using a camera and a device that goes in the wrist from the wrist crease to avoid making that incision on the palm that's been done in the or for years, I started doing that in training and, and when I started practicing in 2012, I've been doing and just got a couple ton releases in the approximately over 2000 at this point using a single port technique, the major roadblocks for moving it out of the or were the equipment. So whenever you do anything with a scope, you usually need a lot of equipment, a tower, a light a monitor. With newer technologies, we have disposable cameras that connect to tablets, which we can connect to a television, which allows us to take that procedure purely mechanically out of the O R. The advantage of taking it out of the O R also decreases the anesthesia time in regards to I can do a local block at the wrist. Keep the patient awake so that they don't have to have the medications and the risks of anesthesia. It also cuts down on time and increases efficiency quite a bit. Patients are usually at the facility for just about under an hour. On average, about 15 minutes, they arrive, I do a wrist block in the preoperative area. Go back and do another case and let them sit for about 10, 15 minutes to let a local anesthetic sit up. We go back to the operating room and the procedure takes about 5 to 10 minutes and then about a 10 minute recovery in the recovery area. And patients are out usually in about 50 minutes. I think a lot of people with carpal tunnel, whether it be a very mild case to a very severe case, uh don't really look for relief because they're afraid of the consequences or the downtime. So the concept of a surgery to patients is sometimes a, a major issue in regards to the interruption in their daily lives by taking out of the O R number one the day of the procedure. It really cuts down on the amount of time dedicated to that procedure during that day rather than dedicating the entire day to that. They can literally come in after having breakfast drive themselves. Have the procedure go home or go out to lunch with the endoscopic carpal tunnel release technique. The incision is much smaller and it's on the wrist crease as opposed to in the palm. So while you're still doing the same thing on the interior of the wrist, you aren't cutting through the muscles and the fat of the of the palm. So there's much less uh recovery and aggressive healing, the incision. So patients usually go back to work at a much quicker rate than with the traditional open technique. The best compliment you can get from a patient is a patient to a patient referral. Uh And I've seen a lot of patients who have talked to my other patients who had it done this way. Uh The other way they compliment me is by having the other side done. So a lot of them have bilateral carpal tunnel and usually within a couple of weeks, they're asking to do the other side because they're sleeping that much better because that hand isn't bothering them. And the one that they haven't had done is still keeping them up at night.
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