CTS Carpal Tunnel Syndrome - Surgical Instruments
Technically called carpal tunnel release surgery, the surgery to treat carpal tunnel syndrome may be of the open or endoscopic type. There are a number of surgical instruments used to open and expose any body part, and they are common to all surgeries. However, carpal tunnel release surgery requires some specialized instruments, especially if performed endoscopically.
In order to open the skin and overlying tissues, which conceal internal body parts, sterile surgical instruments are required. They are similar to instruments used for most other surgeries, not only for carpal tunnel release surgery. Aside from ancillary support instruments such as monitors and magnifiers, dedicated surgical implements include cutting instruments, such as scissors and scalpels; grasping instruments, such as forceps and hooks; tissue exposure instruments, such as retractors and probes; blood control devices, such as hemostats and bipolar electrocautery; and tissue closure devices, such as needle drivers and clamps.
Open release surgery involves cutting open the palm and wrist to expose the transverse carpal ligament. The result is a two-inch long incision and the advantage is complete exposure of the ligament and the surrounding structures. In this way the surgeon can cut, or release, the ligament with more confidence about not harming the adjacent tissues. In addition to the aforementioned general surgical instruments listed, other specialized implements are required including small retractors, a curved hemostat and blunt dissecting scissors.
According to "Chapman's Orthopaedic Surgery," endoscopic release surgery requires the same instruments used for open release surgery. However, since this procedure involves making one or two small incisions---called portals---the procedure requires a wrist arthroscope, which is a tubular viewing apparatus.
In the single portal technique, the arthroscope and a blade assembly are inserted into the same incision and guided to the transverse carpal ligament. Sometimes, the arthroscope has a video camera attached for easier viewing on a television screen.
In the double portal technique, two incisions are made: one on the wrist and one on the palm. Each incision is used for inserting the arthroscope and blade assembly. Usually, a trocar-and-sheath assembly is required for effective insertion and removal of the instruments. The blade assembly is a special knife, which cuts upwards and with a reverse stroke.
It should be noted that it is not unusual for the endoscopic surgery procedure to be abandoned while in progress in favor of changing over to the open release technique. Sometimes visualizing the structures is problematic and the surgeon will opt for obtaining better exposure.