So the next talk is on the efficacy of key old approach to carpal tunnel syndrome under ambulatory strategy. Dr. Duran. Okay, thank you for this great opportunity. I have to make some disclosures. I performed this clinical trial as part of my last year in the medical school. So I want to acknowledge my university, my professor, and also right now I'm working at Mayo Clinic. So I also want to thank Dr. Quinones for his efforts in mentoring me and also for his efforts to increase the education in Mexico and, well, continue with the justification. And also I would like to thank the AANS student chapter programs because for that I connect to this institution here. We all know the great burden of this disease in the general population. And in Mexico we don't have the tools and we have some limitations in our overwhelming public system. So for that we have to rely on treatments that demonstrate efficacy and also that demonstrate that have low cost and that have a, how can I say, low learning curve for the people that perform it. So we did this clinical trial. It's already registered in clinicaltrials.gov and published. It was a prospective non-randomized clinical trial. We analyzed 55 consecutive patients with carpal tunnel syndrome. They were treated with a minimally invasive approach using local anesthesia without tourniquet in ambulatory settings. The inclusion criteria, it was very clear. We compared the diagnosis of carpal tunnel with the clinical diagnosis electromyography and electroneurogram. And we have also created exclusion criteria to avoid confounding factors as the history of direct trauma, endocrine of metabolic disturbance, and previous administration of local steroid. So the surgical technique, it was a direct microsurgical approach of 1.5 centimeters incision in the ternal sulcus. I put this diagram because we don't have like very good quality photos of this clinical trial. So to exemplify this procedure, after this incision, we continue to the subcutaneous phase, having a 0.5 centimeters dissection at the sides, 1 centimeter dissection distal and proximal to the dissection. After that, we continue with the opening of the transverse fibers of the flexor retinaculum with the use of surgical loops. And when we have already released the pressure of the carpal tunnel, we also release the perineural microadhesions of the medial nerve. Having 3 millimeters of free borders, coagulate gently in the carpal fibers to avoid fibrosis in the future. Hemostasis was done, closing in a position with Biclut 3-0s and 0 subdermal 3-0 nylon stitch. So the results. In this study, we don't want to enter in controversies about which method is better. We just want to report our experience in Mexico with this procedure. So we found that almost all the patients start with a grade 4 and 5 of the Levine Severity Scale Preoperative. We have, after the procedure, one hour discharge of 98%, we don't have complications. At 6 months, we have 85% of the patients that recover to grade 1 Levine Scale Severity. And in one year, this amount increased to 97%. So in this case, we have like good results with this procedure. So in the future, we want to increase the population and maybe have like a control trial and see what happens. Okay. Thank you very much. Any questions? Yes, I know you did. Very nice presentation. I am impressed that you can get such good results from such a tiny incision. I, and you said you call it microsurgical, but you don't use the microscope, is that right? Yes, with the cervical lobes, my professor used to use the cervical lobe. So the major cause of failure of carpal tunnel release is incomplete sectioning of the transverse carpal ligament. And with a 1.5 centimeter incision, that means you have to go fairly far approximately and distally under the skin edge where it would be hard to see that you've actually sectioned the entire ligament. How can you be certain that you really have completed the sectioning of the transverse carpal ligament with such a short incision? I'm all in favor of small incisions if you can do the job accurately. So I usually use, I call a mini open carpal tunnel maybe a 2 and a half to 3 centimeter incision. But 1.5 is really a tiny incision. Yes, well, my professor in this case used to rely on anatomical landmarks. So I know that maybe it could be difficult to know if the resection was complete. But at least he, in this case, and with experience, I think that he had like the correct incision. He always said, no wound heals end-to-end. They all heal side-to-side. Why not use an incision in which you can see more? But that's old-fashioned thinking. I'm old-fashioned because I'm old. Thank you very much. Okay, thank you.

video

Dr. Duran

minimally invasive approach

carpal tunnel syndrome

ambulatory strategy