title: Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: a perspective randomised study.
abstract: BACKGROUND
  Carpal tunnel decompression with division of the transverse carpal ligament has been a highly successful procedure for the treatment of carpal tunnel syndrome. The standard longitudinal incision technique, with a long curvilinear incision, has been the optimal treatment procedure for surgical decompression of the median nerve, for many surgeons. The aim of this study was to compare the traditional open carpal tunnel release (TOCTR) technique with the minimal-access carpal tunnel release (MACTR) technique for the treatment of carpal tunnel syndrome (CTS), presenting our experience.
  
  
  METHODS
  A total of 120 patients eligible for carpal tunnel decompression were recruited into the study. The patients were randomised for treatment allocation, at a 1:1 ratio, resulting in 60 patients in group A, treated by standard TOCTR, and 60 patients in group B, treated by MACTR. To evaluate patients' outcomes we used the Boston Carpal Tunnel (BCT) questionnaire; the formed scar was evaluated according to the Vancouver scale and short- and long-term complications. Statistical analysis was performed by the chi-squared test and analysis of variance (ANOVA); Excel was the program used.
  
  
  RESULTS
  In our series, there was no complication related to the surgical intervention of any injury to nerve, artery or tendon structures. In each section of the BCT questionnaire, patients in group B had significantly better results than patients in group A at both 6 and 12 months' follow-up (p < 0.001). For the Vancouver scar scale, there was a significant difference between two groups' scores; group B patients had significant improvements compared with group A patients.
  
  
  CONCLUSIONS
  In our perspective randomised study, MACTR showed statistically significant improvement compared to TOCTR. The patient tolerance is reasonably high and the procedure is compatible with the current minimal invasive trend in surgery.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tarallo
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy. Electronic address: pasquale.fino@gmail.com.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fino
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sorvillo
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Parisi
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Scuderi
mesh_terms: D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction; D062707:Return to Work; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: BCT; MACTR; Median nerve; Median release; STC; TOCTR