The Japanese experience with endoscopic carpal tunnel release.

Endoscopic carpal tunnel release (ECTR) is generally touted to be a less invasive operation that offers the advantages of less postoperative pain and an earlier return to work compared with conventional open carpal tunnel release (OCTR). ETCR, however, does require special new skills that preferably should be acquired by practice on cadavers before clinical use. Because access to fresh cadavers is restricted in Japan, here we have to gain this experience in actual clinical cases with the assistance of another surgeon who is familiar with the technique. In contradistinction, a "mini" open technique can be learned stepwise just by shortening the conventional incision of OCTR during one's own clinical experience. Because reimbursement for ECTR was recently raised to be 1.5 times that for OCTR in Japan, that factor alone might make ECTR more popular in a few years. However, at least for the present, the mini open technique is still less costly without the associated risks of complications inherent with ETCR and has proved for the time being to be more suitable for the current medical climate in Japan.