In Reply

Abstract

I thank Dr. Wiwanitkit for the letter. I address the 3 issues as follows:1Generalizability of the results. Because this is a single-center study involving a single surgeon,1Nakamichi K. Tachibana S. Yamamoto S. Ida M. Percutaneous carpal tunnel release compared with mini-open release using ultrasonographic guidance for both techniques.J Hand Surg. 2010; 35A: 437-445Google Scholar I am unable to answer this question. I agree that the results of any surgical technique depend on the surgeon's experience. This seems particularly the case with the percutaneous carpal tunnel release (PCTR) and mini-open carpal tunnel release (mini-OCTR) techniques because both use ultrasonography, which is examiner-dependent and involves a learning curve. I therefore think that, during a learning process, one would need a longer operating time and have a higher chance of complications, which would produce variable results. With experience, however, the techniques could be performed without difficulties, and then the results would be less variable and more generalizable. To confirm this speculation, however, similar comparative studies in different institutions are needed.2Cost comparison. The mean cost of surgery and follow-up visits until the wound was healed (based on the Japanese government-controlled medical billing system and adjusted for 2007 USD) was USD514 for the PCTR and USD522 for the mini-OCTR. The blade used in the former (USD20) was more expensive than a no. 15 blade in the latter (USD1). However, the quicker wound healing in the PCTR group decreased hospital visits for wound care and offset the blade cost. There was no significant difference in overall cost (p = .21). For cost reduction, unlike the previous report,2Nakamichi K. Tachibana S. Ultrasonographically assisted carpal tunnel release.J Hand Surg. 1997; 22A: 853-862Google Scholar I no longer use a sterile plastic bag to wrap the scanner and sterile jelly. I sterilize the scanner and fill saline between the scanner and palm instead. In addition, I perform the techniques without an assistant and scrub nurse.3Study design. To provide a uniform model, this study included idiopathic carpal tunnel syndrome only. However, the majority of patients visiting our institute have underlying diseases, most frequently hemodialysis-associated amyloidosis, which made the number of idiopathic patients small. Nevertheless, this study demonstrated significantly better outcomes in the PCTR group with respect to postoperative morbidity, functional return, and satisfaction (p < .05). This suggests that the differences between the 2 groups were large enough to confirm with a small sample size. Lack of randomization is another limitation. As shown in the tables, however, the preoperative demographic, clinical, and electrophysiologic data from both groups were comparable, probably because the study population was homogenous. Based on these considerations, I think that the results support our hypothesis that the outcomes of the mini-OCTR improve with further reduction of surgical trauma. Combining this study1Nakamichi K. Tachibana S. Yamamoto S. Ida M. Percutaneous carpal tunnel release compared with mini-open release using ultrasonographic guidance for both techniques.J Hand Surg. 2010; 35A: 437-445Google Scholar and our previous comparison of the mini-OCTR and standard open release, showing similar advantages in the former,2Nakamichi K. Tachibana S. Ultrasonographically assisted carpal tunnel release.J Hand Surg. 1997; 22A: 853-862Google Scholar I believe that the less surgical trauma the technique involves, the less postoperative morbidity and the earlier functional return and achievement of satisfaction the patient has. Percutaneous Carpal Tunnel Release Versus Mini-Open Carpal Tunnel ReleaseJournal of Hand SurgeryVol. 35Issue 6PreviewI read the recent publication by Nakamichi et al. with great interest.1 Nakamichi et al. concluded that “The PCTR provides the same neurologic recovery as does the mini-OCTR. The former leads to less postoperative morbidity and earlier functional return and achievement of satisfaction.1” I agree that the results in this work might lead to this conclusion. However, there are some points to be discussed. First, it is not surprising that the same neurological recovery could be derived from both techniques. Full-Text PDF