Endoscopic treatment of peripheral nerve syndromes according to PD Dr. Kartik G. Krishnan

Endoscopic techniques are becoming more and more important in the surgical treatment of various syndromes. Continuous development and the availability of surgical instruments have resulted in the increasingly easy and fast performance of these techniques. In many surgical areas, minimally invasive techniques currently represent the gold standard; in other areas, they supplement open procedures for aesthetic reasons. The demand for minimally invasive surgical techniques is constantly increasing, especially in the area of peripheral nerve surgery.

Decompression procedures in solitary neuropathies should be based on the following guidelines:

• Decompression of all (including potential) compression sites at the respective anatomical site
• Preservation of neural vascularity
• Facilitation of early mobilization of the associated joint

These goals are achieved in an elegant and safe manner with the minimally invasive endoscopic surgical technique developed by Dr. Krishnan. It permits viewing the structures to be manipulated and all of their branches and supplying vessels from a bird’s eye view by using retractors and the corresponding 30° HOPKINS® telescopes.
The retractors feature an ergonomic handle with integrated suction and are available in two sizes (8 mm and 15 mm). The endoscope is continuously adjustable and features excellent image quality. In addition, the entire system is autoclavable.

This technique offers the following advantages:

• Easy to handle and learn 
• Permits treatment of all nerve compression syndromes, e.g., nerve decompression in the carpal tunnel, tarsal tunnel, cubital tunnel, Guyon’s canal and supinator canal and treatment of meralgia paresthetica, lower thoracic aperture, etc.
• Permits transposition of nerves to a more favorable position, e.g., anterior transposition of the ulnar nerve
• No additional compression of the nerve canal during the decompression procedure (as opposed to the currently used ECTR)
• Constant monitoring of the respective nerve during manipulation
• Visual monitoring of the respective nerve branches and supplying vasa nervorum
• No risk of damaging the nerve during the procedure
• Short surgical time
• Reduced treatment cost
• Shorter hospital stay for patients (the procedures can be performed on an outpatient basis)
• Rapid patient recovery and return to occupational activities