Have you ever heard of the Tome technique for carpal tunnel surgery? I had my first carpal tunnel release six months ago. But my surgeon retired.The new surgeon wants to use this Tome method. Is it okay?
In the last 10 years, a new method has been developed for the surgical treatment of carpal tunnel syndrome. The Indiana Tome Technique combines the benefits of open incision with endoscopic (minimally invasive) approaches. It allows a partial direct view inside the wrist with decreased tissue trauma.
First, a tiny incision along the palm is made to gain access to the transverse carpal ligament. Then, a special tool called a cutting tome is inserted. It looks like the flat prongs of a front-end loader. It can be pushed deep enough into the carpal tunnel to allow the surgeon to completely cut through the transverse carpal ligament without damaging the median nerve and nearby tendons.
Results of previous studies using this system report a 92 per cent success rate. Success was measured by complete pain relief or only minimal residual symptoms after surgery. Other factors used to measure success included grip, key, and three-point pinch strength. The results for these variables with the Indiana Tome technique were similar to the results with open incision surgery.
In a recent study, the charts of 1,332 carpal tunnel patients were reviewed after surgery was done. Carpal tunnel releases using the Indiana Tome system were done by two fellowship-trained hand surgeons. The researchers were particularly interested in complications and complication rate using this method. They also kept track of the time it took for patients to get back to work or to a preoperative level of function and activities.
There were very few complications (less than one per cent) with this technique. Everyone went back to their preoperative work status quickly. The few patients with numbness or hypersensitivity recovered over time. In two cases, the patients' ability to feel two points of pressure (called two-point discrimination) was decreased permanently.
The Indiana Tome technique is safe, reliable, and effective. It must used by an experienced hand surgeon specifically trained to use this tool. In-depth knowledge of the anatomy is a must. In the hands of such an expert, there is less soft tissue damage when compared with the open method.
W. P. Andrew Lee, MD, et al. 13-Year Experience of Carpal Tunnel Release Using the Indiana Tome Technique. In The Journal of Hand Surgery. September 2008. Vol. 33A. No. 7. Pp. 1052-1056.
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