Keyhole Operations

Carpal Tunnel Release ( Keyhole Operations )

Carpal Tunnel

This is an annoying problem but LapSurgery Australia has a minimally invasive solution to it and having performed over 1500 procedures by keyhole method this makes returning to normal activities the better option than having the open method which delays return to work and is more painful.

Introduction

Carpal tunnel syndrome is caused by compression of the median nerve at the wrist. The median nerve supplies the sensation over most of the hand, with the exception of a small area on the little finger side.

Symptoms are numbness and tingling in the fingers often occurring when using the hands during the day and particularly annoying and sometimes very sever at night.

Other symptoms in the hand such as swelling, joint pains and various lumps are not due to carpal tunnel syndrome.

Although the diagnosis can be made very reliably just on the symptoms, in most cases, and especially with WorkCover, an EMG test is required to confirm the diagnosis.

Treatment – Non Surgical

Where symptoms are mild and of recent onset, alteration of working conditions and night time splinting may be of assistance.
Injection of steroids into the carpal tunnel can help, but usually this gives only temporary relief.

Treatment – Surgical

The common operation involves quite a long incision on the palm of the hand, usually needing 6 – 8 stitches. It can take many weeks for recovery.

At LapSurgery we have been performing the minimally invasive (keyhole) technique for more than 15 years and have performed more than 1,500 of these procedures.

In the keyhole approach a small incision is made on the wrist, less than 1cm long. A further 3mm incision is made on the palm of the hand. The incisions are so small that in most cases a stitch is not required. A telescope is inserted between the incisions and the ligament squashing the nerve is divided fully under vision. In fact the vision we get is superior to naked eye vision as it is magnified in high definition on a computer monitor.

The procedure is done as a day case and takes about half an hour. It can be performed under full general anaesthetic or just the arm numb with a mild sedation.

A bandage will be applied to the hand, but the hand can and should be used as soon after the operation as possible. Slings and plasters are not used! Bandages are removed after a few days and the hand can be used normally thereafter. However there may be some swelling and tenderness for several weeks afterwards, but in most cases you can go about all but the very heaviest use of your hands with a week or two.

Relief of the nasty, sometimes painful tingling is immediate. However numbness in the tips of the fingers can take longer to resolve.

Costs

With Private Health Insurance

There is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which table you are on and in some cases you may have to pay an "excess". It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery unless the surgery is done as an emergency. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.

Providing you have  private health insurance you can expect to be out of pocket around between $500 - $700 depending on which health fund you are registered with. 

Without Private Health Insurance

Public hospital waiting lists are very long and the surgery is usually carried out by trainee surgeons under the supervision of one of the specialist surgeons appointed by the hospital. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon will not be involved in your operation.

Hospitals used by LapSurgery Australia for Keyhole surgery are:

  • The Valley Private, Mulgrave
  • Knox Private, Wantirna
  • St John of God, Berwick
  • The Bays, Mornington

 If you do not have private health insurance you can expect to be out of pocket between $2000 - $2500 depending on the hospital your surgery is performed at.  Following your consultation with our surgeon our staff will be able to give you an informed financial consent prior to going ahead with surgery.

FAQ

I'm thinking of having both hands done at once. Will I be able to cope with dressing, showering and in the toilet?

Most people cope very well. It is advisable to have some help at home for the first few days.

I don't have private health insurance. Can you do it for me in a public hospital?

Sorry, we don't operate in public hospitals and to our knowledge most public hospitals don't offer the keyhole carpal tunnel operation. We can provide you with an estimate of costs following a consultation with one of our surgeons should you wish to go ahead and have your surgery done in a private hospital.

I have a DVA gold card. Am I covered for this operation?

Yes! LSA treats gold card DVA patients for all our operations at no out of pocket cost.

When can I use my hand(s) after the operation and when can I drive.

Usually within days of the operation. The simple rule is that if you do something that is not painful then it is OK!

Surgical Risks

Risks of surgery include but are not limited to:

Damage to the nerve

This is exceptionally rare in experienced hands such as ours. On very rare occasions one of the small branches of the nerve to one or other side of one finger can be damaged giving numbness in this area. Changes to the technique introduced many years ago have virtually eliminated this possibility.

Recurrence

About 1% of patients experience recurrent symptoms or don't get relief from the initial operation. There can be many reasons for this and any such recurrence or failure will be investigated fully. Where a repeat operation is necessary it cannot be done with keyhole surgery and a larger incision is needed.

Reflex Sympathetic Dystrophy

This is a rare condition where continuous  burning pain affects the hand. It usually resolves with time and physiotherapy.

Infection

Infection is exceptionally rare.

(Remember that delay in treatment of carpal tunnel syndrome may cause permanent damage
to the median nerve)

Surgical Benefits

Highlights of LSA treatment of carpal tunnel syndrome
  • Minmally invasive keyhole technique
  • Quicker recovery and less discomfort
  • Day case surgery
  • Rapid relief of nasty night time numbness and pain
  • No slings or plasters
  • Tiny incisions, usually no stitches
  • Both hands can be done at the same time if necessary

Post Operative Instructions

For instructions relating to this operation, please visit the Patient Care Instructions page.
 

How do I start the process?

Complete our simple
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1300 527 787

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