“Minimally Invasive vs Standard Open Carpal Tunnel Release: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials”

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Introduction Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder around the world. Minimally invasive carpal tunnel release (MI-OCTR) techniques have been developed as alternatives to standard open CTR; however, the evidence comparing these approaches remains inconclusive. Our study aimed to evaluate the efficacy, safety, and perioperative outcomes of MI-OCTR versus standard open CTR. Methods Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from inception through 20 December 2025. Randomized controlled trials (RCTs) comparing MI-OCTR with standard open CTR were included. Random-effects meta-analysis with Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment and trial sequential analysis (TSA) were performed. Results Ten RCTs (660 randomized units) were included. No significant differences were observed for Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), (mean difference [MD] = −0.36, 95% confidence interval [CI]: −1.07 to 0.35, P-value = 0.23, I² = 98.2%) or Functional Status Scale (MD = −0.27, 95% CI: −0.75 to 0.21, P-value = 0.19). MI-OCTR demonstrated significantly shorter incision length (MD = −2.00 cm, P-value = 0.04) and earlier return to work (MD = −9.66 days, P-value = 0.02). TSA confirmed that only 1.2% of the required information size for BCTQ-SSS had been accrued, indicating the evidence remains inconclusive. Conclusions MI-OCTR and standard open CTR demonstrated similar efficacy in symptom relief, with MI-OCTR offering possible perioperative advantages. The certainty of evidence was very low for most outcomes, and TSA indicated that significantly larger trials are needed to reach definitive conclusions.