The skin is incised and the edges are undermined. ARagnell retractor is placed on either side of the incision and the skin edges are retracted, pulling the palmar fascia away from the underlying neurovascularbundle. The palmar fascia is divided longitudinally to expose the midpalmar fat. The median nerve, superficial palmar arch, and TCL are then identified (Fig. 2). The retractors are repositioned to include the palmar fascia. Apathisthencreated by bluntdissection(with ablunt hemostat)between theTCL andthe contentsofthe carpal canal, aiming ulnarly towards the “x” in the distal forearm. The forearmisthen elevated and the wrist extended over a bolster to introduce the dissector (A.M. Surgical,Smithtown, NewYork).The dissectorisaimedbetweenthe twolines marked on the forearm. Once the pathway is createdwith the dissector,adissecting obturator is introduced (Fig. 3). The tip of the obturator should rest against the undersurface of the TCL at all times. Once the cannula tip is palpable through the skin beneath the “x”, the obturator is removed and the cannula is left in place with the slot facing slightly ulnar.Astandard 4mm30 8 endoscope is introducedthrough theslott ed cannulaand oriented toward the slot (Fig. 4A,B). The TCL is visualized through the endoscope and any remaining tenosynovium is removed with the dissecting obturator (Fig. 5). The median nerve is visualized by rotating the cannula radially (Fig. 6).