Part of the groundswell for endoscopic plastic surgery initially gained momentum in hand surgery, with claims that endoscopic carpal tunnel release allowed less invasive surgery and a more rapid recovery due to diminished pain and scarring than was possible with traditional "open" methods. Admittedly, no ultimate difference in their efficacy as regards symptom relief had been observed. However, in our opinion, some of these conclusions may be flawed, since an "open" method employing the most minimal possible incisions was not necessarily used. Therefore, a more apropos study should compare an acceptable minimally invasive "open" technique versus endoscopic carpal tunnel decompression. A prospective, consecutive series of 96 patients with medically unresponsive, confirmed carpal tunnel syndrome with no other concomitant hand pathology was selected. Fifty-three patients (71 hands) underwent "open" release using a minimal incision, which was comparable in composition to a group of 47 patients (66 hands) who had a two-portal endoscopic release. Scar length (p = 0.999), need for hand therapy (p = 0.798), rate of complications (p = 0.359), length of time before resuming routine activities (p = 0.255), and length of time before return to work (p = 0.373) were not statistically different whether an "open" or "closed" procedure had been performed. Regardless of the technique employed, individuals receiving Worker's Compensation more often required hand therapy (p < 0.02) and had a significantly longer recovery period (p < 0.005). A subgroup of 15 patients with bilateral carpal tunnel syndrome who had decompression using opposing methods had no significant difference in preference.(ABSTRACT TRUNCATED AT 250 WORDS)