Endoscopic carpal tunnel release has been popularized since 1989 when Okutsu described it for the first time. Several surgeons have followed his principles and described their own techniques. These were developed in an attempt to decrease the well-known complications related to the open technique. Single and 2-portal techniques have been described. Indications include patients with moderate Carpal tunnel syndrome (CTS) and failed conservative treatment. A modified Tsai 2-portal technique is used creating a "fixed surgical tunnel" for decompression and a custom made plastic tube is used to check the quality of release. A specific instrumentation is needed (A.M. Surgical, Smithtown, NY). Few complications are associated, finding it a reliable technique for the decompression of the carpal tunnel.