Carpal tunnel syndrome is a common clinical condition, and the common surgical treatment methods include traditional carpal tunnel dissection for median nerve release, small incision carpal tunnel dissection for release, and endoscopic release. The most prominent shortcoming of traditional carpal tunnel release surgery is the long postoperative scar and the resulting scar pain and sensory abnormalities [1], whereas endoscopic surgery requires special equipment and a long learning curve [2], so experienced hand surgeons prefer to perform carpal tunnel median nerve release with a small palmar incision and receive definitive surgical results [3,4]. In this paper, we present a surgical approach based on a small palmar incision combined with the use of SWISS pushknife for carpal tunnel syndrome. The traditional carpal tunnel release surgery is performed under direct vision, which is simple and clinically effective. However, the surgery is more traumatic, and it is easy to leave pain in the pier area, and the postoperative return to work time is usually longer. Maotian et al [9] reported in 2010 that although the occurrence of pain in the pier region after carpal tunnel surgery was not related to the surgical approach, the extent of pain was positively correlated with the length of the palmar incision. Although endoscopic release of the carpal tunnel is theoretically more minimally invasive, it is undoubtedly limited by the equipment, learning curve, and high surgical costs, and has more surgical complications and a tendency to recur than other procedures. In contrast, the small-incision, direct-view incision of the transverse carpal ligament and release of the median nerve is widely used in clinical practice. This technique avoids the large incisions and trauma required for traditional carpal tunnel incision, has great advantages in terms of reducing scar pain and improving appearance, and is also in line with the trend toward minimally invasive traditional surgery. The small incision assisted SWISS pushknife is based on a small incision combined with the application of the SWISS pushknife system, which aims to reduce the incision (37.5px-50px) while expanding the release area. The distal end of the incision is close to the distal end of the transverse carpal ligament, which facilitates us to protect the superficial palmar arch vessels under direct vision and completely release the distal transverse carpal ligament entrapment structures. We selected the follow-up results of 2 papers for the comparison of postoperative SSS, FSS. Satisfactory results were obtained. Especially in the late follow-up, the scar on the palm of the patient was almost imperceptible to the naked eye (Figure 3), and all returned to work 2 weeks after surgery. II. Comparison with simple small incision release Although the small incision (62.5px-75px) can completely dissect the transverse carpal ligament, the extent of its release cannot be compared with that of conventional surgery, especially in the flexor support band extending proximal and distal to the transverse carpal ligament are potential factors for entrapment. Regardless of the location of the small incision near the proximal or distal end, it is difficult to satisfy a complete release without an auxiliary tool. Also, the distal design of the incision is effective in avoiding injury to the metacarpal branch located near the transverse wrist stripe. This further reduces the incidence of postoperative complications. The proximal release range can reach 3-100 px proximal to the transverse carpal tunnel with the assistance of a push knife, and the surgical incision in this group was designed distal to the carpal tunnel, making it possible to start the release operation from the distal end of the transverse carpal ligament, so that even if the median nerve return branch is mutated, it can be protected under direct vision, and the median nerve return branch on one side of this group of patients emanated from the ulnar side and went to the radial side, which was protected under direct vision to avoid injury. Compared with the simple small incision technique, not only the incision is smaller, but also the release is more complete. The risk of nerve injury in endoscopic carpal tunnel release surgery may increase to three times that of open carpal tunnel release surgery [10, 11], and since the push knife is blinded for about 5 cm after entering the proximal end of the carpal tunnel, there is a theoretical possibility of injury to the carpal tunnel contents. Therefore, the unique bayonet design of the head of the pushknife ensures that the pushknife stays close to the underside of the ligament while advancing, and the inner wall of the carpal tunnel is smooth after freeing by the freeing device, thus making it less prone to injury of the median nerve itself. IV. Choice of surgical modality In addition to the SWISS push knife system, many other devices to assist in the release of the transverse carpal ligament have appeared in the literature, including the light knife system [12], the MANOS [13] system, and so on. The choice of which procedure depends not only on the available equipment and instruments, but more importantly, the surgical approach must meet the patient’s needs. If the carpal tunnel syndrome is due to suspected intracarpal tunnel occupancy or synovial inflammatory hyperplasia, the traditional large incision procedure is still the most appropriate. Excluding these factors, the choice of a different procedure depends on the experience of the surgeon.