Carpal tunnel syndrome is the most common entrapment neuropathy dealt with by the clinician. Multiple techniques have been used to surgically treat this pathological condition and all of these approach the carpal tunnel from the palmar surface of the hand or wrist. We have developed a novel endoscopic approach to the carpal tunnel utilizing a dorsal approach that necessitates a good appreciation of the anatomy of this region. This approach was carried out in 10 hands. Through a single dorsal incision we were able to transect the flexor retinaculum in all specimens without obvious damage to neural or vascular tissues. The microscissors used in our study were found to be too delicate for transection of the flexor retinaculum thus another cutting tool should be considered. Our dorsal approach with visualization of the internal aspect of the flexor retinaculum may obviate many of the complications that are seen with the current techniques used to surgically treat carpal tunnel syndrome such as injury to the median nerve and its branches. Clinical trials are now necessary with prospective randomized studies that will determine which techniques are most efficacious and minimize complications most effectively. © 2005 Wiley-Liss, Inc.