INTRODUCTION: This study reports the eleven year follow-up study on scope assisted carpal tunnel release using the distal single incision technique. METHODS: This technique of CTR has been performed on 1465 cases since 1991. A 1.5cm longitudinal distal single incision in the palm allows for direct visualization of the distal edge of the transverse carpal ligament, median nerve, abnormal structures (aberrant motor branch variants and communication branch of the ulnar nerve), and the superficial palmar arch. A specially designed knife/sleeve unit mounted on a standard 4mm endoscope allows for division of the transverse carpal ligament with a distal-to-proximal pass. The interthenar fascia is usually preserved. RESULTS: Postoperative pinch and grip strengths were near or greater than the preoperative level by eight weeks. Patients whose interthenar fascia were preserved had lateral pinch strengths significantly higher postoperatively compared to patients who did not have an intact interthenar fascia. Mean overall return to work was 22 days. 25% of patients required no postoperative analgesics, with minimal scar, ulnar pillar, and radial pillar tenderness. There were no permanent neurovascular injuries to the median nerve or superficial palmar arch. CONCLUSION: This technique allows for a small cosmetically appealing scar and direct identification of key anatomy,. Patients have less loss of strength and function in the early postoperative periods and an overall early return to work and full activities. This technique has shown good long and short term results.