Although introduced more than 20 years ago, endoscopic carpal tunnel release (ECTR) continues to generate debate and controversy among surgeons. This review examines a single surgeon's technique for ECTR over the past 13 years to better understand the effects of a surgeon's experience on outcomes. A retrospective review was performed on a case series of 129 patients ages 25 to 89 years old who underwent an ECTR at Duke University. Ninety-six percent of patients reported improvement in nerve symptoms. There were no nerve complications in the series. The billed cost of ECTR at Duke University was 9% less than standard open release and the average return to work by report by patients was 3 weeks. Previous recommendations against ECTR have focused on increased complication rates and cost, with no reported differences in long-term clinical outcomes. The results demonstrate increased success and lower complication rates for this series of patients. This may indicate a significant correlation between a surgeon's expertise and outcomes for ECTR.