Carpal tunnel syndrome is the most common nerve entrapment syndrome. It is managed surgically by carpal tunnel release (CTR) to alleviate median nerve compression. Its evolution spans over a century initially from open surgery to now minimally invasive approaches, including endoscopic techniques. The first documented surgical release of the carpal tunnel was performed in 1924 by Dr. Herbert Galloway using an open approach. Over subsequent decades, open techniques became the standard, with refinements aimed at reducing scarring and improving patient outcomes. By the 1980s, surgical innovation led to the introduction of endoscopic carpal tunnel release, marking a shift toward minimally invasive methods. Surgeons began employing single-portal and two-portal endoscopic techniques, which provided improved visualization of neurovascular structures while minimizing tissue disruption. These techniques offered better outcomes with reduced postoperative pain and faster recovery. In the early 2000s, fat grafting was introduced as an adjunctive method to enhance healing and minimise complications, further expanding the management options for CTR. These advancements highlight a broader trend toward innovative, minimally invasive procedures driven by technological progress.