During the past 2 decades, increased powerful and quality ultrasound devices have contributed to developing ultrasound surgery more specifically for the hand. Carpal tunnel release under ultrasound now is available as a safe technique. The procedure uses a specific device. A detailed surgical technique is presented. The role of sonography is emphasized. This article discusses the results of the 150 first cases. The author’s experience is compared with other ultrasound-guided carpal tunnel release procedures. Outcome quality optimized by the ultra–mini-invasive approach and ultrasound should increase its use.