Proximal row carpectomy (PRC) is a workhorse surgical procedure used to treat degenerative and traumatic wrist conditions to preserve wrist range of motion. Various modifications of grafts have been used to expand indications. As minimally invasive arthroscopic options become increasingly popular, the use of the wrist arthroscope as a possible adjunct to perform PRC has also come under scrutiny. While it has the potential advantages of minimal soft tissue injury with faster postoperative rehabilitation, there is also a considerable learning curve with a longer intraoperative time. This article reviews the current evidence and discusses emerging trends for this wrist salvage procedure.