This video shows endoscopic carpal tunnel release in a patient who is wide awake. Indications, contraindications, technical pearls, and potential pitfalls are discussed. Preoperative and postoperative imaging studies are presented. To allow the patient to remain wide awake during the procedure, a local injection of lidocaine is administered. A one-portal endoscopic system is used. An incision is made in the proximal wrist crease. The video highlight the technical aspects of the procedure and discusses clinical indications and outcomes. Historical results and outcomes of wide-awake versus sedated endoscopic carpal tunnel release from the literature are presented and discussed.