A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy

Ananthapadmanabhan, Saikrishna; Jabbour, J. T.; Lai, Stephanie; Suruliraj, Anand; Smith, Mark A.; Riffat, Faruque; Devadas, Michael; Liem, Han; Sritharan, Niranjan

doi:10.1016/j.jvoice.2022.03.009

Cited by 2 publications

(5 citation statements)

References 29 publications

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“…In addition, immediate voicing in patients undergoing in-office secondary TE puncture with primary TEP placement has been shown to yield better voicing outcomes when compared to patients who have undergone delayed TEP placement. 14,26 Our success rate of TEP placement via in-office secondary TE puncture with immediate voicing without complications was 100%.…”

Section: Discussionmentioning

confidence: 83%

“…Despite these advantages, the procedure remains underutilized largely because of a lack of straightforward protocols. [11][12][13][14][26][27][28][29][30] Here we describe and demonstrate with a video tutorial a straightforward and efficient method of in-office secondary TE puncture using a commonly utilized TEP puncture set with immediate voicing. We employ a multidisciplinary approach with SLP to determine optimal puncture location, appropriate TEP length, and initiate immediate voicing after TEP placement with a 100% success rate.…”

Section: Discussionmentioning

confidence: 99%

“…In‐office secondary awake TE puncture with primary TEP placement and immediate voicing is a safe and effective procedure with a number of advantages over traditional secondary TE puncture. Despite these advantages, the procedure remains underutilized largely because of a lack of straightforward protocols 11–14,26–30 . Here we describe and demonstrate with a video tutorial a straightforward and efficient method of in‐office secondary TE puncture using a commonly utilized TEP puncture set with immediate voicing.…”

Section: Discussionmentioning

confidence: 99%

“…Additional equipment needed includes a transnasal esophagoscope and an endoscopic snare for select cases. All patients undergo a pre‐procedural counseling and education session with a speech‐language pathologist (SLP) to ensure candidacy for TEP placement to reduce risk of TEP device failure or abandonment 7,14 …”

Section: Introductionmentioning

confidence: 99%

“…All patients undergo a preprocedural counseling and education session with a speech-language pathologist (SLP) to ensure candidacy for TEP placement to reduce risk of TEP device failure or abandonment. 7,14…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Protocolized awake secondary tracheoesophageal puncture with immediate voicing

Jabbour,

Rodriggs,

O'Dea

et al. 2023

Head & Neck

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Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in‐office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit‐based, awake, in‐office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in‐office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Protocolized awake secondary tracheoesophageal puncture with immediate voicing

Jabbour,

Rodriggs,

O'Dea

et al. 2023

Head & Neck

View full text Add to dashboard Cite

show abstract

Chest Tube Placement of Secondary Tracheoesophageal Voice Prosthesis: Overcoming Challenging Anatomy in the Laryngectomy Patient

Shires,

Schertzer,

Ottenstein

et al. 2024

JPM

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Introduction: Total laryngectomy is used to cure advanced larynx cancer in many patients. The removal of the larynx requires the rehabilitation of the patient’s ability to communicate, and one common method is to place a tracheoesophageal voice prosthesis (TEP) as a secondary procedure after the patient has completed cancer treatment. The traditional technique utilizes a rigid esophagoscope for access, but this can prove difficult in many patients who have kyphosis, scarring of the neck, or trismus. We describe a technique to allow TEP placement in these challenging patients that does not utilize rigid esophagoscopy to access the tracheoesophageal puncture site. Methods: For more than 15 years, the senior authors of this study have used this technique in patients in whom traditional methods of TEP with rigid esophagoscope were unsuccessful or not attempted due to the anticipated high probability of failure. The ease of this technique has prompted its use for all patients undergoing secondary TEP placement in their practice. The technique is described in detail in the Methods section below. Results: The described method has been successfully utilized to place TEPs in many patients with challenging anatomy. There have been no failed placements, including a patient with severe trismus who was able to have a TEP placed by placing the chest tube and flexible endoscope transnasally. Further, because of precise visualization and ease of the technique, there have been no observed complications of injury to the pharyngoesophageal lumen or creation of a false passage. Conclusion: The use of a chest tube and flexible scope allows for the protection of the pharyngoesophageal lumen, precise visualization and placement of the puncture, and avoidance of a false tracheoesophageal passage, all while minimizing the need for extension of the patient’s neck. This has proven ideal for patients suffering the consequences of cancer treatment such as cervical scarring, fibrosis, kyphosis, and trismus.

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A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy

Cited by 2 publications

References 29 publications

Protocolized awake secondary tracheoesophageal puncture with immediate voicing

Protocolized awake secondary tracheoesophageal puncture with immediate voicing

Chest Tube Placement of Secondary Tracheoesophageal Voice Prosthesis: Overcoming Challenging Anatomy in the Laryngectomy Patient

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