How we do it: Secondary tracheoesophageal puncture under local anaesthetic, using a trans-nasal flexible laryngo-oesophagoscope (TNFLO)

Abstract

We describe our technique for the formation of a secondary tracheoesophageal puncture and insertion of a voice prosthesis under local anaesthetic in the out-patient department. We use a trans-nasal flexible laryngo-oesophagoscope (TNFLO) to provide direct visualization of the procedure allowing early detection and rectification of any problems that might arise.

Office-based procedures for diagnosis and treatment of esophageal pathology

“…In some cases, direct formation of the fistula is difficult and, thus, needs to be performed in a later stage. Indications are displayed in Table . This procedure is called a secondary TEP and used to be performed by using a rigid endoscope with the patient under general anesthesia .…”

“…Secondary TEP may be indicated in specific laryngectomy patients . Different techniques have been described and no uniform protocols are mentioned.…”

New Method for in-Office Secondary Voice Prosthesis Insertion under Local Anesthesia by Reverse Puncture from Esophageal Lumen

“…[15][16][17]21,22 As a result, sometimes a puncture of the posterior tracheal wall toward the esophageal lumen is very difficult and time-consuming. On the other hand, our new procedure for puncturing the esophageal lumen leaves the tip of the needle visible throughout, so that the surgeon can observe it directly at all times.…”

Office-based tracheoesophageal puncture: Updates in techniques and outcomes

“…(3, 9-11) With our experience, we have gained further surgical expertise and management strategies that has led to increased patient comfort, improved technique, and broadened the indications for the procedure. Changes from our prior publications also include adding topical anesthesia to the tongue base and cervical esophagus.…”