Alternative technique in secondary tracheoesophageal puncture using flexible endoscope and overtube in patients with difficult post-laryngectomy abnormalities

Background: Functional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care. Tracheoesophageal puncture for voice prosthesis insertion performed as a secondary procedure with a rigid esophagoscope and trocar can be technically difficult in certain patients due to post-treatment cervical abnormalities, such as reduced hyperextension, stenosis, and trismus. Methods: This study presents an improved method of secondary tracheoesophageal prosthesis insertion using a flexible endoscope in association with a plastic pliable overtube to keep the virtual esophageal lumen open. By this method, the puncture can be performed easily and safely with the avoidance of unexpected lesions. Results: From 2005 to 2015, 12 (16,9%) out of 71 patients who underwent secondary voice prosthesis placement at our institution required this alternative technique due to anatomical alterations that hindered the execution of the procedure following the standard technique. Conclusion: The procedure was successfully performed in all patients with no related complications.