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Secondary tracheoesophageal puncture: Blind technique with a rigid hysterometer
Author(s) -
Pighi Gian Paolo,
Barbieri Franco,
Adami Roberto,
Fiorino Francesco
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20518
Subject(s) - medicine , cannula , surgery , tracheoesophageal fistula , supine position , voice prosthesis , lumen (anatomy) , prosthesis , fistula , stenosis , esophagus , limiting , laryngectomy , larynx , radiology , mechanical engineering , engineering
Objectives/Hypothesis: The use of a rigid esophagoscope during tracheoesophageal puncture for speaking valve insertion in laryngectomized patients may be hindered by stenosis of the esophagus, or arthritic deformation of the spine, limiting extension of the neck. To prevent complications we currently perform a blind technique in these patients with the use of a rigid hysterometer instead of the esophagoscope. Methods: Ten patients underwent secondary tracheoesophageal puncture using a rigid hysterometer. This was inserted through the mouth and gently advanced along the cervical esophagus to the level of the tracheostomy. A transverse incision was made on the posterior membranaceous wall of the trachea to enable the hysterometer to enter the tracheal lumen. The curved cannula of a Provox trocar was retrogradely inserted into the fistula following the hysterometer as a guide. After withdrawing the hysterometer, a Provox flexible guidewire was introduced into the cannula and advanced up to the oral cavity to anchor a Blom‐Singer prosthesis. Withdrawal of the guidewire enabled the prosthesis to be housed in the fistula. Results: All patients had a successful surgical outcome without any intra‐ or postoperative complications. The resulting fistula was adequate and enabled patients to wear their prostheses without trouble and to quickly acquire an intelligible voice. Conclusions: The limited thickness allows easy advance of the hysterometer beyond esophageal stenotic tracts, and its particular curved conformation permits progression toward the level of the tracheostomy in patients who cannot assume a relaxed, extended supine position on the operating table. Laryngoscope, 2009