Safe and simple method for secondary tracheoesophageal puncture using curved forceps

Area of Science:

• Otorhinolaryngology
• Surgical Innovation
• Speech Rehabilitation

Background:

• Secondary tracheoesophageal puncture (TEP) can be challenging, with higher complication rates.
• Traditional rigid endoscopy is often impossible in irradiated necks due to limited neck extension.
• A new method using curved forceps offers an alternative for difficult TEP procedures.

Purpose of the Study:

• To describe a simple, safe, and effective alternative method for secondary tracheoesophageal puncture.
• To address the difficulties encountered in TEP for patients with irradiated necks and severe fibrosis.
• To present a technique that avoids the limitations of rigid endoscopy.

Main Methods:

• The procedure utilizes Kocher's curved intestinal clamp forceps or Mixter forceps.
• Performed under local or general anesthesia with maximum neck extension.
• Forceps are inserted through the mouth into the esophagus, guided to the tracheostoma, and a guide wire is passed for prosthesis insertion.

Main Results:

• Successfully performed secondary TEP in five patients with severe neck fibrosis.
• Voice prosthesis insertion was easily achieved in all cases post-puncture.
• No peri-operative complications were observed in any of the cases.

Conclusions:

• This curved forceps technique is a safe, simple, and effective method for secondary TEP.
• The procedure is easily performed in any clinical setting.
• The method is associated with no complications, offering a reliable option for challenging cases.