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Hybrid primary puncture in stapler-assisted total laryngectomy
Jacopo Galli1,2, Luca Perna1, Giorgia Rossi1
1Otorhinolaryngology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy.
Head & Neck
|November 21, 2023
Summary
A novel hybrid surgical technique for primary tracheoesophageal (TE) puncture in stapler-assisted total laryngectomy simplifies voice prosthesis (VP) insertion. This method avoids complications and facilitates VP placement, even with mechanical sutures.
Area of Science:
- Surgical Oncology
- Otolaryngology
- Speech and Voice Rehabilitation
Background:
- Total laryngectomy necessitates surgical techniques for voice restoration.
- Traditional tracheoesophageal (TE) puncture often requires rigid esophagoscopy.
- Stapler-assisted total laryngectomy presents unique challenges for primary voice prosthesis (VP) placement.
Purpose of the Study:
- To present a new hybrid surgical technique for primary TE puncture.
- To demonstrate the feasibility and safety of retrograde VP placement in stapler-assisted total laryngectomy.
- To highlight tips and tricks for this innovative surgical approach.
Main Methods:
- A hybrid technique involving an upper mini-pharyngotomy for retrograde VP insertion.
- Integration of this technique with stapler-assisted total laryngectomy.
- Elimination of the need for rigid esophagoscopy during the procedure.
Main Results:
- The hybrid procedure allows for primary TE puncture and VP placement.
- This technique was not associated with adverse events like pharyngocutaneous fistula (PCF) or functional complications in the authors' experience.
- Successful VP insertion was achieved, even in cases utilizing mechanical sutures.
Conclusions:
- The described hybrid technique is a valid and safe approach for primary voice prosthesis insertion.
- It simplifies the process by enabling retrograde placement via mini-pharyngotomy.
- This method is effective in stapler-assisted total laryngectomy, offering a reliable option for voice rehabilitation.
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