In-office secondary tracheoesophageal puncture with immediate voicing in post-laryngectomy patients

Tracheoesophageal puncture (TEP) is the preferred method for voice rehabilitation following total laryngectomy (TL). In 2016, we described a novel method for in-office, secondary TEP with immediate prosthesis placement using a transnasal esophagoscope (TNE) and Seldinger technique. The present study provides an updated report on its utility and outcomes.

We performed a retrospective review of patients who underwent in-office secondary tracheoesophageal puncture with immediate prosthesis placement following total laryngectomy at our institution between 2012 and 2024. Procedural success, complications, and voice outcomes were assessed to evaluate the utility and safety of this technique.

From 2012 to 2024, we used our technique for secondary TEP in 378 patients following TL with a 99.2% success rate. Patients had a median age of 63 (19-93) years and 82.3% were male (n = 311). The median time between TL and first TEP was 37 (7-6334) days. The majority of patients (93.4%) were able to voice immediately after voice prosthesis placement. Two patients (0.5%) developed pneumothorax post-procedure requiring admission and 2 procedures (0.5%) were aborted due to intolerance. No false passages, esophageal perforations, or bleeding complications encountered.

Our technique for in-office secondary TEP via TNE and the Seldinger technique is feasible, effective, and well tolerated by patients.