title: Safe and simple method for secondary tracheoesophageal puncture using curved forceps.
abstract: BACKGROUND
  Secondary tracheoesophageal puncture is sometimes difficult and has a higher complication rate. In the irradiated neck, where neck extension is difficult, the traditional tracheoesophageal puncture method of insertion with a rigid endoscope is not possible. We describe a simple, safe and effective alternative method of tracheoesophageal puncture using curved forceps (Kocher's curved intestinal clamp forceps or Mixter forceps).
  
  
  METHODS
  The procedure is performed under local or general anaesthesia with equal ease. Maximum neck extension is achieved. The curved intestinal forceps are passed through the mouth into the oesophageal lumen. The instrument tip can easily be seen or felt at the posterior wall of the tracheostoma. A small incision is made in the mucosa to allow the forceps tip to emerge, and a guide wire is passed through this incision out of the mouth. The prosthesis can be guided over the guide wire, in retrograde fashion, to fit the puncture hole.
  
  
  RESULTS
  Secondary tracheoesophageal puncture was performed in five cases with severe neck fibrosis. In all cases, valve insertion was easily achieved after secondary tracheoesophageal puncture, without any peri-operative complications.
  
  
  CONCLUSIONS
  This is a safe, simple and effective method for secondary tracheoesophageal puncture. It can be performed easily in any setting and is not associated with any complications.
authors.affiliation: Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala, India.
authors.forename: N P
authors.initials: NP
authors.lastname: Trivedi
authors.forename: V
authors.initials: V
authors.lastname: Kekatpure
authors.forename: M A
authors.initials: MA
authors.lastname: Kuriakose
authors.forename: S
authors.initials: S
authors.lastname: Iyer
mesh_terms: D000768:Anesthesia, General; D000772:Anesthesia, Local; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005355:Fibrosis / Q000601:surgery; D006801:Humans; D007831:Larynx, Artificial; D008488:Medical Illustration; D019919:Prosthesis Implantation / Q000379:methods; D011677:Punctures / Q000379:methods*; D013525:Surgical Instruments / Q000706:statistics & numerical data*; D014132:Trachea / Q000601:surgery*