title: Simplified technique of tracheoesophageal prosthesis placement at the time of secondary tracheoesophageal puncture (TEP).
abstract: OBJECTIVE
  Secondary tracheoesophageal (TE) puncture standardly involves placement of a catheter at time of TE fistula creation. We explore the feasibility of placement of the prosthesis at the time of TE puncture (TEP) obviating the need for a subsequent procedure to place the prosthesis. We describe the technique and evaluate the success and potential advantages.
  
  
  METHODS
  Retrospective chart review of consecutive patients who underwent TE prosthesis placement at the time of secondary TEP from 3/2009 to 1/2011.
  
  
  METHODS
  Fourteen patients underwent the primary TE prosthesis placement at the time of secondary puncture and were evaluated. Assessed outcomes included patient demographics, success of prosthesis placement, need for repeat procedure, early or late prosthesis dislodgement, complications, and specific voice outcomes.
  
  
  RESULTS
  Patient cohort included nine males, five females, with average age of 64 years. All TE prosthesis placements were successful. The 12-mm 20 F Blom-Singer Indwelling prosthesis was used in all cases. No complications occurred during prosthesis placement. Two perioperative complications occurred: one case of transient pulmonary edema from general anesthesia, one case of posterior tracheal wall swelling. The second was addressed with placement of a larger prosthesis. All patients successfully achieved good voice at an average of 4 days after the procedure (range: 1-9 days).
  
  
  CONCLUSIONS
  This initial series of 14 consecutive patients demonstrates successful TE prosthesis placement at the time of secondary TE puncture. Functional voice was achieved in all patients with no significant immediate complications. No dislodgements occurred and no repeat procedures were required. Voice acquisition was achieved at an earlier time (4 days on average) than with traditional techniques and without the necessity of a subsequent procedure. Primary prosthesis placement at the time of secondary TE puncture is a successful option for surgical voice restoration with distinct advantages and minimal complications.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Division of Head and Neck Surgery, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA. daniel_deschler@meei.harvard.edu
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
authors.forename: Derrick T
authors.initials: DT
authors.lastname: Lin
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Bunting
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures; D012189:Retrospective Studies; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome