Secondary tracheoesophageal puncture in-office using Seldinger technique.
OBJECTIVE
Evaluate the safety and efficacy of in-office secondary tracheoesophageal puncture (TEP) technique using transnasal esophagoscopy (TNE) and the Seldinger technique in conjunction with a cricothyroidotomy kit for placement.


METHODS
Case series with chart review.


METHODS
Academic medical center.


METHODS
A retrospective chart review was performed on 83 subjects who underwent in-office secondary TEP. Variables that were examined included disease site, staging, histologic diagnosis, extent of resection and reconstruction, chemoradiation, functional voice status (as assessed by speech pathologist in most recent note), and complications directly related to the procedure.


RESULTS
Eighty-three individuals from our institution met our criteria for in-office secondary TEP from 2005 to August 2012. Of these, 97.6% (81/83) had no complications of TEP. The overall complication rate was 2.4% (2/83). Complications included bleeding from puncture site and closure of puncture site after dislodgement of prosthesis at the time of puncture. Fluent conversational speech was achieved in 69.9% of all patients (58/83), and an additional 19.3% (16/83) achieved functional/intelligible speech; of those, 3.6% (3/83) were unable to achieve fluent conversational speech due to anatomic defects from previous surgery.


CONCLUSIONS
An in-office TEP can be safely performed using the Seldinger technique with direct visualization using TNE, despite the extent of resection or reconstruction, with functional speech outcomes comparable to other studies available in the literature.
Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.
Christopher J
CJ
Britt
Dylan
D
Lippert
Rachael
R
Kammer
Charles N
CN
Ford
Seth H
SH
Dailey
Timothy
T
McCulloch
Gregory
G
Hartig
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D013065:Speech Intelligibility; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome
Seldinger; cricothyroidotomy; efficacy; esophagoscopy; kit; outcomes; prosthesis; safety; secondary; speech; tracheoesophageal puncture; transnasal