title: Office-based tracheoesophageal puncture: updates in techniques and outcomes.
abstract: OBJECTIVE
  Tracheoesophageal puncture (TEP) is an effective rehabilitation method for postlaryngectomy speech and has already been described as a procedure that is safely performed in the office. We review our long-term experience with office-based TEP over the past 7 years in the largest cohort published to date.
  
  
  METHODS
  A retrospective chart review was performed of all patients who underwent TEP by a single surgeon from 2005 through 2012, including office-based and operating room procedures. Indications for the chosen technique (office versus operating room) and surgical outcomes were evaluated.
  
  
  RESULTS
  Fifty-nine patients underwent 72 TEP procedures, with 55 performed in the outpatient setting and 17 performed in the operating room, all without complication. The indications for performing TEPs in the operating room included 2 primary TEPs, 14 due to concomitant procedures requiring general anesthesia, and 1 due to failed attempt at office-based TEP. Nineteen patients with prior rotational or free flap reconstruction successfully underwent office-based TEP.
  
  
  CONCLUSIONS
  TEP in an office-based setting with immediate voice prosthesis placement continues to be a safe method of voice rehabilitation for postlaryngectomy patients, including those who have previously undergone free flap or rotational flap reconstruction. Office-based TEP is now our primary approach for postlaryngectomy voice rehabilitation.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jbergeron@ohns.stanford.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bergeron
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Nausheen
authors.initials: N
authors.lastname: Jamal
authors.affiliation: Department of Audiology and Speech, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Erman
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Chhetri
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome