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Barber SR, Kozin ED, Naunheim MR, Sethi R, Remenschneider AK, Deschler DG. 3D-printed tracheoesophageal puncture and prosthesis placement simulator. Am J Otolaryngol 2018; 39:37-40. [PMID: 28964552 DOI: 10.1016/j.amjoto.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/14/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES A tracheoesophageal prosthesis (TEP) allows for speech after total laryngectomy. However, TEP placement is technically challenging, requiring a coordinated series of steps. Surgical simulators improve technical skills and reduce operative time. We hypothesize that a reusable 3-dimensional (3D)-printed TEP simulator will facilitate comprehension and rehearsal prior to actual procedures. METHODS The simulator was designed using Fusion360 (Autodesk, San Rafael, CA). Components were 3D-printed in-house using an Ultimaker 2+ (Ultimaker, Netherlands). Squid simulated the common tracheoesophageal wall. A Blom-Singer TEP (InHealth Technologies, Carpinteria, CA) replicated placement. Subjects watched an instructional video and completed pre- and post-simulation surveys. RESULTS The simulator comprised 3D-printed parts: the esophageal lumen and superficial stoma. Squid was placed between components. Ten trainees participated. Significant differences existed between junior and senior residents with surveys regarding anatomy knowledge(p<0.05), technical details(p<0.01), and equipment setup(p<0.01). Subjects agreed that simulation felt accurate, and rehearsal raised confidence in future procedures. CONCLUSIONS A 3D-printed TEP simulator is feasible for surgical training. Simulation involving multiple steps may accelerate technical skills and improve education.
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Sethi RKV, Deschler DG. National trends in primary tracheoesophageal puncture after total laryngectomy. Laryngoscope 2017; 128:2320-2325. [DOI: 10.1002/lary.27066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rosh K. V. Sethi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Daniel G. Deschler
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
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Robinson RA, Simms VA, Ward EC, Barnhart MK, Chandler SJ, Smee RI. Total laryngectomy with primary tracheoesophageal puncture: Intraoperative versus delayed voice prosthesis placement. Head Neck 2017; 39:1138-1144. [PMID: 28230917 DOI: 10.1002/hed.24727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/15/2016] [Accepted: 12/29/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Studies support using intraoperative voice prosthesis insertion performed at the time of primary tracheoesophageal puncture (TEP) during laryngectomy. However, none have compared intraoperative voice prosthesis insertion with delayed voice prosthesis insertion. The purpose of this study was to prospectively examine patient, services, and cost benefits of intraoperative versus delayed voice prosthesis placement. METHODS Voice prosthesis use, duration to the first voice prosthesis change, early communication, and costs were compared between 14 patients who underwent a laryngectomy and who received intraoperative voice prosthesis placement, and 10 patients who underwent initial catheter stenting and then delayed voice prosthesis insertion. RESULTS Intraoperative voice prosthesis placement was associated with significantly fewer early device changes (1.4 vs 2), voice prosthesis changes because of resizing (8% vs 80%), longer durations to initial voice prosthesis change (159.7 vs 24.5 days), earlier commencement of voice rehabilitation (13.2 vs 17.6 days), reduced length of hospital stay (17.2 vs 24.5 days), and cost savings of $559.83/person. CONCLUSION Superior clinical and patient benefits are associated with intraoperative voice prosthesis placement during primary TEP. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1138-1144, 2017.
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Affiliation(s)
- Rachelle A Robinson
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Virginia A Simms
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, Queensland, Australia
| | - Molly K Barnhart
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia
| | - Sophie J Chandler
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.,The Clinical Teaching School, University of New South Wales, Kensington, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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Naunheim MR, Remenschneider AK, Bunting GW, Deschler DG. Placement of a 16-French voice prosthesis at the time of secondary tracheoesophageal voice restoration. Am J Otolaryngol 2015; 36:509-12. [PMID: 25891859 DOI: 10.1016/j.amjoto.2015.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/11/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and prosthesis placement. Prosthesis placement at the time of tracheoesophageal puncture (TEP) utilizing 20-French prostheses has been previously described. Smaller initial prostheses may allow fluent speech with reduced long-term complications, such as widening of the fistula and peri-prosthesis leakage. This study evaluates the safety and efficacy of the 16-French prostheses placement at the time of secondary TEP. METHODS All cases of 16-French tracheoesophageal voice prosthesis (TEVP) placement at the time of secondary TEP were reviewed from 1/2011 through 12/2013 at a large academic medical center. Perioperative complications attributable to device placement were recorded, including inability to place prosthesis, intraoperative complications, post-operative infection, prosthesis dislodgement, prosthesis leakage, and inability to obtain voice. RESULTS Twenty-one patients received placement of a 16-French TEVP at the time of secondary TEP. All prostheses were placed without intraoperative complications. The proportion of patients who had minor complications within the first postoperative month was 23.8%, including leakage through the prosthesis (3 of 21), granulation tissue near the prosthesis (1 of 21), retained sheath (1 of 21) and prosthesis displacement (1 of 21). Leakage and displacement were addressed with change and replacement, respectively. Fluent voicing was achieved in 85.7% patients, with a median time to voicing of 18.5days. CONCLUSIONS Placement of 16-French TEVPs is effective and safe, with an acceptable rate of minor complications attributable to the prosthesis. Therefore, a smaller prosthesis may be primarily placed at the time of secondary TEP and is our preference.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States.
| | - Aaron K Remenschneider
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States.
| | - Glenn W Bunting
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States.
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States.
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Damrose EJ, Cho DY, Goode RL. The hybrid tracheoesophageal puncture procedure: indications and outcomes. Ann Otol Rhinol Laryngol 2014; 123:584-90. [PMID: 24642586 DOI: 10.1177/0003489414525591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This report aimed to describe a novel and efficient method of tracheoesophageal puncture using a hybrid device assembled from 2 commercially available puncture kits; to demonstrate the utility of this technique in the performance of primary and secondary procedures, under general and local anesthesia, with and without flap reconstruction; and to evaluate the efficacy of concurrent puncture and valve placement. METHODS Thirty-four patients who underwent either primary or secondary tracheoesophageal puncture for voice restoration. Charts were reviewed retrospectively for complications, time to first valve change, operative time, and blood loss. RESULTS Using this novel hybrid device, simultaneous puncture and valve placement was achieved in 34 consecutive patients. There was 1 major complication; blood loss was negligible; and the procedure could be accomplished in all cases. There were no cases of prosthesis failure as a result of the insertion technique. CONCLUSION Concurrent tracheoesophageal puncture and voice prosthesis placement is a simple and efficient method of voice restoration in the laryngectomized patient and can be more easily accomplished with a hybrid device assembled from the components of 2 commercially available puncture kits. It can be performed under local as well as general anesthesia. The procedure is adaptable to a variety of clinical situations.
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Britt CJ, Lippert D, Kammer R, Ford CN, Dailey SH, McCulloch T, Hartig G. Secondary Tracheoesophageal Puncture In-Office Using Seldinger Technique. Otolaryngol Head Neck Surg 2014; 150:808-12. [DOI: 10.1177/0194599814521570] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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. Study Design Case series with chart review. Setting Academic medical center. Subject and 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. Conclusion 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.
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Affiliation(s)
- Christopher J. Britt
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Dylan Lippert
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Rachael Kammer
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Charles N. Ford
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Seth H. Dailey
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Timothy McCulloch
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Gregory Hartig
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
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Pagedar NA, Bayon R, Gudgeon J, Nelson RF, Van Daele DJ, Hoffman HT. Tracheoesophageal puncture with immediate prosthesis placement. Laryngoscope 2013; 124:466-8. [PMID: 24130080 DOI: 10.1002/lary.23756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Fukuhara T, Fujiwara K, Nomura K, Miyake N, Kitano H. New Method for in-Office Secondary Voice Prosthesis Insertion under Local Anesthesia by Reverse Puncture from Esophageal Lumen. Ann Otol Rhinol Laryngol 2013; 122:163-8. [DOI: 10.1177/000348941312200304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We clarify and demonstrate the utility of our new method of voice prosthesis insertion using puncture from the esophageal lumen. Methods: Our new reverse puncture method using a flexible endoscope can be performed in an outpatient clinic under local anesthesia. We conducted a clinical trial with patients with head and neck cancer between April 2010 and February 2012. Our study focused on the following three points: 1) the percentage of patients for whom the procedure was successful; 2) the duration of the operation; and 3) any adverse effects. Results: The puncture was performed successfully for 21 of 22 patients (95%). The mean duration of the operation, excluding the time for local anesthesia, was only 11.6 minutes. All patients began voice rehabilitation and attained peroral intake immediately after the operation. None of the patients suffered complications from the procedures. Conclusions: Most patients were treated with our new method with ease and at low risk. The high success rate and the absence of complications demonstrate the benefits of our method. We conclude that our method can be recommended for secondary reverse tracheoesophageal puncture.
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[A novel puncture instrument: the Provox-Vega® puncture set. Its use in voice prosthesis insertion following laryngectomy]. HNO 2012; 61:30-7. [PMID: 22767197 DOI: 10.1007/s00106-012-2551-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a guidewire and anatomic hemostatic forceps. The use of these instruments requires a certain level of experience on the one hand, while on the other use of a trocar and subsequent manipulation with the hemostatic forceps can lead to tissue trauma around the membranous wall or damage to the voice prosthesis. We present the results of a phase I/II study using a novel atraumatic puncture set for primary and secondary insertion of voice prostheses. PATIENTS AND METHODS Once patients had been fully informed and given their consent, the Provox-Vega® puncture set was used in 21 patients in either a primary (16) or a secondary (5) procedure. All procedures were documented on video, while approach, complications and surgical success were recorded using a questionnaire. RESULTS The average surgical time was 83.5 (± 19.12) s for primary voice prosthesis insertion and 212.57 (± 93.03) s in secondary procedures. The prosthesis could be inserted without complication in 19 patients, while a longer prosthesis needed to be selected intraoperatively in two patients due to a thick membranous wall. No serious complications were observed. One patient incurred a discrete injury to the mucosa of the esophageal posterior wall. CONCLUSION The Provox-Vega® puncture set proved itself to be a safe aid in the insertion of voice prostheses. It is significantly easier to use than other systems and tissue trauma is minimal. In most cases, no further instruments were required.
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