Tkaczuk Andrew T, Taylor Rodney J, Wolf Jeffrey S
ORL J Otorhinolaryngol Relat Spec. 2018;80(1):36-40. doi: 10.1159/000485513. Epub 2018 Mar 28.
Tracheoesophageal puncture (TEP) for post-laryngectomy speech rehabilitation can be performed at the time of laryngectomy (primary) or at a subsequent time (secondary). Traditionally, the secondary procedure is performed using a rigid esophagoscope. Diseases like esophageal stricture, limited neck extension, and soft-tissue fibrosis can make this procedure technically challenging or impossible. We developed a novel device to perform a secondary tracheoesophageal puncture using a flexible esophagoscope.
To test the feasibility of a novel device used to create a secondary TEP in post-laryngectomy cadavers.
In this study, we performed a total laryngectomy on 3 fresh cadavers to establish the feasibility of our prototype. In each cadaver, a flexible esophagoscope was passed into the pharynx with the prototype. The prototype was passed through a working port and deployed to distend the esophagus. The puncture was visualized and a wire was passed via the newly established fistula. The device was activated, securing the wire, and then the esophagoscope and device were removed.
There was 100% successful deployment of the prototype device, allowing rapid creation of the puncture and security of the guide wire in each cadaver. There was no evidence of collateral mucosal injury or esophageal perforation.
The prototype device offers an alternative method to safely and efficiently perform a secondary TEP without the requirement of rigid esophagoscopy which can sometimes be technically impossible in this patient population.
用于喉切除术后言语康复的气管食管穿刺（TEP）可在喉切除时（一期）或随后（二期）进行。传统上，二期手术使用硬质食管镜进行。诸如食管狭窄、颈部伸展受限和软组织纤维化等疾病会使该手术在技术上具有挑战性或无法进行。我们开发了一种新型装置，可使用柔性食管镜进行二期气管食管穿刺。
测试一种用于在喉切除术后尸体上创建二期TEP的新型装置的可行性。
在本研究中，我们对3具新鲜尸体进行了全喉切除术，以确定我们原型的可行性。在每具尸体中，将柔性食管镜与原型一起插入咽部。将原型通过工作通道插入并展开以扩张食管。观察穿刺情况，并通过新建立的瘘管插入一根导丝。启动装置，固定导丝，然后取出食管镜和装置。
原型装置的部署成功率为100%，能够在每具尸体中快速创建穿刺并确保导丝固定。没有侧支黏膜损伤或食管穿孔的迹象。
该原型装置提供了一种替代方法，可安全有效地进行二期TEP，而无需使用硬质食管镜，而在这类患者中有时使用硬质食管镜在技术上是不可能的。
