Placement of a tracheoesophageal prosthesis using intraoperative ultrasound: A novel technique.

Abstract

In patients who undergo a total laryngectomy, one of the most common techniques for voice rehabilitation is a tracheoesophageal prosthesis. Typically, this is accomplished using an endoscope down the oesophagus to visualise puncturing of the posterior tracheal wall; however, we present a case in which the use of an endoscope was not feasible, and a novel technique had to be utilised. A mid-70s male who had a total laryngectomy secondary to laryngeal carcinoma was undergoing tracheoesophageal puncture for prosthesis placement, when it was noted that he had significant stenosis of his proximal oesophagus, precluding the use of an endoscope. The senior author decided to use intraoperative ultrasound to visualise the oesophageal lumen for proper placement of the puncture. This case demonstrates the ability of intraoperative ultrasound to visualise the oesophageal lumen and accurately place the tracheoesophageal puncture in cases where an endoscope cannot be used. We present a novel technique in which ultrasound was used to visualise the oesophageal lumen and identify the needle puncturing the posterior tracheal wall for placement of a tracheoesophageal prosthesis.