Primary Placement of a 16 French Voice Prosthesis at the Time of Tracheoesophageal Voice Restoration

Abstract

Objectives: Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and secondary prosthesis placement. Successful primary prosthesis placement at the time of primary or secondary puncture using a 20 French prosthesis has been previously described. We now wish to evaluate whether 16 French prostheses can be used safely and effectively. Methods: All cases of primary 16 French tracheoesophageal voice prosthesis (TEVP) placements at a large academic medical center were retrospectively reviewed from January 2011 through December 2013. Perioperative complications attributable to device placement were recorded. These included inability to place prosthesis during procedure, intraoperative issues with primary placement, postoperative infection, prosthesis dislodgement, leakage around/through the prosthesis, or inability to obtain voice. Results: Twenty-two patients received primary placement of a 16 French TEVP. All prostheses were successfully placed, and there were no intraoperative complications. Approximately 18% of patients had a postoperative complication, including leakage through the prosthesis (3 of 22) and prosthesis displacement (1 of 22). These were addressed with prosthesis change and replacement, respectively. Conclusions: Placement of 16 French TEVPs is effective and safe, with a low rate of complication directly attributable to the prosthesis itself. Therefore, a smaller prosthesis may be primarily placed at the time of TEVR and is preferred over the previously described 20 French prosthesis.