return to: Tracheoesophageal Puncture

Laryngectomy Home Care Booklet; Total Laryngectomy

Modified Operative Note

Procedure: Creation of tracheo-esophageal fistula for voicing after total laryngectomy

Indications: 77 yo m with h/o total laryngectomy who has had a TEP in the past and would like to have one again. He is a poor candidate for general anesthesia.

Anesthesia: Monitored awake with sedation.

    The stoma was sprayed with topical phenylephrine 1% and lidocaine 4%.

    The posterior trachea wall at the level of the proprosed puncture (site of previous puncture) was injected with ~2ml of 1% lidocaine with 1:100,000 epinephrine.

     He swallowed ~15ml of 2% Viscous lidocaine jelly in 5ml increments allowing time for it to fully anesthetize the oral cavity, neopharynx and esophagus

Procedure Details:

The patient was positioned supine with supplemental 02 by blow by.

A #32 Mahoney dilator (hollow, no mercury inside) was passed into his esophagus.

A 25g spinal needle was used to puncture into the dilator through posterior trachea wall. A vertical incision was made with the scalpel (#11 blade) immediately adjacent to the spinal needle through mucosa to visualize the blue color of the dilator.

The new tracheo-esophageal fisula was widened by placement of skin hooks to evert mucosa from esophagus to clearly visualize the dilator.

A 16 gauge red rubber catheter placed through the fistula with controlled opening with the skin hooks in place as the Mahoney dilator was removed. The red rubber catheter was advanced into his stomach with return of gastric fluid.

The catheter was then secured with the lumen closed with a figure of 8 silk (2-0) suture to prevent refluxate and leakage. 0 silk suture was tied tightly around the upper aspect of the #16 red rubber catheter and tied around the neck with benzoin-steristrips additionally employed to secure the red rubber catheter to the neck.

The patient tolerated this procedure well.