Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome
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ORIGINAL ARTICLE
Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome Sajith Babu Thavarool1 • Sandeep Vijay2 • Manu S3 • Naveen George3 • Raveena R. Nair3
Received: 9 August 2020 / Accepted: 14 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Objectives Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option. Methods Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared.
& Sandeep Vijay [email protected]; [email protected] Sajith Babu Thavarool [email protected] Manu S [email protected] Naveen George [email protected] Raveena R. Nair [email protected] 1
Dept of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
2
Fellow in Head and Neck Oncology, Dept of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala 670103, India
3
Fellow in Head and Neck Oncology, Dept of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
Results There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method. Conclusion TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups. Keywords Larynx cancer Voice rehabilitation Voice prosthesis Local anaesthesia Percutaneous endoscopic gastrostom
Introduction Total laryngectomy is the treatment of choice for laryngeal cancers with cartilage erosion and extra laryngeal spread as well as in majority of the advanced recurrent cancers of larynx and pharynx. Loss of voice is one of the major consequences of total laryngectomy. Various voice rehabilitation methods are available with varying results which includes oesophageal voice, external devices and voice prosthesis [1, 2]. These methods have evolved and developed over the time. However, the use of voice prosthesis have become the common method over the last few decades because of its high success rate [3–5]. Voice prosthesis (VP) is inserted into the puncture fistula (TEP) which
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