Tracheo-oesophageal fistula and total voice prosthesis placement using the Provox Puncture Kit Set® with flexible bronchoscopy guidance

Aim: One of the treatments of the voice loss after laryngectomy is the insertion of voice prosthesis. This treatment, that requires the creation of a tracheo-oesophageal fistula is usually performed in an operating room, under general anesthesia through the use of rigid esophagoscopy and is associated with serious complications.We present a new method for tracheo-oesophageal fistula and voice prosthesis placement using the Provox Puncture Kit Set ® with flexible bronchoscopy guidance. Patients&Method: 6 patients were included. An endotracheal tube was inserted through the esophagus with fiberbronchoscope guidance. The puncture site was located in the the trachea using transillumination.The trocar was punctured under direct visualization with the bronchoscope. The guide was inserted through the trocar and the bronchoscope was removed. Once the craneal extreme of the guide was visualized emerging from the endotracheal tube the trocar and the tube were removed. In the caudal extreme of the guide the dilator-prosthesis system was introduced. By pulling the guide the prosthesis was placed in the fistula and the guide was removed. Results: The tracheo-oesophageal fistula creation and prosthesis placement was performed successfully in all cases with obtanion of voice immediately after the procedure. All procedures were performed in the bronchoscopy unit, in an outpatient setting, under conscious sedation with no complications. Conclusions: The tracheo-oesophageal fistula creation and voice prosthesis placement using the Provox Puncture Kit Set ® with flexible bronchoscopy guidance is an easy procedure that avoids hospitalization and general anesthesia.