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Primary tracheoesophageal puncture in stapler-assisted laryngeal closure: a surgical modification
  1. Jeyashanth Riju1,
  2. Rajiv C Michael1,
  3. Sheth Meet Chetan2 and
  4. Antony Paulose1
  1. 1 Head and neck surgery, Christian Medical College and Hospital Vellore, Vellore, Tamilnadu, India
  2. 2 Department of ENT(Laryngology), Christian Medical College and Hospital Vellore, Vellore, Tamilnadu, India
  1. Correspondence to Dr Jeyashanth Riju; jjriju{at}


With the advancements in the medical field, many innovations in medical devices have happened. Using a surgical stapler to close the laryngectomy defect without opening the pharynx is particularly advantageous in a total laryngectomy (TL). However, performing the tracheoesophageal puncture (TEP) during stapler closure of the larynx has not been widely advocated, due to the fear of complications related to the procedure.

We treated two male patients with advanced glottic malignancy who underwent a TL. To restore their ability to speak, we performed a primary TEP and immediate voice prosthesis placement. After the TEP, we closed the larynx using a stapler. The surgical technique used in this procedure has been thoroughly explained.

The use of a surgical stapler for pharyngeal closure during a TL has several advantages, particularly with regard to the duration of surgery. The current techniques appear to be promising in reducing TEP-related complications during stapler-assisted laryngeal closure.

  • Voice prosthesis
  • Laryngectomy
  • Artificial Larynx
  • Larynx cancer
  • Surgical stapler

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  • Contributors The following authors were responsible for drafting the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: JR, SC and AP. The following authors gave final approval of the manuscript: RM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.