Transesophageal echocardiography (TEE) is an integral component of modern-day cardiac surgical conduct.[1] While TEE probe insertion is a relatively simple procedure usually successful in the first attempt, it is not sans risks particularly when difficulties are encountered while performing the same. The American Society of Echocardiography and Society of Cardiovascular Anesthesiologists outlines a complication rate of 0.03 to 1.2% with intraoperative or i-TEE.[2] The consequences of trauma owing to multiple attempts at probe insertion can pose considerable concerns of oropharyngeal injury and/or bleeding.[3] [4] This becomes further compounded in view of preoperative anticoagulants, systemic heparinization, and a predisposed patient profile (e.g., cyanotics).[5]

Centralizing the focus on the anatomical peculiarities, there are some potential sites of resistance to a smooth TEE probe insertion namely pyriform fossa and arytenoids.[3] [6] Herein, simple positioning maneuvers can be instrumental in overcoming the same. Appropriate to the context, the SORT maneuver: (S)niffing position with an anteflexed probe (O)rientation, contralateral head (R)otation and probe (T)wisting, described by Najafi and Golzari, classifies as a noteworthy proposition for nasogastric tube (NGT) and TEE probe insertion.[7] We present a case series highlighting the application of a modified version of the originally described maneuver to aid difficult TEE probe insertion in cardiac catheterization laboratory (CCL), followed by the use of the former in operation theater (OT) setting.