Page 38 - Prosthetic voice rehabilitation-5th edition

perpendicular puncture towards the lumen of the scope. The sharp tip of the trocar is caught in the esophagoscope under visual guidance of the assistant. With the PVPS, the sharp needle in the package is used for the TEP. Since this needle is considerably thinner than the Trocar and Cannula, and very much sharper, the puncture is much easier than with the latter instrument, especially in fibrosis at the puncture site, as will be noticed immediately by clinicians familiar with the traditional TEP procedure. In case of the traditional TEP, the trocar is removed and the flexible guide wire introduced through the cannula. With PVPS, the guide wire can be introduced directly into the lumen of the needle. In both methods, the guide wire the will appear in the esophagoscope and can be pushed upwards. The esophagoscope is now removed and the Provox voice prosthesis is attached to the connector head of the guide wire (Figures below) By pulling the guide wire inwards, the introduction string of the prosthesis is introduced into the TE tract. During this stage of the procedure the ventilation tube of the anesthetist can be re-introduced for a few minutes. Finally, after removing the ventilation tube once more, the prosthesis can be pulled and rotated into the TE tract with the help of two curved non-toothed hemostats. In case of the PVPS, the dilator with the pre-mounted Vega prosthesis is attached and secured to the guide wire (Figures below left). Next the prosthesis can be pulled in place by advancing the dilator, which gradually widens the TEP tract, and by the unfolding of the tracheal flange with the loop around the voice prosthesis (Figures below right). 38