Page 2 - Supplement to 5th edition - New Provox Vega insertion system

The book “A practical guide to postlaryngectomy rehabilitation, including the Provox system (5th edition)”, with fully integrated video and sound material, was published online in 2016. It already included the Provox Vega and Vega XtraSeal voice prostheses, extensively described on pages 10, 13, and 64. Since then, a new insertion system was introduced for the replacement of these voice prostheses. This supplement describes the differences, and similarities with the replacement tool for Provox2 and Provox ActiValve, and the Smart Inserter system for Provox Vega, and it also outlines the possibility for using a gelatin capsule for the insertion of these voice prostheses.
Provox Vega (above) and Provox Vega XtraSeal (below)
Introduction
The anterograde insertion of Provox2 with a simple insertion tube was a great step forward compared to the former retrograde guide wire method needed for the replacement of the original Provox voice prosthesis (1, 2). This anterograde replacement made the procedure less uncomfortable for patients and less cumbersome for clinicians. Proper manual forward folding of the esophageal flange into the insertion tube was the essential first step for an optimal delivery of the voice prosthesis into the TEP tract. However, some clinicians did not appreciate this and found it somewhat cumbersome, and would prefer an automatic folding device. This resulted in the development of the Smart Inserter (3). This ‘clever’ device also reduced the chances of involuntary overshooting of the voice prosthesis, but still allowed voluntary overshooting, essential e.g. in case of TEP tract hypertrophy. Although many clinicians considered the SmartInserter a step forward in the safety and comfort of the procedure, there still were proponents of the original insertion method. Moreover, there were also clinicians, who were more familiar with the gel cap method used for the softer flanged Blom-Singer devices(4). These notions lead to the development of the new Provox Vega with Insertion system, which can be used in its totality, i.e. “System Insertion”, with the folding mechanism detached, very similar to the former Provox insertion method, i.e. “Tube Insertion”, or using a gel capsule, i.e. “Capsule Insertion”. Which of these methods is used, is often a preference of the clinician, but also anatomical variations can play a role in favoring one or the other method. E.g. in easily accessible TEPs “System Insertion”, in more angled TEPs and when overshooting is demanded, “Tube Insertion”, and with narrow stomas, the “Capsule Insertion”.