Insertion of the Provox® Vega™ prosthesis using the Puncture Set™

The new Puncture Set for the Provox® Vega™ prosthesis has been available in Germany since June 2011. It can be used for the primary insertion of a voice prosthesis following laryngectomy or for secondary insertion, and is a development of the widespread system consisting of puncture trocar, pharynx protector and guide wire.

A mechanism for the automatic unfolding of the tracheal prosthetic flange when drawing the prosthesis into the shunt is a significant improvement that greatly simplifies and accelerates the intraoperative shunt placement and primary insertion of the prosthesis. Another improvement is the atraumatic dilatation of the puncture canal after the shunt puncture and before insertion of the voice prosthesis.

The Provox® Vega Puncture Set™ consists of a Provox® Vega prosthesis (1) that is attached to a puncture dilator (2), a blue plastic guide wire (3), a bent puncture needle (4) and a small transparent pharynx protector (5), also made of plastic. The pharynx protector is only to be used for insertion of a voice prosthesis in laryngectomy. For secondary insertion, the Puncture Set may be used in conjunction with a rigid oesophagoscope or pharyngoscope.

The materials of the Provox® Vega Puncture Set™ are all sterile disposable products. The Puncture Set is available with Provox® Vega prostheses in diameters 17 Fr, 20 Fr and 22.5 Fr and in shaft lengths 8 mm, 10 mm and 12.5 mm; the 17 Fr Set is also available in 15mm.

The pharynx protector is inserted in the pharynx. The puncture is made 5-10 mm below the upper edge of the tracheostoma into the protector.
The puncture needle is visible in the transparent pharynx protector.
The blue guide wire is inserted through the needle.
The blue guide wire is fed out through the blue guide wire. Now first the needle is removed, and then the pharynx protector.
The guide wire is inserted in the tip of the dilator.
The guide wire is pulled out to approx. 10 cm at the thick end of the dilator.
Now the guide wire is folded, and the tip pushed into a nut on the thick end of the dilator to make a loop.
The guide wire loop is pulled tight. The dilator is now attached to the guide wire.
The dilator and the attached voice prosthesis are pulled into the pharynx by the guide wire
The tip of the dilator appears in the trachea.
The dilator expands the puncture to the diameter of the prosthesis shaft.
The retaining tape of the voice prosthesis at the end of the dilator appears in the trachea.
It is advisable to stabilise the shunt with forceps while the voice prosthesis is being pulled into the shunt.
The voice prosthesis is now in place. The deployment mechanism for the tracheal flange obviates the need to deploy the flange with clamps.
The Provox Vega prosthesis that is now correctly in place is rotated, and the retaining tape removed.