Important considerations when choosing between primary and secondary tracheoesophageal

Patients and surgeons share common goals post-surgery that should guide the decision on primary
and secondary tracheoesophageal puncture:

  • Allow early voice rehabilitation with positive psycho-social impact
  • Successful voice rehabilitation
  • Avoid second surgical procedure
  • Minimize complications and tissue trauma

Reasons to perform a secondary puncture:

There are few absolute contraindications to primary TEP placement. Disruption of the
tracheoesophageal party wall, either inadvertently, or as part of an esophagectomy and esophageal
reconstruction precludes primary TEP placement given the increased risk of mediastinitis.

Zenga et al., 2018 (1)

When patients fail to obtain useful esophageal, and/or electrolarynx speech, or dissatisfaction with
the results of either of these two speaking methods.

Hilgers et al., 2016 (2)

Watch the animation below, showing a secondary puncture of the TE wall (after a total laryngectomy)
and the placement of a Provox Vega voice prosthesis with the Provox Vega Puncture Set.

Provox Vega Puncture Set- Secondary Puncture and Prosthesis Placement

Always read the Instructions for use before starting to use any of the products. For Instructions for
use, please visit


1 Zenga J, Goldsmith T, Bunting G, Deschler DG. State of the art: Rehabilitation of speech and swallowing after total laryngectomy. Oral Oncol. 2018;86:38-47.
2 Hilgers F, Balm AJ, Gregor RT, Tan B, van den Brekel MM, Scholtens B, et al. A practical guide to postlaryngectomy rehabilitation, including the Provox System. The Netherlands Cancer Institute; 5th Edition, 2016. Available from: