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Shunt creation using the puncture trocar and pharynx protector after Hilgers

The pharynx protector after Hilgers consists of the grip (1) and a protector sleeve (2).

The protector sleeve can be inserted on the left or right of the grip, depending on how the pharynx protector is used.

The puncture trocar after Hilgers consists of a pointed arched trocar (3) for the puncture and an outer tube that fits around it exactly (4), both attached to a grip (5). 

The trocar for the puncture is inserted in the tube so the grips are horizontal and parallel (6).

The shunt creation with the puncture trocar and the pharynx protector after Hilgers is demonstrated in the following on a surgical model (no laboratory animals involved)

The shunt model has already been prepared:

The pharynx (1) is open, the larynx has been removed and a tracheostoma (2) set up. Trachea (3) and esophagus should not be separated.

The pharynx protector is fed into the open pharynx (4).
The pharynx protector (1) is pushed forward until its lumen can be seen or felt on the Pars membranacea of the trachea.

In the picture, a light is inserted in the pharynx protector, and the light can be seen on the Pars membranacea of the trachea (2).

The trocar (3) is now fed through the tracheostoma and placed approx. 1 cm caudal of the cranial edge of the tracheostoma. The tip of the trocar must be opposite the opening of the pharynx protector so the puncture can be made safely in the lumen of the pharynx protector

A sterile Provox® Guidewire is prepared. It fits through the outer tube of the puncture trocar.
The trocar is removed once the puncture has been made with the trocar and outer tube (1) through the Pars membranacea and front wall of the esophagus into the pharynx protector.

The outer tube (1) is left in place.

The guide wire (2) is now fed through it and into the open pharynx.

When the guide wire is clearly visible in the pharynx, the pharynx protector is removed, as otherwise it would prevent the voice prosthesis from being drawn in.
The pharynx protector has been removed.

The outer tube (1) is also drawn back, and a voice prosthesis (2) attached to the guide wire (3).
The voice prosthesis is now drawn into the puncture shunt by the guide wire (1).

The tracheal flange usually has to be unfolded using anatomical clamps (2) and gentle pulling.
Nubs (3) on the attachments of the collar of the voice prosthesis serve as orientation for the ?unfolding of the flange. They should lie on the outside, i.e. facing the tracheal lumen.

Note: A sterile Provox 2 prosthesis is now also used for the primary insertion. The Provox 1 prosthesis, which was originally intended for that purpose, will shortly be withdrawn from the market