Voice Rehabilitation by Voice Prostheses After Total Laryngectomy: A Systematic Review and Network Meta-Analysis for 11,918 Patients

Purpose Our aim was to assess the different voice prostheses (VPs) to identify the most efficient, safest, patient-tailored, longest lifetime, and inexpensive VPs and assess the different factors affecting their quality. Method In September 2017, 15 databases were searched to include all randomized controlled trials. A new search was done in May 2019 to include all other study design articles, which include all the new-era VPs subtypes. Network meta-analysis (NMA) was applied to all 27 outcomes, besides NMA overall and partial order setting was done by using Hasse scatter plots. p values were used in NMA, where the best VPs are approaching one and the least approaches zero. Meta-analysis was done for the rest of the outcomes. Results Two hundred one articles were eligible for inclusion in our study ( N = 11,918). Provox-2 was significantly the most efficient and safest device concerning the most patient preference (odds ratio [ OR ] = 33.88 [0.65, 1762.24]; p = .92), the least dislodgement (risk ratio [RR] = 0.27 [0.13, 0.57]; p = .79), the least airflow resistance (RR = 0.42 [0.08, 2.11]; p = .84), the least granulation formation (RR = 0.73 [0.02, 26.32]; p = .60), and the least VPs' inaccurate size (RR = 0.77 (0.23, 2.61); p = .66). Heat and moisture exchanger addition showed a significant increase in maximum phonation time and breathing experience, with p values (1 and .59), respectively. While heat and moisture exchanger addition showed a significant decline in stoma cleaning frequency, coughing frequency, forced expectoration, sputum production, sleeping problems, and loosening of adhesive, with p values (.99, .72, .69, .96, 1, and 0.96), respectively, Groningen low resistance and Nijdam were considered the worst devices with both overall mean p value of .44. Conclusions Provox-2 is considered the best choice as being the most preferable for patients, with the least airflow resistance, dislodgment, granulation formation, and prosthesis inaccurate size. Groningen low resistance and Nijdam were considered the worst devices according to our analysis. Supplemental Material https://doi.org/10.23641/asha.14802903

Laparoscopic Surgery in COVID-19 Era in a Tertiary Hospital in Nepal

Introduction: There is great concern and risk of transmission of COVID-19 infection from the aerosolized smoke during laparoscopic surgery although there is a lack of enough literature to prove this. To minimize these risks and get the benefi t of laparoscopic surgery, we used a low-cost fi ltration system connected to an underwater seal bag fi lled with a 5% sodium hypochlorite solution.Materials and Methods: This is a retrospective study of prospectively maintained data of cases of laparoscopic surgeries using a low-cost fi ltration device system connected with an underwater seal bag fi lled with 5% sodium hypochlorite solution. Use of personal protective equipment, minimal staff in operative theatre, preoperatively testing of patients before admission for surgery was done. During surgery, minimal use of electrocautery in low power setting maintaining low pneumoperitoneum and cautious desuffl ation of smoke during and end of the procedure from one of the trocars fi tted to heat and moisture exchanger Filter, connected through a tube to 5 % sodium hypochlorite solution in underwater seal bag was performed.Results: During the lockdown from May 2020 to October 2020, 41 elective laparoscopic surgeries were done. All patients were tested negative before the procedure. No staff in operation theatre developed symptoms of COVID-19 or tested positive for COVID-19 infection for up to 2 weeks period.Conclusions: In this Pandemic situation, we have to co-habit with this SARS-Cov-2 virus. Minimally invasive surgeries can be continued with safety measures with modifications like the use of low-cost filtration devices for smoke filtration and evacuation.

Humidification and the HME filter

The process of intubation and ventilation bypasses both the physiological humidification system and protective filtering processes. Various devices have been developed to aid in providing humidification of medical gasses and to serve as filters to reduce transmission of microbes. The following types of devices are available: * Heat and moisture exchanger without filter (HME) * Electrostatic filter with or without HME * Pleated filter with or without HME