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Surgical techniques employed during a total laryngectomy can have a significant impact on the patient’s ability to produce tracheoesophageal voice, use HMEs and handsfree speaking valves. This webinar provides an overview of surgical techniques for tracheoesophageal puncture and stoma creation to achieve successful handsfree speech. It will also provide an overview of the decision-making process of when to perform a primary or secondary puncture, with respective advantages and disadvantages. Finally, it will address the medical and therapeutic techniques for handsfree speech troubleshooting and present the patient’s perspective. Timed agenda: 0-5 Welcome and introduction 5-25 Primary vs secondary puncture and VP placement: Assessment and patient selection, advantages and disadvantages 25-45 Surgical refinements and their impact on voice, stoma attachments and FreeHands Speech 45-75 Speech therapy to achieve handsfree speech including candidacy, success factors, timing, and practical approaches, and the patient perspective 75-90 Q & A Webinar learning outcomes: - Be aware about the advantages and disadvantages of primary VP placement - Describe how surgical decisions affect postoperative rehabilitation - Discuss protocols to optimize handsfree speech