This guide will help you get ready for your total laryngectomy at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Show
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will refer to it as you learn more about your recovery. Back to topAbout Your SurgeryAbout your larynx (voice box)Your larynx is in your neck above your trachea (windpipe). It’s the entrance to your airway and is important in breathing, swallowing, and speaking.
About your total laryngectomyA total laryngectomy is a surgery to remove your whole larynx (see Figures 1 and 2). Figure 1. Before laryngectomy Figure 2. After laryngectomy After your surgery, you’ll need to adjust how you speak and breathe.
Your incisions (surgical cuts) will be closed with plastic or nylon sutures (stitches). The sutures will stay in place for about 2 weeks. They may be removed at your post-operative visit with your surgeon. If you’ve had radiation therapy to the area, they may need to stay in place for longer. The length of your surgery depends on which type of surgery and incisions you have. Your surgeon will talk with you about this before your surgery. We recognize that your upcoming surgery is life-changing. Your care team at MSK will help you through the process. Back to topGetting Ready for Your SurgeryThis section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready. As you read through this section, write down questions to ask your healthcare provider. Getting Ready for SurgeryYou and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.
About Drinking AlcoholThe amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
Here are things you can do before your surgery to keep from having problems:
About SmokingIf you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507. About Sleep ApneaSleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep. OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure. Using MyMSKMyMSK (my.mskcc.org) is your MSK patient portal account. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care. If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office. For help, watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593. Within 30 days of your surgeryPresurgical Testing (PST)Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location will be printed on the appointment reminder from your surgeon’s office. It’s helpful to bring the following things to your PST appointment:
You can eat and take your usual medications the day of your appointment. During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers. Talk with them to make sure you have an appointment to see a speech therapist in MSK’s Speech and Hearing Center. You should have this appointment before your surgery. Your NP will talk with you about which medications you should take the morning of your surgery. Identify Your CaregiverYour caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home. For Caregivers Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.mskcc.org/caregivers or read A Guide for Caregivers. Complete a Health Care Proxy FormIf you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment. A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
7 days before your surgeryFollow Your Healthcare Provider’s Instructions for Taking AspirinIf you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary SupplementsStop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Herbal Remedies and Cancer Treatment. 2 days before your surgeryStop Taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. NSAIDs can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. 1 day before your surgeryNote the Time of Your SurgeryA staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014. The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go. This will be one of the following locations:
Instructions for Eating Before Your Surgery The morning of your surgeryInstructions for Drinking Before Your Surgery You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else. Do not drink anything starting 2 hours before your scheduled arrival time. This includes water. Take Your Medications As InstructedA member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications. Things to remember
What to bring
Where To ParkMSK’s parking garage is on East 66th Street between York and 1st avenues. If you have questions about prices, call 212-639-2338. To reach the garage, turn onto East 66th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital. There are other parking garages located on:
Once you’re in the hospitalMany staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day. When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear. Meet With a NurseYou’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams. Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room. Meet With an AnesthesiologistYou’ll also meet with an anesthesiologist before surgery. They will:
Get Ready For Your SurgeryWhen it’s time for your surgery, you’ll need to remove your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles. You’ll either walk into the operating room or a staff member will bring you there a stretcher. A member of the operating room team will help you onto the operating bed. They’ll place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery. During your surgeryAfter you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You’ll also have a nasogastric (NG) tube placed through your nose into your stomach to deliver food and a urinary (Foley) catheter placed to drain urine (pee) from your bladder. Once your surgery is finished, your incisions will be closed with sutures (stitches). Your incisions may be covered with a bandage. Your breathing tube is usually taken out while you’re still in the operating room. Back to topRecovering After Your SurgeryThis section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home. As you read through this section, write down questions to ask your healthcare provider. In the Post-Anesthesia Care Unit (PACU)When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You’ll have a loose collar on your neck over your new stoma. This will deliver humidity and a small amount of extra oxygen to your lungs to keep the lining of your trachea moist. You’ll also have compression boots on your lower legs. Pain medicationYou’ll get IV pain medication while you’re in the PACU. You’ll be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA). Tubes and drainsYou’ll have the following tubes:
Moving to your hospital roomMost people stay in the PACU overnight. After your stay in the PACU, a staff member will take you to your hospital room. In your hospital roomThe length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 10 to 14 days. When you’re taken to your hospital room, you’ll meet one of the nurses who will care for you while you’re in the hospital. They’ll explain how to control the lights and TV in your room and introduce you to other staff members who will help care for you during your stay. Your nurse will also explain how to use the call bell system. It has an alert indicating you can’t speak. When you use the call bell, the person who answers will ask what you need. If no one is in your room to speak for you, a staff member will come to your room to help you. CommunicatingYou’ll get a dry erase board to write on and a point-to-talk communication board to help you communicate. iPads are also available for your use. About 3 to 5 days after your surgery, you’ll start using an electrolarynx to speak. About 2 to 3 weeks after your surgery, you can start learning to use other ways to speak, such as esophageal speech or tracheoesophageal speech. For more information about these communication options, read the section “Ways to communicate.” Managing your painYou’ll have some pain after your surgery. At first, you’ll get your pain medication through your IV line. You’ll be able to control your pain medication using a PCA device. Once you can get food through your NG tube, you’ll get your pain medication through your NG tube as well. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can move around. Controlling your pain will help you recover better. You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications. Moving around and walkingMoving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed. Eating and drinkingWhile you have an NG tubeYou’ll start getting water and nutrients through your NG tube the day after your surgery. Your NG tube will be removed once you can swallow liquids. This usually happens 8 to 10 days after surgery. If you had chemotherapy, radiation therapy, or other treatments before your surgery, your NG tube may need to stay in place for longer. You may also have an x-ray to make sure you’ve healed enough and are ready to start swallowing safely. After your NG tube is removedOnce your NG tube is removed, you’ll start by only drinking liquids. You’ll then slowly move on to puréed foods, then to soft solid foods, and eventually to solid foods. Your healthcare provider will tell you when and what types of liquids and food you can have based on how you’re healing. About swallowingSwallowing after a total laryngectomy is usually similar to the way you swallowed before your surgery. If you had trouble swallowing before your surgery, it may even be easier to swallow after surgery. At first, it might feel like food or liquid is sticking in your throat and not going down your esophagus. If this happens, you may need to use the back of your tongue to give the food a little extra push when you start to swallow. Tell your healthcare provider if you’re having trouble swallowing. They’ll refer you to a specialist who can help you with your speech and swallowing. Caring for your laryngectomy stomaRight after your surgery, your nurse will care for your stoma. Over time, they’ll teach you how to suction and care for your stoma yourself. Remember that you’ll be a neck breather, so you’ll need to keep your airway open to breathe. Suctioning your stoma will keep it free of secretions and mucus and allow air in and out of your lungs. Your nurse will teach you how to suction your stoma and how often to do this. Using a heat and moisture exchanger (HME)You’ll also need to keep your stoma and airway moist. The moisture will help you cough out secretions and mucus. It will also keep mucus from drying out and causing plugs that can block your breathing. Before your surgery, your nose and upper airway warmed and moisturized the air you breathed. After your surgery, you’ll use a HME to moisturize the air you breathe through your stoma. A HME is a small round device that you put over your stoma. There are different types of HMEs. Your nurse will help you find the one that works best for you. HMEs work best when you wear one all the time. While you’re in the hospital, use a HME or humidity collar as much as possible. We’ll also give you HMEs to use at home. Taking your HME out before you cough can help keep it clean. Put a new HME on your laryngectomy tube every day. Inspect your HME often, at least 3 times per day, to make sure it’s clean. If your HME is dirty, wipe it clean or change it. Never rinse it under water. It might seem like you have more mucus or are coughing more when you first start using an HME. This is normal. It might take a few days or weeks of using a HME before it seems to be helping. If you’ve been using a HME for 3 weeks and don’t feel like you’re making less mucus and coughing less, tell your healthcare provider. Your laryngectomy tubeYou’ll also get a soft plastic laryngectomy tube to keep the opening of your stoma from getting smaller (see Figure 3). Your healthcare provider will tell you how long you need to wear it. Figure 3. Laryngectomy tube Clean your laryngectomy tube regularly to help to keep it free of secretions. We recommend cleaning your tube at least twice a day or more as needed. Your nurse will show you how. For instructions for caring for your stoma and cleaning your laryngectomy tube, read the section “Caring for and suctioning your laryngectomy stoma.” ShoweringYour healthcare provider will tell you when you can shower. For most people, this is at least 1 week after surgery. Your nurse will give you a reusable shower shield to keep water from getting in your stoma when you shower. Bring it home when you’re discharged. Keep using it at home. Don’t take baths or submerge yourself under water. If you do, too much water can enter your stoma. If this happens, you can drown. Planning for your dischargeBefore you leave the hospital, your case manager will meet with you to determine what kind of help you’ll need at home. This may include a visiting nurse to reinforce what you learned about caring for your stoma while you were in the hospital. Your case manager will order a portable suction machine for you to use at home. The machine will be delivered to you while you’re still in the hospital. Your nurse will show you how to use it before you leave. Your nurse will give you supplies so you can care for and suction your stoma for a couple of days after you’re discharged. We’ll also send you a kit that has the supplies you need for your laryngectomy. Depending on what you need, you may have more supplies delivered to your home. You should also find a medical supply store near your home. At homeWe strongly recommend registering with the MedicAlert® Foundation and wearing a MedicAlert ID with the words “Neck breather” on it. This way, if you stop breathing, medical personnel will know to give you oxygen through your neck instead of through your mouth. Visit www.medicalert.org to register. Filling out your Recovery TrackerWe want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker. Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes. Your answers to these questions will help us understand how you’re feeling and what you need. Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read About Your Recovery Tracker. Managing your painPeople have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incisions for 6 months or longer. This doesn’t mean something is wrong. Follow these guidelines to help manage your pain at home.
Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual). Preventing and managing constipationTalk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.
If you haven’t had a bowel movement in 2 days, call your healthcare provider. Physical activity and exerciseYou can go back to doing most activities right after your surgery. Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your healthcare provider before starting more strenuous exercises. Don’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 2 weeks. Ask your healthcare provider how long to avoid heavy lifting. Don’t go swimming or use hot tubs or saunas. It’s also best to avoid being on small boats because they have a higher chance of rolling over. Managing your feelingsAfter surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200. The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness. When to call your healthcare providerCall your healthcare provider right away if:
Contact informationMonday through Friday from 9:00 a.m. to 5:00 p.m., contact your healthcare provider’s office. After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider. Caring for and suctioning your laryngectomy stomaYou and your caregiver will need to learn how to suction and care for your new stoma. Remember that you’ll be a neck breather, so it’s important to keep your airway open so you can breathe. Suctioning your stoma will keep it free of secretions and allow air in and out of your lungs. Your nurse will teach you how to suction your stoma and how often to do this. How to suction your laryngectomy stoma
Once you’re done:
While you’re at home, change the suction catheter every week or more often if it’s dirty or clogged. While you’re in the hospital, you’ll use a new catheter each time you suction. How to remove, clean, and reinsert your laryngectomy tubeClean your laryngectomy tube regularly to help to keep it free of secretions. We recommend cleaning it at least twice a day or more often as needed. Your nurse will show you how.
Ways to communicateYou’ll need to learn a new way of speaking after your total laryngectomy. There are 3 options:
All these options use an alternate sound source to make sound either outside your body using an electronic device or inside your body using the tissue and structures in your throat. The type of surgery you had will determine which of these options you can use. Your speech therapist will explain these options before your surgery. After your surgery, they’ll monitor your progress to help you decide what options are right for you. All these communication options require practice and time. ElectrolarynxAn electrolarynx is a device you put against your neck to make your voice (see Figure 7). To speak, you use your mouth, lips, and tongue to shape the sound, like you did before your laryngectomy. Figure 7. Using an electrolarynx The new voice made with the electrolarynx won’t sound the same as your old one. It will sound more electronic. With practice, it can become more natural, with your own speech patterns and accents. You can use an electrolarynx to speak as early as 3 to 5 days after your surgery. It’s easy to learn. Esophageal speechWith esophageal speech, you make sounds by pushing or swallowing air into your esophagus, then pushing it back up through your throat and out of your mouth while shaping the sound of words with your mouth. Esophageal speech sounds more natural than an electrolarynx, but it’s much harder to learn. It takes 3 to 6 months of training with a speech therapist. Not everyone can learn esophageal speech. The extent of your surgery and your healing will determine if it’s an option for you. Tracheoesophageal speechWith tracheoesophageal speech, your surgeon makes a hole between your trachea and esophagus using a procedure called a tracheoesophageal puncture (TEP). They can make the TEP during your laryngectomy surgery or as a separate procedure after you’ve healed. If it’s done as a separate procedure, it’s usually about 3 to 6 months after your total laryngectomy. Something must always stay in your TEP tract or it will close, like a cut. Your surgeon will place either a thin catheter (tube) or a TEP prosthesis in your TEP tract to keep it open. A TEP prosthesis is a valve that lets you speak when it’s open and lets you eat and drink without aspiration (food or liquid entering your lungs) when it’s closed. If your surgeon places a catheter in your TEP tract, your speech pathologist will replace it with a TEP prosthesis once the site has healed. This is usually about 10 to 12 days after the TEP is made. To make tracheoesophageal speech, you must breathe in and then cover your stoma (see Figure 8). The air from your lungs will be forced through the TEP prosthesis and into your throat. Your throat will vibrate to make sound (see Figure 9). Tracheoesophageal speech sounds similar to your speech before your laryngectomy. Figure 8. Blocking your stoma for TEP speech (front view) Figure 9. Blocking your stoma for TEP speech (side view) Emergency precautions for TEPIf you had a TEP, you’ll get a TEP Prosthesis Dislodgement Kit when you’re discharged from the hospital. This kit has written directions and different sized catheters in case your TEP prosthesis falls out. This isn’t likely to happen, but if it does, don’t panic. Follow the steps below.
If you can’t find the TEP prosthesis and think it may have fallen into your lungs:
If you can’t put a catheter into your TEP tract:
Support ServicesThis section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery. As you read through this section, write down questions to ask your healthcare provider. MSK Support ServicesVisit the Cancer Types section of MSK’s website at www.mskcc.org/types for more information. Admitting Office Anesthesia Blood Donor Room Bobst International
Center Caregivers
Clinic Counseling
Center Female
Sexual Medicine & Women’s Health Program Food Pantry Program Integrative Medicine
Service You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550. Male Sexual and Reproductive Medicine Program MSK
Library Nutrition Services Patient and Caregiver Education Patient and Caregiver Peer Support
Program Patient
Billing Patient Representative Office Perioperative Nurse
Liaison Private Duty Nurses and Companions Resources for Life After Cancer (RLAC) Program This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues. Social
Work Our social workers can also help refer you to community agencies and programs. They also have information about as financial resources, if you’re having trouble paying your bills. Spiritual Care MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call. Tobacco Treatment
Program Virtual Programs Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register. External support servicesAccess-A-Ride Air Charity
Network American Cancer Society (ACS) Cancer and Careers CancerCare Cancer Support Community Caregiver Action
Network Corporate Angel Network Gilda’s Club Good
Days Healthwell
Foundation Joe’s House LGBT Cancer Project LIVESTRONG Fertility
Look Good Feel Better
Program National Cancer
Institute National Cancer Legal Services Network National LGBT Cancer Network Needy Meds NYRx Partnership
for Prescription Assistance Patient Access Network Foundation Patient Advocate Foundation RxHope Laryngectomy, oral cancer, and head and neck cancer support servicesSupport for People with Oral and Head and Neck Cancer
(SPOHNC) Web Whispers Educational ResourcesThis section has the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery. As you read through these resources, write down questions to ask your healthcare provider.
Which of the following nursing intervention is a priority for a patient with laryngectomy?Airway maintenance
A priority for patients who have undergone a total laryngectomy is for them to learn how to care for their new airway. The lower airway is no longer connected to the upper airway, so patients must pay critical attention their only source of breathing—the stoma.
What is the communication technique for a patient after laryngectomy?Electrolarynx after a laryngectomy
An electrolarynx is a battery operated machine that produces sound for you to create a voice.
How do you handle a laryngectomy?Management of a patient with a laryngectomy stoma
Preoxygenation is performed over the laryngeal stoma and ventilation can be performed by placing a paediatric facemask over the stoma site. Other options are to place an inflated laryngeal mask airway or the end of a catheter mount over the stoma.
What happens after a total laryngectomy?If you have had all of your larynx removed (total laryngectomy), you will not be able to speak normally, because you'll no longer have vocal cords. There are a number of different ways you can learn to communicate again, although they can take weeks or months to learn.
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