Transoral Robotic-Assisted Removal of a Submucosal Pyriform Sinus Foreign Body

Submucosal foreign bodies of the medial pyriform sinus represent a challenge given limited visualization and difficult retraction with endoscopic approaches, and risk of injury to the recurrent laryngeal nerve with open approaches. Transoral robotic surgery (TORS) offers improved visualization and multiple working arms to facilitate retraction. We present a novel case utilizing the Da Vinci SP system for removal of an embedded fishbone of the medial pyriform sinus.

An 84-year-old woman presented with five days of odynophagia and globus sensation after swallowing a fish bone. Non-contrast computed tomography scan revealed a 3.0 cm submucosal object within the post-cricoid soft tissue. On initial rigid endoscopy, the foreign body was completely submucosal and could not be identified. She ultimately underwent robotic-assisted removal of the foreign body with the DaVinci SP system. Using the Feyh-Kastenbauer retractor with a laryngeal blade for exposure, the post-cricoid and medial pyriform mucosa were elevated in a submucosal plane superficial to the posterior cricoarytenoid muscle allowing for identification and removal of the foreign body. She resumed oral intake on postoperative day four and advanced to a regular diet. In-office laryngoscopy at two weeks demonstrated normal vocal fold mobility bilaterally.

TORS with the DaVinci SP system allows for greater access, visualization, and dexterity within the pyriform sinus than traditional endoscopic approaches while avoiding the morbidity of open surgery, making it an ideal option for embedded foreign bodies and other submucosal pathologies.