Congenital pyriform sinus fistula in a child: Transoral semiconductor laser cauterization and closure by nonabsorbable suture using the ORBEYE exoscope

Pyriform sinus fistula (PSF) is a congenital disease derived from the remnants of the third or fourth branchial cleft. Until now, open neck surgery has been the main curative treatment, but recent years have seen reports of cases treated using endoscopic oral fistulectomy, chemocauterization, or ablation. We used the ORBEYE 4K 3-dimensional surgical microscope system (Olympus, Japan) to cauterize the fistula cavity with a semiconductor laser and to close the fistula opening with a monofilament non-absorbent thread. The use of the ORBEYE exoscope, with which a good view of the surgical field can be shared with all surgical staff, and which provides a sufficient working space, has rarely been reported for PSF surgery, but indications for PSF cases are expected to increase in the future with the adoption of such methods. In addition, laser ablation of the fistula lumen alone poses an initial risk of influx of infection sources after surgery, so closure of the opening with nonabsorbable thread was considered important for improving curability.