A Novel Two Surgeons Approach to Bronchial Foreign Body Removal by Optical Instruments- An 11 Years Institutional Experience

Utility of Optical Forceps and Tracheotomy for Tracheobronchal Foreign Body

Tracheobronchial foreign body is a life-threatening situation where quick decisions need to be taken. The preparedness for the same can never be over emphasized. This study was undertaken to understand the preference and utility of various types of foreign body forceps. This is a retrospective study in a tertiary care center. Data over 5 years (2016-2021) was analyzed to understand the utility of the optical forceps and the conventional (standard) forceps in the current scenario. The difficult cases where tracheotomy was done were also studied. Observations: 109 bronchoscopies were done during this period. In 90 patients optical forceps was used, flexible fiberoptic bronchoscope was used in 10 situations to locate and confirm the foreign body (FB) before extraction with standard or optical forceps. In 2 adult patients flexible fiber optic bronchoscope with forceps was used to extract, peripheral lying FB (pin). Standard (conventional) forceps with size 3 bronchoscope was used in 13 patients who were below 1 year. There were 2 postoperative mortalities. Tracheotomy was done in 6 patients, 4 were repaired primarily and in 2 tracheostomy tube was inserted. Conclusion: Optical forceps took care of 86% of foreign body. The Standard forceps have stood the test of time and are still useful. Having flexible fiberoptic in the armamentarium is a necessity now with newer challenges. Large swollen FB which cannot be extracted through glottis should be removed with tracheotomy rather than struggling at the glottis-sub glottis and have a complete obstruction. The optical forceps, standard forceps, ventilating rigid bronchoscope, flexible fiberoptic bronchoscope, Dormia basket, Fogarty's catheter are necessary in the armamentarium of an otolaryngologist and are not replaceable for one another.