Greetings, let us talk about another technique for foreign body retrieval and this time we will learn about a net, a retrieval net and a snare and these are my acknowledgements and today's learning objectives include, you know, the difference between a net and a snare and how do we use these two different devices. Retrieval net, the design is similar to a snare with the addition of a meshed net attached to the snare loop and the operation of this device is similar to what we use for all of the other devices in the endoscopy unit. You put your thumb in that ring and then the forefinger and the middle finger in the two slots on the slider and you open your hand, the net opens and if you close your hand, the net closes. If you open your hand, the net opens and if you close your hand, the net closes. Very simple. The net is frequently used after removing a large polyp that cannot be suctioned through the biopsy channel and in that case, we use a net to retrieve the polyp. When you're opening a net, it's important to open the net slowly and once the endoscopist puts the net over polyp tissue or resected tissue or a bunch of polyps, then he will ask you to close the net and in that case, make sure you close the net slowly so that it helps the endoscopist to make minor adjustments so as to avoid catching on to the mucosa. If you close the net fast and you catch the mucosa and the endoscopist pulls, he can rip the lining of the colon, so important to keep that thing in mind. The other thing is if clips were placed after resection of a polyp to prevent bleeding or perforation and you're trying to collect polyp tissue adjacent to that, you have to be very careful in slowly opening the net so that it avoids catching on to a clip. If you open the net very fast and the endoscopist did not have time to adjust where the net is opening, the net can catch on to a clip and it will become a mess. So keep that thing in mind. In addition to retrieval of polyps, a net can be used for removing food boluses from the stomach or from the esophagus. It can also be used for removing coins. So anything that can come into a net, large bulky items, not necessarily sharp items and pointed items. So in addition to the use of a net, sometimes we use a snare for removing polyps and removing foreign bodies. When it comes to removing polyps, you have to be careful as the snare is being brought out with the scope through the difficult portions of the colon like a sigmoid colon that has a lot of diverticulosis and narrowing. Sometimes you can lose that polyp. Hence it makes more sense to use a net to retrieve a polyp from the right colon. If it is in the rectum and you don't want to waste money, you can use a snare to pull that polyp out. When it comes to operation of a snare, again exactly similar technique that we have already talked about. After handling the device like is shown here, opening the hand opens the snare and closing the hand closes the snare. Again open, close. So when you give any device, you have to keep in mind that you give the device with the device enclosed in the sheet by keeping your hands closed. So here is an x-ray where a patient has swallowed a teaspoon and for long objects like this, a snare is a good way to get that long object as long as you can align that to the GA junction and the esophagus carefully. So we have learned about the use of a retrieval net and a snare. Retrieval net for removing polyps, food boluses and coins. Net can be used for long objects as well as for polyps. If you are assured that you are not going to drop that polyp as you are bringing it out through a narrow sigmoid colon with a lot of diverticulosis. Thank you.

retrieval net

snare

foreign body retrieval

polyps

colon