A novel retrieval method using a Cusco speculum for large colorectal resection specimens following endoscopic treatment.

Endoscopic submucosal dissection (ESD) was performed for early rectal cancer in a 70-year-old man (●" Fig.1). The bulky tumor occupied nearly half of the lumen. As the forcible removal of the resected specimen from the rectum using only the retrieval net (Disposable Loop Retrieval Net; net diameter 40×75 mm; Meditalia, Palermo, Italy) could have resulted in its fragmentation, we decided to take a different approach. The endoscope was withdrawn from the patient’s body, so that it could be passed through a Cusco speculum (●" Fig.2). When the endoscope was reinserted into the rectum, the specimen was grasped with the retrieval net. The Cusco speculum was then carefully inserted into theanus to dilate the anal canal and retrieve the specimen (●" Fig.3;●" Video 1). The actual size of the specimen was 50×45mm in diameter and the height of the raised portionswas 25mm (●" Fig.4). In thisway, the specimen was retrieved undamaged and there were no complications due to the procedure. ESD is the gold standard for en bloc excision of large colorectal tumors. After ESD, the whole specimen must be retrieved in order to ensure that correct pathological evaluation can be performed. In the lower gastrointestinal tract, the anal canal is the narrowest portion because of the presence of the anal sphincter. During the retrieval process, the specimen can easily be fragmented because of the tightening force of this muscle. Various techniques have therefore been devised to retrieve large specimens without damaging them [1–3]. In this study, we used a Cusco speculum, which is frequently used in the obstetrics and gynecology department of any hospital and can be reused repeatedly. Furthermore, the procedure did not adversely affect the patient. It has been reported Fig.5 The large polyp that was also identified: a in endoscopic view; b following retrieval, when it was found to be approximately 50mm in diameter. Fig.2 The endoscope passing through a Cusco speculum, with the retrieval net inserted through the endoscope.