Tissue containment and recovery systems and methods

Abstract

The system provides a method for surgically removing tissue through small incision sites and / or body openings. [Solution] The tissue containment and containment system includes a primary chamber, and a secondary channel extending from this primary chamber is interconnected with the primary chamber. A tissue specimen is placed into the primary chamber through a first opening 12 while floating in a body cavity. The first opening is drawn in through a first incision or body opening, and a narrower secondary channel is positioned at a second incision or body opening. A second opening 14 provided at the end of the secondary channel allows observation of the tissue specimen in the primary chamber, which is being cut through the first opening, by a scope inserted through the secondary opening. Other systems and methods are provided for sealing the second opening to create a closed system that enables deployment, containment, volume reduction, and safe retrieval of the tissue specimen.

Description

Technical Field

[0001] This application relates to medical devices, and particularly describes a system and method for surgically removing tissue through a small incision site and / or body opening, and such a system includes a specimen containment bag.

[0002]

Description of Related Applications

Background Art

[0003] If necessary, a small incision is made in the patient to access surgically targeted tissue located within a body cavity. Surgically targeted tissue can also be accessed through a body opening without an initial incision. In some cases, the targeted tissue is accessed directly through an incision or body opening. In some cases, an access instrument system is placed within, across, at, and / or within an incision and / or body opening and positioned to retract tissue, expand, reshape, and / or isolate an incision or body opening. The access instrument system serves as a gate or portal for accessing targeted tissue located within or adjacent to a body cavity or body opening. The targeted tissue is dissected from adjacent and surrounding tissue using known surgical techniques or procedures. Once freed, the targeted tissue is in a state where it can be removed at any time through a small incision or body opening. If the targeted tissue is too large to be removed in its entirety, the size of the targeted tissue is reduced to partially remove the targeted tissue through a small incision. Ideally, the surgeon "cores out" or "peels the surface" of the targeted tissue to keep it in as integral a state as possible. However, in more than 50% of cases, the targeted tissue will break into multiple small pieces.

[0004] Reducing the size of a target tissue is called slicing. In slicing, the target tissue is cut into small pieces using a knife or electric slicer, and the tissue is then removed through a small incision. The small pieces of target tissue are removed from the patient through a small incision. When reducing the size of the target tissue so that it fits through a small incision, some pieces of tissue may be cut off and left in the patient's body. Therefore, slicing is contraindicated in cases of malignant tumors or endometriosis. When cancer is sliced, the cancer may spread malignant tissue and advance the stage of the cancer, which may increase the patient's mortality rate.

[0005] Hysterectomy is an example of a surgical procedure that may involve dissection. More than 500,000 hysterectomies are performed annually on women in the United States. Common reasons for a woman to undergo a hysterectomy include the presence of fibroid, cancer, endometriosis, or uterine prolapse. Approximately 200,000 of these hysterectomies are performed laparoscopically. If the uterus is too large (over 300g) to be removed through the vagina, or if the cervix remains in place, the size of the specimen must be reduced in order to remove it through an abdominal incision or vaginally. During myomectomy (fibroid removal), it may be necessary to use dissection techniques to remove large fibroids. During dissection, the target tissue (usually the uterus and sometimes adnexal structures) is brought to the surface of the abdominal wall, for example, using a tissue gripper, and its size is reduced using a blade before being removed from the pelvic cavity through an incision. Alternatively, the target tissue is removed through a body opening, such as the vagina. Fibroids or leiomyomas account for approximately 30–40% of hysterectomies. These are benign tumors of the uterus, and these fibroids or leiomyomas can cause heavy and painful bleeding. In the past, it was thought that these tumors could be missed cancers or leiomyosarcomas, affecting about 1 in 10,000 women. More recent data confirms an extremely high risk of missed malignancies among these tumors, estimated at 1 in 1,000–1 in 400. Because the risk is so high, many surgeons have begun to modify their techniques to perform a closed shredding process, enclosing the specimen in a bag rather than shredding without a bag in a process called open shredding, thereby containing the scattered fragments and preventing the spread and seeding of tumor cells.Many gynecologists' associations, including the American Association of Gynecologists (AAGL), the American Congress of Obstetricians (ACOG), and the Society of the American Oncology (SGO), have issued statements warning of the potential risks of open shredding. On April 17, 2014, the FDA issued a statement advising against the use of open, motorized shredding for hysterectomies and myomectomies for women undergoing these procedures for fibroid. The FDA also increased the estimated likelihood of malignancy to 1 in 350. For these reasons, there is a need for systems and methods to safely and effectively reduce tissue specimens. This invention relates to such safe systems and methods for both manual and motorized shredding performed in a closed system. [Overview of the Initiative]

[0006] According to one aspect of the present invention, a tissue storage bag is provided. The tissue storage bag has a first opening and a second opening connected to each other by a side wall of a soft material. The side wall constitutes a first internal compartment and a base, the base being configured to allow a tissue sample to be placed into the first internal compartment through the first opening and to support the tissue sample on the base. The side wall forms an elongated, hollow, sleeve-shaped neck extension which constitutes a second internal compartment having a proximal end connected to the first internal compartment and a distal end connected to the second opening. The second opening is in fluid communication with the second internal compartment. The second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to the side wall of the first internal compartment at the first side. The neck extension extends laterally away from the first longitudinal axis, which is defined by the radial plane of the first opening when the bag is in its non-flexible form. The second longitudinal axis is defined by the radial plane of the second opening when the bag is in its non-flexible form. The side wall has a width perpendicular to the first longitudinal axis and a length along the first longitudinal axis at the location of the first internal compartment, and the neck extension has a width perpendicular to the second longitudinal axis and a length along the second longitudinal axis. The width of the neck extension is smaller than the width of the first internal compartment. The proximal end of the neck extension forms an access path intersection between the first compartment and the second compartment at the location of the first internal compartment.

[0007] According to another aspect of the present invention, a tissue storage bag is provided. The tissue storage bag has a first opening and a second opening connected to each other by a side wall of a soft material. The side wall constitutes a first internal compartment and a base, the base being configured to allow a tissue sample to enter the first internal compartment through the first opening and to support the tissue sample on the base. The side wall forms an elongated, hollow, sleeve-shaped neck extension which constitutes a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening. The second opening is in fluid communication with the second internal compartment. The second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to the base of the first internal compartment. The neck extension extends along a first longitudinal axis defined by the radial plane of the first opening when the bag is in a non-flexible form, and along a second longitudinal axis defined by the radial plane of the second opening when the bag is in a non-flexible form. The side wall has a width perpendicular to the first longitudinal axis and a length along the first longitudinal axis at the location of the first internal compartment. The neck extension has a width perpendicular to the second longitudinal axis and a length along the second longitudinal axis. The width of the neck extension is smaller than the width of the first internal compartment. The proximal end of the neck extension forms an access path intersection between the first and second compartments at the location of the first internal compartment.

[0008] According to another aspect of the present invention, a containment container is provided. The containment container has a first opening provided at a first end, a second opening provided at a second end, and a side wall connecting the first opening and the second opening to each other. The side wall constitutes an interior extending between the first opening and the second opening. The side wall has a diameter and cross-section and length perpendicular to the longitudinal axis. The containment container further has at least one fastener connected to the side wall around the interior at a location between the first opening and the second opening. The fastener is configured to reduce the diameter of the side wall at the location of the fastener.

[0009] According to another aspect of the present invention, a method for deploying a tissue containment bag within a body cavity is provided. The method includes the step of preparing a tissue containment bag having a first opening and a second opening connected to each other by side walls of a soft material. The side walls constitute a first internal compartment and a base, the base being configured to allow a tissue specimen to enter the first internal compartment through the first opening and to support the tissue specimen on the base. The side walls form an elongated, hollow, sleeve-shaped neck extension that constitutes a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening. The second opening is in fluid communication with the second internal compartment. The second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to the first internal compartment. The neck extension extends outward from the first internal compartment when in deployment configuration. The neck extension has a retractable and feedable configuration. This method includes the step of inserting a tissue containment bag into a body cavity while it is in the feedable configuration. This method also includes the step of moving the neck extension from the feedable configuration to the deployed configuration within the body cavity.

[0010] According to another aspect of the present invention, a method for removing a tissue specimen from a body cavity is provided. The method includes the step of preparing a tissue containment bag having a first opening at a first end, a second opening at a second end, and a side wall connecting the first and second openings. The side wall constitutes an interior extending between the first and second openings and has a diameter and cross-section perpendicular to the longitudinal axis. The tissue containment bag has an elastic, compressible ring connected to the side wall coaxially with the second opening and configured to hold the second opening in an open position. The method includes the step of inserting the second opening and ring of the tissue containment bag into a body cavity by passing them through a body opening or incision. The method includes the step of inserting the tissue specimen into the tissue containment bag by passing it through the second opening. The method includes the step of moving the second opening and ring into the tissue containment bag, past the tissue specimen placed in the containment bag and toward the first opening, thereby placing the tissue specimen into the containment bag.

[0011] According to another aspect of the present invention, a method for performing a hysterectomy on a patient is provided. The method includes the step of making an abdominal incision and approaching the body cavity. The method includes the step of making the uterus movable within the body cavity. The method includes the step of preparing a tissue containment bag having a first opening and a second opening connected to each other by side walls of a soft material. The side walls constitute a first internal compartment and a base, the base being configured to allow a tissue specimen to enter the first internal compartment through the first opening and to support the tissue specimen on the base. The side walls form an elongated, hollow, sleeve-shaped neck extension that constitutes a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening. The second opening is in fluid communication with the second internal compartment. The second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to a first internal compartment. The neck extension extends outward from the first internal compartment when in the deployed position. The method includes the step of inserting the tissue containment bag into a body cavity. The method includes the step of inserting the uterus into the first opening of the tissue containment bag. The method includes the step of moving the neck extension into the deployed position. The method includes the step of pulling the second opening of the tissue containment bag out of the patient through the patient's vaginal canal while the first internal compartment remains positioned in the body cavity. The method includes the step of pulling the first opening of the tissue containment bag into an abdominal incision while the first internal compartment remains positioned in the body cavity. The method simultaneously includes the step of observing the uterus in the first internal compartment through the other of the first or second opening while reducing the volume of the uterus in the tissue containment bag through either the first or second opening. The method includes the step of removing the uterus from the patient.

[0012] According to another aspect of the present invention, a method for removing a tissue specimen from a body cavity is provided. The method includes the step of making an abdominal incision to approach the body cavity. The method includes the step of making the tissue specimen movable within the body cavity. The method includes the step of preparing a tissue containment bag having a first opening and a second opening connected to each other by side walls of a soft material. The side walls constitute an internal compartment. The side walls have a first external pocket on one side of the side wall and a second external pocket on the opposite side. The first and second pockets are located near the second opening. The method includes the step of inserting the tissue containment bag into the body cavity. The method includes the step of inserting the tissue specimen into the internal compartment by passing it through the first opening of the tissue containment bag. The method includes the step of folding and rolling the distal side wall of the first pocket and positioning the rolled side wall within the first pocket. The method includes the step of pushing the first pocket into the second pocket.

[0013] According to another aspect of the present invention, a method for extracting a tissue specimen from a body cavity is provided. The method includes the step of preparing a tissue containment bag having a first opening at a first end, a second opening at a second end, and a side wall connecting the first and second openings. The side wall has a diameter and cross-section perpendicular to the longitudinal axis and defines the length extending internally and between the first and second openings. The containment container has a plurality of fasteners connected to the side wall around the interior and spaced apart from each other along the length of the containment container between the first and second openings. Each fastener is configured to individually reduce the diameter of the side wall at the location of the fastener's position when operated. The method includes the step of inserting at least the second opening of the containment container into a body cavity. The method includes the step of passing a tissue specimen having the first diameter through the second opening into the interior of the containment container. The method includes the step of reducing the diameter of a tissue sample to a second diameter by activating one or more fasteners at the location of the tissue sample to reduce the diameter of the containment container. The method also includes the step of removing the tissue sample having the reduced second diameter.

Brief Description of the Drawings

[0014] [Figure 1A] It is a perspective view of the storage bag of the present invention seen from above. [Figure 1B] It is a perspective view of the storage bag of the present invention seen from above. [Figure 2] It is a perspective view of the storage bag of the present invention seen from above. [Figure 3A] It is a perspective view of the storage bag of the present invention seen from above. [Figure 3B] It is a perspective view of the storage bag of the present invention seen from above. [Figure 3C] It is a perspective view of the storage bag of the present invention seen from above. [Figure 4] It is a side view of the storage bag of the present invention. [Figure 5A] It is a perspective view of the storage bag of the present invention seen from above. [Figure 5B] It is a perspective view of the storage bag of the present invention seen from above. [Figure 6] It is a schematic diagram of the storage bag of the present invention located in the patient's body. [Figure 7A] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7B] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7C] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7D] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7E] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7F] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7G] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7H] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7I] It is a cross-sectional view of the storage bag of the present invention taken along line 7I of FIG. 7H. [Figure 7J] It is a perspective view of the storage bag of the present invention seen from above. [Figure 7K]This is a perspective view of the storage bag of the present invention as seen from above. [Figure 7L] This is a cross-sectional view of the storage bag of the present invention. [Figure 7M] This is a cross-sectional view of the storage bag of the present invention. [Figure 7N] This is a cross-sectional view of the storage bag of the present invention. [Figure 7O] This is a cross-sectional view of the storage bag of the present invention. [Figure 7P] This is a cross-sectional view of the storage bag of the present invention. [Figure 7Q] This is a schematic view of two retractors, a scope, a trocar, a tissue specimen, and the storage bag of the present invention located in a patient's body. [Figure 7R] This is a perspective view of the storage bag of the present invention as seen from above. [Figure 8A] This is a cross-sectional view of the storage bag of the present invention. [Figure 8B] This is a cross-sectional view of the storage bag of the present invention. [Figure 8C] This is a cross-sectional view of the storage bag of the present invention, showing a state where a part of the storage bag is rounded. [Figure 8D] This is a cross-sectional view of the storage bag of the present invention, showing a state where a part of the storage bag is rounded and inserted into the first pocket. [Figure 8E] This is a cross-sectional view of the storage bag of the present invention, showing a state where a part of the storage bag is rounded and inserted into the first and second pockets. [Figure 9] This is a cross-sectional view of the storage bag of the present invention with a binding end portion. [Figure 10] This is a cross-sectional view of the storage bag of the present invention with a sealed end portion. [Figure 11] This is a cross-sectional view of the storage bag of the present invention having an interlock-type releasable seal at one end. [Figure 12] This is a cross-sectional view of the storage bag of the present invention configured to be heat-sealed and a cross-sectional view of an instrument used for heat-sealing the storage bag. [Figure 13] This is a perspective view of the storage bag of the present invention as seen from above. [Figure 14A]This is a schematic diagram of a gripping device for drawing a specimen into the containment bag of the present invention. [Figure 14B] This is a schematic diagram of a specimen located inside the storage bag of the present invention and a gripping device that is grasping the second opening of the storage bag. [Figure 14C] A schematic diagram of a specimen located inside the containment bag of the present invention and a gripping device that is pulling the second opening of the containment bag inverted proximally beyond the specimen in order to place the specimen inside the containment bag. [Figure 15] This is a top-down perspective view of the storage bag of the present invention, which has two rings at one end. [Figure 16] This is a top-down perspective view of the storage bag of the present invention, which has seven openings. [Figure 17] This is a top-down perspective view of the storage bag of the present invention, which has four openings. [Figure 18A] This is a top-down perspective view of the storage bag of the present invention, which is equipped with a scope window. [Figure 18B] This is a cross-sectional view of the scope located at the scope window of the storage bag of the present invention. [Figure 19A] This is a top-down perspective view of the storage bag of the present invention, which is equipped with a sealing port. [Figure 19B] This is a cross-sectional view of a scope inserted beyond the sealing port of the containment bag of the present invention. [Figure 20] This is a schematic diagram of a trocar inserted into the opening of a containment bag at the tissue wall according to the present invention. [Figure 21] This is a schematic diagram of the proximal end and opening of the containment bag, which is drawn through the lumen of the trocar at the tissue wall according to the present invention. [Figure 22] This is a perspective view of the seal at the opening of the storage bag of the present invention, seen from above. [Figure 23] This is a perspective view from above of the trocar at the opening of the storage bag of the present invention. [Figure 24A] This is a top-down perspective view of the storage bag equipped with the channel of the present invention. [Figure 24B] This is a top-down perspective view of the storage bag equipped with the channel of the present invention. [Figure 24C]This is a cross-sectional view of a storage bag equipped with a channel according to the present invention. [Figure 25] This is a schematic diagram of the present invention concerning a containment bag and a blowing or gas injection system for a body cavity. [Figure 26] This is a schematic diagram of the double-walled storage bag and blowing system of the present invention. [Figure 27] This is a top-view perspective of the perforated storage bag of the present invention. [Figure 28] This is a top-down perspective view of the storage bag with the clip holder of the present invention. [Figure 29] This is a top view perspective of the storage bag with adhesive holder of the present invention. [Figure 30] This is a perspective view from above of the storage bag with the neck extension portion of the present invention turned inside out. [Figure 31] This is a top-view perspective of a storage bag equipped with an external pocket for the neck extension of the present invention. [Figure 32A] This is a schematic diagram of a specimen in a storage bag equipped with a drawstring according to the present invention. [Figure 32B] This is a schematic diagram of the present invention, showing a sample inside the storage bag with the drawstring activated to reduce the diameter of the bag and the sample. [Figure 32C] This is a schematic diagram of the present invention, showing a sample inside the storage bag with the drawstring activated to reduce the diameter of the bag and the sample. [Figure 33A] This is a schematic diagram of the knot pusher and drawstring in the opening configuration around the perimeter of the storage bag of the present invention. [Figure 33B] This is a schematic diagram of a knot pusher and drawstring in a reduced or operational form around the perimeter of the storage bag of the present invention. [Figure 34A] This is a schematic diagram of a specimen inside the containment bag of the present invention, showing the specimen inserted into the containment bag with a drawstring and a core removal device positioned across the body wall. [Figure 34B] This is a schematic diagram of a specimen inside the containment bag of the present invention, showing the drawstring in a retracted or operational state. [Figure 34C]This is a schematic diagram of a specimen inside the containment bag of the present invention, showing the drawstring in a retracted or operational state. [Figure 35A] This is a schematic diagram of a specimen inside the storage bag of the present invention, showing the state in which the drawstring and core removal device are initially inserted into the storage bag. [Figure 35B] This is a schematic diagram of a specimen inside the storage bag of the present invention, showing the drawstring in a retracted or operational position, and the core removal device being inserted into the storage bag for the second time. [Figure 35C] This is a schematic diagram of a specimen inside the containment bag of the present invention, showing the drawstring in a retracted or operational state. [Figure 36A] This is a schematic diagram of a specimen inside the storage bag of the present invention, showing the state in which the drawstring and core removal device are initially inserted into the storage bag. [Figure 36B] This is a schematic diagram of a specimen inside the storage bag of the present invention, showing the drawstring in a retracted or operational position, and the core removal device being inserted into the storage bag for the second time. [Figure 36C] This is a schematic diagram of a specimen inside the containment bag of the present invention, showing the drawstring in a retracted or operational state. [Modes for carrying out the invention]

[0015] Referring next to Figures 1A and 1B, the storage bag 10 of the present invention is shown. The storage bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The rings 18 and 20 are connected to the side wall 16 by housing the rings 18 and 20 in pockets formed by the side wall 16 itself and / or using adhesive. The side wall 16 is made of any suitable soft material, such as polymer, cloth, cloth-reinforced polymer, mesh, nylon, fiber, etc. The first opening 12 is larger or larger in diameter than the second opening 14, and the side wall 16 has a truncated cone shape. Thus, the first ring 18 is larger or larger in diameter than the second ring 20. The sidewall 16 is formed by heat-sealing the sidewall material, thereby forming one or more seams or joints longitudinally along the length of the bag 10. As shown in Figure 1B, the bag 10 may optionally have at least one fastener or clasp 22 connected to the sidewall 16 at the location between two rings 18,20. In one embodiment, the fastener 22 includes ring bands, girdles or thongs, tapes or other means known in the art that can tighten at least partially the sidewall 16 and reduce the diameter of the sidewall 16 at the location of the fastener 22. Other forms of fasteners 22 are included in the scope of the present invention. Multiple fasteners 22 can also be employed and spaced apart from one another along the longitudinal axis of the bag 10, which will be described in detail below. A single fastener 22 functions to reduce the diameter of the bag 10 at approximately midway between the two openings 12,14, thereby forming a base 24 for the bag 10, also called a bottom, floor, or semi-floor, which can support a surgical tissue specimen. Generally, the fastener 22 also functions to close the side walls 10, creating two compartments or chambers within the bag 10, namely a first proximal compartment 26 and a second distal compartment 28 separated from each other by the abdominal band.The fastener 22 is advantageously releaseable so that the lumen of the bag 10 is not interrupted from the first opening 12 to the second opening 14. To facilitate the placement and removal of the bag 10, the first tether and tag are preferably attached to the first ring 18, and the second tether and tag are preferably attached to the second ring 20. As shown in Figures 1A and 1B, the first opening 12 and the second opening 14 are coaxial or substantially aligned along the longitudinal axis of the bag 10 when the bag 10 is in its normal, non-flexible orientation, thereby forming a sleeve-like tubular structure.

[0016] For use, the containment bag 10 of the present invention is used for surgical procedures including the dissection and subsequent dissection of the uterus or other surgical targets. For use, first an incision is made in the patient's abdominal region, typically at the navel. The retractor is inserted into the incision.

[0017] A retractor (not shown) typically has a first ring and a second ring connected to each other by a soft side wall. The side wall forms a lumen connected to each other between the openings of the first ring and the second ring of the retractor. The second ring is elastic and compressible. When compressed, the second ring takes on an elongated oval shape, and this second ring is inserted into the abdominal cavity through an incision in the abdominal wall, which is preferably already expanded by injection or blown gas to create a surgical working space. If the second ring is no longer compressed to a low-profile state, it expands freely to its original high-profile form due to its own elasticity as a result of being made of appropriate material, structure and design. The side wall of the retractor connects the second ring to the first ring. When the second ring is placed in the patient's body, the side wall crosses the incision and the abdominal wall, while the first ring is located outside the patient's body above the abdominal wall. Because the lateral wall is relatively loose, small incisions tend to cause the lateral wall to arch inward toward the retractor lumen. The first ring is configured to roll down to retract and widen the opening in the abdominal wall. The first ring rolls itself back to wrap the lateral wall material around the first ring of the retractor, thereby reducing the length of the retractor. As the length of the retractor is reduced, the second ring is pulled toward the first ring. As the rolling of the first ring continues, the length of the lateral wall decreases, thereby increasing the tension on the lateral wall, which moves the lateral wall outward toward its cylindrical shape, thereby retracting the tissue and bringing it into contact with the outer surface of the lateral wall, thereby widening the opening in the abdominal wall. The first ring has an elongated oval-oval cross-sectional shape that facilitates the rolling of the lateral wall and prevents the lateral wall from rolling out compared to a ring with a circular cross-section. The sidewalls are made of polyurethane laminate or similar materials including woven or reinforced polymer materials to resist cuts or tears in the sidewalls.Various embodiments of an approach system to be included in or integrated into a shredding system, wherein the entire approach system, several parts of the approach system, or combinations of the approach system and / or its components are arranged to provide channels and / or substantially regions according to various embodiments of the present invention, as described in U.S. Patent Application No. 13 / 865,854 filed on April 18, 2013, No. 61 / 880,641 filed on September 20, 2013, No. 12 / 578,422 filed on October 13, 2009, No. 61 / 104,963 filed on October 13, 2008, No. 12 / 358,080 filed on January 22, 2009, and No. 11 / 374,188 filed on March 13, 2006. Specification No., Specification No. 11 / 683,821 filed on March 8, 2007, Specification No. 12 / 396,624 filed on March 3, 2009, Specification No. 14 / 209,161 filed on March 13, 2014, Specification No. 12 / 873,115 filed on August 31, 2010, Specification No. 12 / 840,989 filed on July 21, 2010, 2006 1 The disclosures described in U.S. Patent No. 11 / 548,758 filed on 12 October, U.S. Patent No. 10 / 516,198 filed on 30 November 2004, and U.S. Patent No. 10 / 666,579 filed on 17 September 2003 are incorporated herein by reference, and their contents are included as if they were contained herein.U.S. Patent Provisional Application No. 61 / 970,436, filed March 26, 2014; U.S. Patent Provisional Application No. 61 / 987,413, filed April 23, 2014; U.S. Patent Provisional Application No. 62 / 014,038, filed June 18, 2014; U.S. Patent Provisional Application No. 62 / 024,698, filed July 15, 2014; U.S. Patent Provisional Application No. 62 / 079,171, filed November 13, 2014; U.S. Patent Provisional Application No. 62 / 081,297, filed November 18, 2014; U.S. Patent Provisional Application No. 61 / 982,997, filed April 23, 2014; and U.S. Patent Provisional Application No. 62 / 107,107, filed January 23, 2015, are all incorporated herein by reference and their entire contents constitute part of this specification.

[0018] The retractor is inserted into the incision, and after widening the opening at the incision, the access port cap / platform is attached to the first ring of the retractor, thereby covering and sealing the opening created by the retractor. The access port cap preferably has one or more access ports, including a blowing port, and / or is preferably made of a permeable material, such as gel, that seals around the inserted instrument. The blowing gas is delivered across the incision sealed by the access port cap to blow the patient's abdominal cavity and create an expanded surgical working space. The body cavity is blown or inflated by delivering gas across the access port cap into the abdominal cavity. Instruments, such as grippers, scissors, scopes, and electrocautery / electrosurgical instruments, are inserted through the access port to dissect the uterus. These instruments are removed, and the access port cap / platform is removed.

[0019] For use, insert the bag 10 through the umbilical incision. Reattach the access port cap / platform to the first ring of the retractor and re-blow through the body cavity to allow visualization of the procedure with the access port cap / platform or a scope inserted through a secondary incision. Using the grasper, insert the dissected tissue specimen, such as the uterus, into the first opening 12 of the bag 10 while positioned in the abdominal cavity. The first opening 12 is larger than the second opening 14 of the bag 10, thereby facilitating the introduction of the tissue specimen. The round rings 18,20 are also flexible, and it is preferable to compress these rings into a low-profile shape suitable for insertion through small ports and / or incisions. Pull the tether attached to the first ring 18 to pass the larger of the first rings 18 through the umbilical incision. Remove the access port cap / platform and pull out the first rings 18 of the bag 10 and a portion of the side wall 16 located near the first rings 18 from the first incision. A portion of the side wall 16 covers the first ring of the retractor, and the access port cap / platform is reattached to the retractor, thereby trapping the bag between the access port cap / platform and the retractor ring. Since the uterus has been detached, the tether attached to the second ring 20 of the bag 10 is grasped from the now open vaginal canal. The second ring 20 of the bag 10 is pulled into the vaginal opening, and the second access port cap / platform is attached to the second ring 20. The second ring 20 is compressed to a low profile orientation to facilitate its removal. The access port cap / platform is small enough to fit onto the smaller second ring 20. The scope is inserted into the bag 10 through the second access port cap / platform. The second opening 14 is small so as to be dimensioned and shaped to allow insertion of a thin, long instrument for placement and / or observation along the vaginal canal, such as a scope or a powered or manual shredding instrument for shredding the uterus in the sac. In a variation, a trocar may be inserted through the second access port cap / platform, and a scope may be inserted through the trocar.In yet another embodiment, the access port cap / platform is not used, and the balloon catheter is inserted into the second opening 14 into which the scope is inserted. In yet another embodiment, the scope is inserted into the bag 10 without an access port cap / platform or retractor. In yet another embodiment, the retractor may be positioned inside the second opening 14 of the bag 10, and the vaginal canal may be retracted together with the bag 10 by the retractor. Alternatively, as a variation, the second opening 14 of the bag 10 is pulled through the lumen of the retractor, which is already positioned in place within the vaginal canal.

[0020] The shredding instrument is inserted through the first access port cap / platform, through the vaginal canal, and through the second opening 14 of the bag 10, and the shredding of the specimen is started under observation via the inserted scope, which advantageously provides an unobstructed view of the procedure. This procedure results in shredding through the umbilical or other incision site within the abdominal field. An alternative to shredding through the umbilical canal is shredding through the vaginal canal, which is described further below.

[0021] After the shredding, which is performed through the umbilical or other incision site, is completed, the bag 10 is removed from the patient by first removing the access port cap / platform at the vaginal canal, where it is attached to a small second ring 20. If a retractor is used at the vaginal opening, this is also removed. The second opening 14 of the bag is sealed prior to removal of the bag by various methods described in detail below. For example, by making a knot at the distal end of the bag 10, the side wall 16 near the second opening 14 is rolled up or tucked into one or more pockets or side wall 16. The first access port cap / platform and retractor are removed at the umbilical or other abdominal incision site, if either is used. With this second opening 14 of the bag sealed, the entire bag 10 is passed through the abdominal incision and removed from there. At the time of removal, the majority of the uterus or tissue specimen has already been removed or reduced in size by the shredding process which facilitates the removal of the larger specimen. By sealing the second opening 14 prior to removing the bag, the contents of the bag are prevented from spilling out. Therefore, the system remains completely sealed.

[0022] In another form of retraction performed through the umbilicus or another abdominal location, the bag 10 is inserted into the body cavity and the specimen is inserted into the first opening 12. The access port cap / platform is removed from the retractor and the retractor is further withdrawn before the first ring 18 is retracted to the patient's abdominal surface. The first ring 18 is then squeezed into a low-profile form and the proximal portion of the bag 10 is pulled out through the umbilicus together with the rest of the bag, in which case the specimen in this portion remains located in the abdominal cavity. The retractor is reinserted into the opening of the bag 10 and then, favorably, the tissue is retracted together with the side wall 16 of the bag 10 as shown in Figure 6. The access port cap / platform is reattached to the retractor ring as shown in Figure 6. The proximal portion of the bag 10 covers the retractor and the first ring 18 of the bag 10 is located outside the patient's body.

[0023] As an alternative to dissection performed through the umbilical region, a tissue specimen, such as a uterine dissection, performed through the vaginal canal is described next. Insert the bag 10 through an incision in the umbilical region or another abdominal location. It is preferable to insert the retractor into the incision and retract the surrounding tissue. Reattach the access port cap / platform to the first ring of the retractor and blow through the body cavity again to allow visualization of the procedure with the access port cap / platform or a scope inserted through a secondary incision. Insert the dissected tissue specimen, such as the uterine region, into the first opening 12 of the bag 10 using the grasper. Pull the tether attached to the first ring 18 to pass the large first ring 18 through the vaginal canal rather than through the abdominal incision. Pull out the first ring 18 of the bag 10 and a portion of the side wall 16 located near the first ring 18 from the vaginal canal. Insert the retractor into the first opening 12 of the bag 10 and retract the vaginal canal together with the bag 10 at the placement of the retractor by rolling the first ring itself and wrapping its side wall around the first ring of the retractor. Attach the access port cap / platform to the retractor ring. As a variation, the retractor may be placed before the bag 10 is pulled through the vaginal opening, in which case the access port cap / platform captures the bag 10 in contact with the first ring of the retractor. Grasp the tether attached to the small second ring 20 of the bag 10 from the umbilical incision or other abdominal incision. Pull the second ring 20 of the bag 10 through the umbilical incision or other abdominal incision and attach the second access port cap / platform to the second ring 20. The second access port cap / platform is small to fit the second ring which is smaller than the first access port cap / platform. The scope is inserted into bag 10 through the second access port cap / platform, thereby observing the shredding process. As a variation, a trocar may be inserted through the second access port cap / platform, and the scope may be inserted through the trocar.As a variation, a balloon trocar may be employed without an access port cap / platform or retractor, or the scope may simply be inserted into the bag 10 at a second opening 14 located at the umbilicus or other incision. The shredder is inserted through the first access port cap / platform and the vaginal canal, and the shredding of the specimen is started under observation through the scope inserted through the vaginal canal and the second opening 14 of the bag 10, advantageously providing an unobstructed view of the procedure. The bag 10 is removed from the patient by removing the first access port cap / platform attached to the retractor at the vaginal opening. The retractor at the vaginal opening is also removed. Any retractor or second access port cap / platform at the second opening 14 is removed. The second opening 14 of the bag 10 is sealed by various methods described in detail below. For example, it is preferable to roll up or curl the side wall 16 located near the second opening 14 and tuck it in, or to tie a knot in the side wall 16. With the second opening 14 sealed, the entire bag 10 is removed by passing it through the vaginal canal. At the time of removal, most of the uterus or tissue specimen has already been removed or reduced in size by the mincing process.

[0024] Next, with reference to Figure 2, another form of the storage bag 10 will be described below using the same reference numerals to indicate the same parts of the present invention. The bag 10 of Figure 2 can also be used in any one or more of the methods described above. The bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The rings 18, 20 are connected to the side wall 16 by housing the rings 18, 20 in pockets formed by the side wall 16 itself and / or using adhesive. The side wall 16 is made of any suitable soft material, such as polymer, cloth, cloth-reinforced polymer, mesh, nylon, fiber, etc. The first opening 12 is larger or larger in diameter than the second opening 14, and therefore the first ring 18 is larger or larger in diameter than the second ring 20. The side wall 16 is funnel-shaped, thereby dividing the lumen of the bag 10 into a first compartment 26 and a second compartment 28. The first compartment 26 has a curved side wall and is substantially parabolic funnel-shaped when the bag 10 is in its natural, non-flexed orientation. The side wall 16 is formed by heat-sealing the side wall material longitudinally to form one or more seams along the length of the bag 10. At the intersection of the first compartment 26 and the second compartment 28, a narrow-diameter local introduction channel 30 is provided, which advantageously reduces the amount of specimen passing through it, thereby creating a base 24 for the bag 10, also called a bottom, floor, or semi-floor, that can support surgical tissue specimens, and the narrow-diameter introduction channel prevents tissue specimens from easily moving into the second compartment 28. The curved side wall 16 helps to hold the specimen at the base 24, thereby forming a reservoir-like shape.From the intersection 30 to the second opening 14, the cross-section of this opening is substantially constant and / or gradually increases or decreases, thereby dimensioning and shaping it so that it can be positioned through the vaginal canal, and forming a tubular sleeve-like section of the bag 10 that is extremely narrow compared to the first compartment 26, which has a large cross-sectional opening along the first compartment 26. The first tether and tag are preferably attached to the first ring 18, and the second tether and tag are preferably attached to the second ring 20, thereby facilitating the positioning and removal of the bag 10.

[0025] Next, referring to Figures 3A to 3C, another storage bag 10 of the present invention is shown. The storage bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The rings 18 and 20 are connected to the side wall 16 by housing the rings 18 and 20 in pockets formed by the side wall 16 and / or by adhesive. The side wall 16 is made of any suitable soft material, such as polymer, cloth, cloth-reinforced polymer, mesh, nylon, fiber, etc. The first opening 12 is larger than the second opening 14, and the side wall 16 has a truncated cone shape. Thus, the first ring 18 is larger or larger in diameter than the second ring 20. The sidewall 16 is formed by heat-sealing the sidewall material, thereby forming one or more seams or joints longitudinally along the length of the bag 10. The bag 10 has one or more inwardly extending lateral seams 32 that reduce the diameter of the lumen of the bag 10 at the location between the first opening 12 and the second opening 14. The seams 32 are formed in the sidewall 16 by selectively hot-sealing several portions of the sidewall 16 to each other, thereby reducing the diameter of the sidewall 16 at the location of the seams. Four seams 32 spaced apart around the sidewall 16 are shown in Figure 3B, and two seams 32 are shown in Figure 3C positioned opposite each other. The seams 32 reduce the diameter of the bag 10 at any location, including the midpoint between the two openings 12, 14, and as a result, form a base 24 for the bag 10, also called a bottom, floor, or semi-floor, which can support a surgical tissue specimen. Generally, the seam 32 functions to close the side wall 16 and to form two compartments within the bag 10, namely a first proximal compartment 26 and a second distal compartment 28 separated from each other by the seam 32.A diameter-reducing introduction passage 30 is provided at the intersection of the first compartment 26 and the second compartment 28, which advantageously reduces the amount of sample passing through it, thereby creating a base 24 or semi-base. The first tether and tag are preferably attached to the first ring 18, and the second tether and tag are preferably attached to the second ring 20, thereby facilitating the placement of the bag 10 and facilitating its removal.

[0026] Referring next to Figure 4, the containment bag 10 is shown for the purpose of illustrating various dimensions of the bag 10 of the present invention. Such dimensions are not limited to the form of the bag 10 itself, and substantially the same dimensions can be used for any one or more variations of the bag disclosed herein. The length A of the bag 10 is approximately 20.0 inches (50.8 cm). The diameter B at the first opening 12 is approximately 9.0 inches (22.86 cm). The diameter C at the second opening 14 is approximately 5.0 inches (12.7 cm). The distance D from the second opening 14 to the seam 32 or fastener 22 is approximately 8.0 inches (20.32 cm). The diameter G of the entry channel 30 is approximately 1.5 inches (3.81 cm). The rings 18,20 are made of a plastic that is rigid, elastic, and flexible, and can take on a high-profile expanded form in a normal, undeformed state when relaxed, and a low-profile compressed form. The low-profile form is elongated and oval with reduced sides at the opening, and is configured to be easily inserted through a small incision. The high-profile form is substantially circular, but may be of any shape. The rings 18,20 support the cyst sidewall 16 and open the cyst sidewall 16 when the rings 18,20 are moving from the low-profile form to the high-profile form. The rings 18,20 are elastic, and these rings tend to spring back to their non-deformed high-profile form. The physician can easily compress the rings 18,20 to reduce their size so that they can be inserted into the body cavity through an incision.

[0027] Referring now to Figures 5A and 5B, another modification of the storage bag 10 is shown, where the same reference numerals are used to indicate the same parts. The storage bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The rings 18 and 20 are connected to the side wall 16 by housing them in pockets formed, for example, by the side wall 16 which is heat-healed itself and / or by adhesive. The side wall 16 is made of any suitable soft material, such as polymer, cloth, cloth-reinforced polymer, mesh, nylon, or fiber. The first opening 12 is larger or larger in diameter than the second opening 14, and the side wall 16 has a truncated cone shape. Therefore, the first ring 18 is larger or larger in diameter than the second ring 20. The sidewall 16 is formed by heat-sealing the sidewall material, thereby forming one or more seams or joints longitudinally along the length of the bag 10. As shown in Figures 5A and 5B, the bag 10 is formed into a first compartment 26 and a second compartment 28, with an access passage 30 formed at the intersection of these compartments. The first compartment 26 has a proximal section that is substantially cylindrical in shape, with a vertical sidewall 16 connected to a distal section that is funnel-shaped, which has an inclined sidewall 16 when the bag 10 is in the normal non-flexed orientation as shown. The funnel-shaped distal section is connected to the second compartment 28 via the access passage 30. The access passage 30 is dimensioned and shaped to allow a scope to pass through. The scope is typically inserted into the second compartment 28 through the second opening 14, and such scope is extended all the way to near the access path 30 for observation of the cuttings performed in the first compartment 26.Therefore, the entry passage 30 is dimensioned to be as small in diameter as possible to form a base 24 large enough to support the specimen and receive the scope shaft, while preventing the specimen from escaping from the first compartment 26. The inclined side wall 16 of the funnel-shaped distal section of the first compartment 26 forms a base 24, also called a bottom, floor, or semi-floor, for a bag 10 that can support a surgical tissue specimen. The entry passage 30 is small in diameter, approximately the same as the diameter of a 5-10 mm scope. In the modified example shown in Figure 5B, the diameter of the entry passage 30 is smaller than the diameter of the second opening 14. The larger diameter at the second opening 14 compared to the diameter at the entry passage 30 facilitates the raising of the second ring 20 while it is rolling up or curling itself, thereby reducing the length of the second compartment 28. A third ring (not shown) may be provided further near the second ring 20, and the second ring 20 and the third ring may function as the same integrated, built-in retractor as described above. The second opening 14, which is larger in diameter than the diameter of the entry passage 30, also facilitates instrument insertion and tissue retraction. The side wall 16 of the second compartment 28 gradually slopes outward with increasing distance from the entry passage 30 to the second opening 14. The bag 10 in Figures 5A and 5B is shown with a sealing mechanism 34 configured to seal the second opening 14 and prevent specimens from leaking out of the bag 10. Various possible sealing mechanisms 34 that may be included in this configuration and any modifications of the containment bag 10 are described in detail below. A first tether / tag 36 may be attached to the first ring 18, and a second tether / tag 38 may be attached to the second ring 20, thereby facilitating the placement and removal of the bag 10.

[0028] Next, referring to Figures 7A to 7R, the storage bag 10 of the present invention is shown. The storage bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The rings 18 and 20 are connected to the side wall 16 by, for example, heat-sealing the rings 18 and 20 themselves and / or by adhesive to the pocket formed by the side wall 16. The side wall 16 is made of any suitable soft material, such as polymer, cloth, cloth-reinforced polymer, mesh, nylon, fiber, etc. The first opening 12 is larger or larger in diameter than the second opening 14. The side wall 16 is shaped like a teapot, in which case the second opening 14 forms an opening at the spout or neck of the container. The side wall 16 has a base 24 configured to support a tissue sample. Unlike the above-described embodiment in which the first opening 12 and the second opening 14 are substantially coaxial or parallel to each other along the longitudinal axis of the bag 10 when the bag 10 is placed flat or suspended in the air in an unbent orientation, in this modification, the first opening 12 and the second opening 14 are adjacent to each other, or parallel to each other, or have longitudinal axes at an angle to each other, in which case the first ring 18 defines a first longitudinal central axis perpendicular to the radial plane of the ring 18 and / or opening 12, and the second ring 20 defines a second longitudinal central axis perpendicular to the radial plane of the ring 18 and / or opening 14. The openings 12, 14 are eccentric to each other or not concentric to each other. The base 24 is provided with a first side 40 and a second side 42 relative to the base and the first opening 12. The second opening 14 is formed in the first side 40 of the bag 10. The first side 40 of the bag 10 can form an extension neck 44 of various dimensions, shapes, lengths and positional locations relative to the side 40 and the base 24. In Figure 7A, the second opening 14 is slightly lower than the first opening 12 when measured from the base 24.In Figure 7B, the second opening 14 is at approximately the same height as the first opening 12 when viewed from the base 24. In Figure 7C, the second opening 14 is higher than the first opening 12 when viewed from the base 24, and this second opening also has a slender, elongated neck extension 44 leading to the second opening 14, compared to the short neck extension 44 shown in Figures 7A, 7B, and 7D. In Figure 7E, the neck extension 44 is positioned near the base 24 at the bottom of the side 40. The angle of the neck extension 44 relative to the base 24 in Figure 7E is smaller than the angle of the neck extension 44 relative to the base 24 in Figures 7A, 7B, 7C, or 7D. In one such modification in Figure 7E, one side of the neck extension 44 is continuous with the base 24, thereby forming a large-diameter effective base. The angle of the neck extension 44 is substantially equal to that of the base 24, and the neck extension 44 is positioned at a certain distance or height from the base 24. In Figure 7F, the neck extension 44 is positioned in the middle of the side 40. In this configuration, the base 24 forms a large bowl with wide sides to accommodate the specimen 16 and, advantageously, to prevent the specimen from moving into the neck extension 44. In Figure 7G, the neck extension is positioned at the top of the side 40 near the first opening 12 and at a long distance from the base 24. Still referring to Figures 7A to 7R, the dimensions of the intersection with the entry passage 30 or the neck extension 44 may vary. For example, in Figure 7A, the entry passage is larger in diameter than in Figure 7B, as is the difference between the entry passages in Figures 7C and 7D. In Figure 7F, the access path 30 is extremely small in diameter and is located substantially intermediate between the first opening 12 and the base 24 or along the first side 40. In Figure 7E, the access path 30 is located near the base 24 and is continuous with it. In Figure 7G, the access path 30 is located near the first opening 12.

[0029] Next, various tethers / tags and their various forms will be described below with reference to Figures 7H to 7P. Each bag 10 has at least one of a first tether 36 with a tag as an option associated with a first opening 12 and a second tether 38 with a tag as an option associated with a second opening 14. Some figures in this description do not show tethers, show one tether at the first opening and one tether at the second opening, or show tethers at both the first and second openings, but the present invention is not limited to these, and any number of tethers and combinations are within the scope of the present invention, regardless of whether the figures show such combinations of various tether placement locations, and whether they are shown without tethers or with tethers. Examples of tethers include strings, such as strings made of nylon, tabs, films, tapes, leads, etc. A tag is attached to the proximal end of the string. The tag is a piece of plastic that facilitates the identification and grasping of the location of the tether. A tether may or may not include a tab. Furthermore, the term "tether" is used interchangeably with the term "tab," or vice versa. In Figure 7B, the first tab 36 is shown at the second side 42, and the second tab 38 is shown at the second opening 14. In one embodiment, the first tab 36 is connected to the first ring 18, and the second tab 38 is connected to the second ring 20.

[0030] In Figure 7H, the first tab 36 is interconnected with the second tab 38, with the first tab positioned at the first opening 12 and emerging at the first side 40, and the second tab 38 extending along the neck extension 44 and emerging at the second opening 14. In Figure 7H, the first tab 36 and the second tab 38 are the same tab, with the free end of such tab extending from the bag 10 and having a tag as shown, which may or may not be fixedly attached to their respective corresponding rings 18, 20. In another embodiment, the first tab 36 and the second tab 38 have separate tags. One or more tabs are fixed to the bag 10 and / or their respective rings 18, 20. Naturally, as described above, the tabs may be tags, strings, tethers, films, tapes, leads, etc. Figure 7I shows an enlarged cross-section of the second opening 14 in Figure 7H, in which case the second tab 38 is wrapped around the second ring 20 before it emerges at the second opening 14. The first tab 36 is also preferably wrapped around the first ring 18 in a similar manner. In a modified example where the first tab 36 and the second tab 38 are separate tabs, the first tab 36 is preferably connected to the first ring 18, and such first tab does not extend along the first side 40 of the bag 10. In another modified example where the first tab 36 and the second tab 38 are separate tabs, the first tab 36 is fixed to the first ring 18 and / or the side wall 16, and if such first tab is fixed to the side wall 16, it is preferable that it extends along the side wall 16 for any distance. In one configuration, the first tab 36 extends along the first lateral portion 40 of the side wall 16 to near the intersection of the side wall 16 and the neck extension 44. This configuration is advantageous because when the first tab 36 is pulled, the portion of the side wall 16 located above the neck extension 44 is pulled upward, thereby bringing the bag 10 closer to the abdominal wall and pushing that portion of the side wall 16 above the neck extension 44 together with it, thereby facilitating the removal of the bag 10 from the abdominal cavity. Alternatively, the second tab 38 extends along only a portion of the neck extension 44.The neck extension 44 is a separate tubular, sleeve-shaped arm that branches off from the main first compartment 26 of the bag and extends laterally outward from the side wall 16 in a straight or oblique direction, connecting the second opening 14 to the first compartment 26 via an intersection called an entry passage 30 located between the first opening 12 and the second opening 14.

[0031] In Figure 7J, the bag 10 has a first tab 36 located at the second side portion 42 and extending out at the first opening 12, and a second tab 38 extending out at the second opening 14. The second tab 38 extends along the bottom of the neck extension portion 44 and extends continuously along the base portion 24 as shown, and such second tab may or may not be interconnected with the first tab 36.

[0032] In Figure 7K, the bag 10 has a first tab 36 located at the first opening 12 of the second side portion 42, which is adjacent to and above the neck extension 44, and a second tab 38 located at the second opening 14. The second tab 38 extends along the length of the neck extension 44 and extends upward along the first side portion 40 to the first opening 12, but does not extend beyond the first opening 12. Also, Figure 7K shows a relatively large and deep sample receiving portion when viewed laterally and vertically, because the base portion 24 extends continuously into the neck extension 44 to the first side portion 40. The first side portion 40 is shown in Figure 7K extending from the first opening 12 for approximately one-third of the length of the first side portion 40, in which case the sample receiving portion extends upward from the base portion 24 for approximately two-thirds of the length of the first side portion 40. In the configuration in which the base 24 is continuous with the neck extension 44, the provision of such a large specimen receiving section prevents twisting of the neck extension 44, because the diameter of the neck extension 44 at the second opening 14 is smaller compared to the width of the neck extension 44 at the introduction passage 30 formed by the intersection of the neck extension 44 and the first side portion 40. Thus, the neck extension 44 flares outward or increases in diameter as the distance toward the bag 10 increases, and decreases in size or diameter as the distance toward the second opening 14 increases. A scope inserted through the second opening 14 can have its distal end positioned close to the base 24, thereby allowing observation of careful shredding progressing without damaging the bag wall. Furthermore, a zero-degree scope can be easily employed to observe the shredding process occurring inside the bag. Referring back to Figure 7F, we see that the neck extension 44 has a width or diameter at the second opening 14 that is approximately the same as the width or diameter at the entry passage 30 formed by the intersection of the neck extension 44 and the first side portion 40. The wider entry passage 30 advantageously provides a wide specimen observation and receiving area and further minimizes the twisting of the neck extension 44 itself.

[0033] Next, with reference to Figures 7L and 7M, the configuration of the tabs for the bag 10 will be described in detail, although the neck extension 44 is shown for illustrative purposes only and the same configuration can be used anywhere in the bag 10 where the tabs are placed, such as the side wall 16, the first side 40 and the second side 42. The side wall 16 has primary seams 46a, 46b formed along the edge of the bag. The primary seams 46a, 46b are formed by adhesive and / or by hot sealing the two sides of the bag side wall 16 together. The primary seams 46a, 46b help to define the shape of the bag 10. A secondary seam 48 is shown adjacent to and spaced from the primary seam 46a, thereby forming a channel 50 for the tabs 36, 38. Naturally, primary seams 46a, 46b may not be provided in some areas of the bag 10, in which case a secondary seam 48 is formed near the edge of the side wall 16. The tabs 36, 38 may be fixed within the channel 50 or may be freely translated within the channel 50. Figure 7M shows the axis of the tab 38 which defines the axis of rotation as the center around which the neck extension 44 tends to rotate. The presence of the tab 38 at the neck extension 44 is advantageous because the rotated or twisted neck extension 44 can be quickly straightened by simply pulling the tether 38 at the proximal end where the tag is located. The tab 38 can be located anywhere around the neck extension 44. In one embodiment, the tab 38 is provided along at least a portion of the top of the neck extension 44. In this embodiment, advantageously, the second tab 38 can be lifted by lifting the tag at the end of the tab 38, which causes the remainder of the neck extension 44, which is wound or tangled around the longitudinal axis of the neck extension 44, to spread out relatively downward and not rotate, thereby opening the lumen of the neck extension 44. Spreading or untangling the neck extension 44 is preferably done while the neck extension 44 is positioned in the patient cavity in the blown state and before the second ring 20 is pulled to a position, for example, through an incision or body cavity, for example, the vagina.After the second ring 20 is positioned outside the patient's body, unwinding the neck extension 44 becomes difficult due to pressure applied to the neck extension 44 from adjacent tissue edges. Tabs 38 along at least a portion of the neck extension 44 greatly assist in quickly orienting and positioning the neck extension relative to anatomical structures. Pulling or lifting the tabs 38 unwinds the neck extension 44 and prevents it from obstructing the scope while the scope is inserted and further while the scope is observing the specimen. Tabs 36,38 are preferably colored in a contrasting color to the rest of the bag side wall, so that the user can observe the tabs 36,38 to determine if the neck extension 44 is in the correct position. For example, the user can see the colored tabs 36,38 and, for example, if these tabs are oriented along the bottom end of the neck extension 44 or form a straight line, the user can see that there is one or two twists in the neck extension 44 and that the tabs 36,38 need to be drawn so that they form a straight line along the top of the neck extension 44. Instead of the tabs 36,38 which serve as an indicator of whether the bag 10 is properly oriented, the bag 10 itself may have contrasting color indicator markers, such as lines and arrows, printed on it, thereby providing the user with information about the position of the bag 10 and / or the neck extension 44.

[0034] In another embodiment, referring to Figure 24A, the channel 50 along the neck extension 44 is preferably connected to a fluid supply source, which, when delivered into the channel 50, expands the neck extension 44 to the correct orientation and direction. The channel 50 may extend only along the neck extension 44 of the bag 10 or only along the side wall 16. In Figure 24A, the channel 50 is shown extending along both the neck extension 44 and the side wall 16 from the second opening 14 to the first opening 12. The proximal end of the channel 50 may have a connector 124 configured to be connectable to a fluid supply source and located outside the patient's body, for example, near the first opening 12 as shown in Figure 24B or near the second opening 14 as shown in Figure 24A. In both Figures 24A and 24B, the channel 50 extends from the first opening 12 to the second opening 14. The channel 50 can be used in any form of the bag 10 described herein, and the channel is not limited to two sleeve-shaped headed bags as shown in Figures 24A and 24B. One or more channels 50 may be connected to each other or separated from each other. Although the channel 50 is shown as straight, these channels may form a pattern suitable for blowing or have a plurality of spaced-apart rings around the neck extension 44 or other part of the bag 10. The channel 50 is formed by heat-sealing parts of the bag together as described above to form a primary seam 46 and a secondary seam 48 as shown in Figure 24C. The channel 50 may be a separate tube attached to the bag 10 internally or externally.

[0035] In another configuration, a connector 124 configured to perform one or more of the following functions is provided at or near the first opening 12 at the proximal end of the bag, such functions are to inflate the bag 10 by blowing into it, to inflate the second bag 10 by blowing into it, to inflate the inner bag by blowing into it, to inflate the outer bag by blowing into it, to inflate the abdominal cavity by blowing into it, and to inflate the channel 50 by blowing into it. For example, as shown in Figure 25, a Y-shaped connector 124 connected to a blown fluid source can split the blown fluid between the inside of the bag 10 and the abdominal cavity 74 located outside the bag 10 via the trocar 90 or blown needle. An optional access port cap / platform 76 can be used to seal the first opening 12 and connect the connector 124 to the cap / platform 76 or the bag 10 itself. The blowing and inflating of both the bag 10 and the peritoneal cavity 74 creates equal pressure. The bag 10 acts as a membrane, and the organs in the peritoneal cavity are advantageously kept away from the bag 10, thereby protecting the organs from accidental fragmentation. In another example, the connector 124 may be a three-way connector for directing the blown fluid into the peritoneal cavity 74, the bag 10, and the channel 50 to widen the neck extension 44. Another embodiment is shown in Figure 26, in which the system includes a first bag 10 containing the specimen 78 and a second bag 11 containing the first bag 10. The first bag 10 or inner bag 10 is located inside the second bag 11 or outer bag 11. The connector 124 is configured to deliver the blown fluid to one or more of the first bag 10 and the second bag 11. Preferably, blowing to both the first bag 10 and the second bag 11 is done via the connector 124. An access port cap / platform 76 is used to contain the blown fluid pressure in the first bag 10, and the connector 124 may be directly connected to each bag 10,11, or it may be connected via the cap / platform 76 for discharging the blown fluid to the first bag 10 and directly to the second bag 11 for discharging the blown fluid to the second bag 11. The connector 124 in Figure 26 may be a three-way connector 124, which can further deliver the blown fluid into the abdominal cavity 74.The double-bag system in Figure 26 has the advantage of providing additional protection even if the inner bag 10 is accidentally punctured by a surgical instrument. In such a case, the containment of the specimen is not compromised because the outer bag 11 holds the specimen within a closed system.

[0036] Next, referring to Figures 7N to 7P, details of examples of tether / tab configurations provided at either the first opening 12 or the second opening 14, or both, are shown. For illustrative purposes, Figure 7N shows a cross-section of the second opening 14 and the neck extension 44. The tab 38 extends within the channel 50 and emerges at the second opening 14. Placing the tab 38 within the channel 50 is illustrative, and the tab may be formed integrally with the bag. In Figure 7O, a tab for the second ring 20 is shown for illustrative purposes, and the same configuration can be used for the first ring 18 at the first opening 12. In Figure 7O, the tether 38 is tied or wrapped around the second ring 20. A knot may also be formed. In Figure 7P, the tether 38 is looped multiple times around the second ring 20, thereby forming multiple coils before emerging at the second opening 14. It is preferable that the knot is also formed in the manner shown in Figure 7P to secure the tether 38 to the second ring 20. The tether can be attached anywhere along the ring and / or bag, and the same applies to the first opening 12. Figure 7Q shows the bag 10 in use as shown in Figures 7A to 7R, which will be described in detail below. Figure 7R shows the storage bag 10 as described herein in accordance with the present invention.

[0037] Next, with reference to Figure 8A, a sealing mechanism 34 available for use in the neck extension 44 or the second compartment 28 will be described in detail. The sealing mechanism 34 is configured to seal the second opening 14 of any illustrated bag configuration. When the shredding is complete and the bag 10 is ready for removal at any time, it may be removed through an incision in the abdominal wall, for example, at the umbilical region, or through the vaginal opening or other body opening. Therefore, one end of the bag 10 must be pulled out, and thus the opposite end must be sealed to maintain a closed system and prevent leakage of the specimen. The sealing mechanism 34 will be described, for example, with respect to the second opening 14, which is a preferred location for the sealing mechanism 34. The sealing mechanism 34 includes a first pocket 52 and a second pocket 54. The first pocket 52 is located on one side of the bag 10, and the second pocket 54 is located on the opposite side of the bag 10 as a whole, but the present invention is not limited to such configurations. A first pocket 52 is formed by attaching a first patch 56 to the outer surface of a side wall 16. The first patch 56 is attached to the side wall 16 by adhesive or by heat sealing of the first patch 56. In one embodiment, the first patch 56 is attached along three sides around its circumference, with one side remaining detached, which serves as part of the opening to the first pocket 52. The first patch 56 is shown with oblique lines in Figure 8A. A second pocket 54 is formed by attaching a second patch 58 to the outer surface of a side wall 16 located opposite the first patch 56. The second patch 58 is attached to the side wall 16 by adhesive or by heat sealing of the second patch. In one embodiment, the second patch 58 is attached along three sides around its circumference, with one side remaining detached, which serves as part of the opening to the first pocket 54. The second patch 58 is shown in Figure 8A with a dashed oblique line mark. The opening 60 of the first pocket 52 is oriented distally away from the second opening 14, and the opening 62 of the second pocket 54 is oriented proximal toward the second opening 14.Therefore, the pocket openings 60 and 62 face each other. Also, the pocket openings 60 and 62 are aligned longitudinally with the second opening 14, so that the first pocket 52 is located distal to the second opening 14, and the second pocket 54 is located distal to the first pocket 52.

[0038] Referring to Figures 8B to 8E, the elastic second ring 20 is constricted to a low-profile shape as shown in Figure 8B. The second ring 20 is rolled distally, and the side wall 16 of the neck extension 44 is wrapped around the second ring 20 all the way to the first opening 60 facing distally on the first pocket 52, as shown in Figure 8C. The rolled-up neck extension 44 is inserted into the first pocket 52 as shown in Figure 8D. Next, the first pocket 52 is folded back with its contents and inserted / stored in the second pocket 54 as shown in Figure 8E. The first pocket 52 is inserted into the second pocket 54 so that the second pocket 54 surrounds the first pocket 52 and its contents. By storing the first pocket 52 in the second pocket 54, it is advantageous that the rolled-up bag is prevented from getting caught on something during the collection of the shredded bag. This form and method of the bag 10 is advantageous in that it seals the contents containing the fluid within the bag 10 and prevents such contents from escaping through the second opening 14 during removal of the bag 10. The elastic second ring 20, when squeezed, is biased and expands into its enlarged high-profile form. Advantageously, the elasticity of the second ring 20 biases it toward the inner wall of the first pocket 52 together with the side wall 16 wrapped around it. The elasticity of the second ring 20 causes it to tend outward and press the side wall 16 against the adjacent portion of the side wall 16 in a partially rolled-up state, thus producing a locking feature and sealing effect. Thus, a seal is made by rolling up the bag 10 and the elastic second ring 20.

[0039] Next, other structures and methods for sealing the second opening 14 will be described. Now referring to Figure 9, another method is shown in which a knot 64 is made at the distal end of the storage bag 10 to seal the second opening 14. In another embodiment, the distal end of the bag 10 is provided with double-sided tape 66, which seals the second opening 14 at a distance from the proximal side of the second ring 20 as shown in Figure 10. Referring to Figure 11, an interlocking ridge and groove 68 are provided, the groove being formed on one inner surface of the side wall 16 and the ridge being formed on the opposite inner surface of the side wall 16. The ridges are configured to interlock with the groove when pressed together by the user's fingers or by employing a zipper. In Figure 12, this is done by using a bipolar instrument 72 to send electric current or heat to heat-seal or melt the opposing side walls 15 at the neck extension 44 to seal the bag 10. In this configuration, the bag 10 is made of a suitable material, such as a thermoplastic resin, and the apparatus 72 is configured not to overheat or melt the bag 10.

[0040] For use, after the uterus has been dissected as described above, the insertion and removal of the same containment bag 10 as described with reference to Figures 7 to 12 will be described next. The viewpoint of this method also applies to any form of bag described herein. The containment bags 10 in Figures 7A to 7R will be called dual-head bags 10 for ease of explanation and to distinguish them from the tubular bags in Figures 1 to 6. First, if a trocar is present, it is removed from the umbilical incision. Any one of the dual-head bags 10 in Figures 7A to 7R is inserted through the umbilical incision, and the trocar is reinserted. The trocar may be inserted directly into the umbilical incision or through an access port cap / platform connected to a retractor positioned within the incision. Referring back to Figure 7Q, the abdominal cavity is re-blown through the access port cap / platform 76 or through the trocar, thereby providing a good view for positioning the bag 10. The scope is inserted through the umbilical incision 80, and the dissected uterus 78 is inserted into the sac 10 using a grasper. A second incision 82 is made in the abdominal wall 84 at the medial-lateral location of the umbilicus. The surgical grasper is inserted through the second incision 82, the tether at the second opening 14 is grasped, and this is pulled into the second incision 82, thereby drawing the neck extension 44 towards the abdominal wall 84. The small second ring 20 is pulled into the second incision 82. In one configuration, if the neck extension 44 is sufficiently long, it is preferable to pull the second ring 20 into the vaginal canal and vaginal opening. The tether attached to the larger or larger diameter first ring 18 is pulled toward the umbilical incision. When the first opening 12 of the bag 10 is drawn toward the abdominal wall 84, remove the trocar and / or access port cap / platform 76 and retract the first ring 18 and the proximal portion of the bag 10 into the umbilical incision. If the retractor 86 is in place at the abdominal incision, it is preferable to remove the retractor 86 and then retract the first ring 18. If the retractor 86 has been removed, bring the first ring 18 toward the surface of the abdominal wall 84 and insert the retractor 86 into the first opening 12 of the bag 10.The sac 10 is retracted by the retractor 86 from the adjacent tissue at the location of the abdominal incision 80 as shown in Figure 7Q. Next, the access port cap / platform 76 is connected to the retractor 86 by snapping it under or over the first ring of the retractor 86. The sac 10 is held firmly in place at the umbilical incision between the retractor 86 and the tissue wall 84. If the retractor 86 cannot be removed, the sac 10 is pulled into the lumen of the retractor 86 and placed over the first ring of the retractor on the outside of the abdominal wall. The access port cap / platform 76 is reattached by snapping it either over the first ring 18 of the sac 10 or under / over the first ring of the retractor 86. When the access port cap / platform 76 is snapped onto the underside / overside of the first ring of the retractor 86, it captures the side wall 16 of the bag between the retractor 86 and the access port cap / platform 76 and holds it in place. If the retractor 86 is not used at all, in which case the bag 10 is inserted into the umbilical incision 80, or if the retractor 86 is initially used to insert the double-headed bag 10, it is preferable not to reinsert the retractor into the bag 10 at the first opening 12 as described above. In such a situation, the first ring 18 of the bag 10 is pulled into the umbilical incision 80 and placed on the abdominal wall 84. The access port cap / platform 76 is attached directly to the first ring 18 of the double-headed bag 10. The shredder is inserted into the double-headed bag 10 through the first opening 12, and the scope 88 is inserted into the neck extension 44 toward the introduction passage 30 of the first compartment 26 through the second opening 14. The scope 88 may be inserted directly into the double-headed bag 10, or it may be inserted through the trocar 90 positioned in the second opening 14, as shown in Figure 7Q. Figure 20 also shows in detail the trocar 90 inserted into the second opening 14 of the bag 10.The bag 10 is inserted through an incision small enough to fit the trocar 90 and retracted, so that the side walls 16 of the bag are tightly pressed against the tissue edge 45 by the trocar 90, thereby preventing the inhaled gas from escaping from the abdominal cavity 74 as shown in Figure 20. Figure 23 shows the trocar 90 configured to be removable and sealably attached to the second opening 14. In Figure 23, a mounting feature provided at the end of the neck extension 44 snaps and locks to the trocar 90 in a seal manner, thereby maintaining pressure and preventing the inhaled fluid from escaping from the bag 10 or from the abdominal cavity 74. In a variation, as shown in Figure 21, at least the proximal portion of the neck extension 44, together with the second ring 20 (if used), is retracted into the cannula lumen of the trocar 90. Thus, a seal against the tissue edge 45 is provided by the trocar 90, which is dimensioned to be equal to or smaller than the outer diameter of the trocar 90 and inserted into an incision, thereby preventing the escape of the blown gas into the abdominal cavity 74. In one embodiment, the trocar 90 is equipped with a balloon 92, which retracts the tissue together with the side wall 16 of a bag 10 placed in a second incision 82. In a variation, an access port cap / platform may be attached to the second ring 20, and the scope 88 is inserted through the access port cap / platform with or without the trocar 90. In another embodiment, at least one seal 120 is provided at the second opening 14 as shown in Figure 22. The seal 120 may be removably fitted into the second opening, for example, in a snap-fit ​​or twist-and-lock configuration. Two or more seals may also be provided in the form of a seal assembly that fits into and is connected to the second opening 14. The seal assembly may include a zero seal, which prevents gas and fluid from escaping across the seal when no instrument is inserted through the zero seal. The zero seal may be a double duckbill valve or other valve. The seal assembly may further include an instrument seal that makes contact with the inserted instrument to prevent fluid and gas from escaping across the seal.Furthermore, a seal shield is provided to protect the seal from damage caused by collision with the instrument. The shredding of the uterus 78 is initiated while under observation by the scope 88 in an unobstructed state. After the shredding is complete, the shredder, scope 88, and trocar 90 (if used) are withdrawn through the second opening 14. To seal the neck extension 44, the second opening 14 is closed according to any one of the methods described above to prevent any specimen or fluid particles remaining in the bag from escaping the bag 10 during its withdrawal from the patient. The second ring 20 is inserted into the abdominal cavity 74 through the second incision 82. In one embodiment, the neck extension 44 is raised by rolling or curling it up and stored in the first and second pockets 52, 54, or, as a variation, the neck extension 44 is tied in a knot 64. The access port cap / platform 76 and / or retractor 86 at the umbilical incision 80 are removed, and the double-headed bag 10 is passed through the umbilical incision 80 and withdrawn from the body cavity 74. This same procedure can be employed with the tubular bag 10 throughout the specifications shown, for example, in Figures 1 to 6. The containment bag 10 and method effectively create a containment shredding system, in which case the shredding is performed within a closed system provided by the containment bag 10, whether manual or powered, and its placement is within an anatomical structure. The opening of the bag 10 is sealed, and the procedure is performed carefully to prevent accidental scattering of tissue throughout the abdominal cavity. The containment bag 10 advantageously provides a gate or portal into the bag via a second opening through which a scope can be inserted to further monitor the shredding procedure to ensure that the neck extension or the integrity of the bag is not compromised during the process. This provides the surgeon with extra safety precautions, including direct observation of the surgical subsection field while maintaining a closed system. The viewing angle through the neck extension or second opening provides the viewer with a clear, external view of both the bag and the specimen, as well as their positions relative to the subsection instrument throughout the subsection. Furthermore, the system and various forms of the present invention provide an easy way to deploy the bag into place internally.

[0041] After laparoscopically dissecting the uterus, the bag 10 is inserted into the peritoneal cavity 74 either via the vagina or the abdomen. At the time of bag insertion, pneumoperitoneum may be lost. After bag insertion, pneumoperitoneum is re-established. The dissected uterus is placed in the bag 10, and the bag 10 is manipulated laparoscopically to pull the bag opening into a desired location, which may include any one or more of the following locations: umbilical incision, abdominal incision, lateral incision, and vaginal opening. The tether / tab is pulled, and the trocar is placed into the second opening 14, or the second opening 14 is covered with an access platform or port, or the second opening 14 is pulled into the lumen of the trocar 90. Next, the entire bag opening is closed and sealed, and blown into the bag and / or peritoneal cavity. Next, the specimen in the bag is shredded. Shredding may be performed using powered or manual shredding methods and instruments. The second opening 14 and the other bag port openings are sealed except for one opening, for example, the first opening 12, which is pulled to remove the bag through an incision, for example, at the umbilical region. The bag port openings are sealed to prevent any specimen from escaping its containment within the bag 10 when the bag is being removed. The bag is removed by pulling it through an abdominal incision, for example, at the umbilical region. Now, we will describe additional embodiments of the invention in which the above-described methods and features can be utilized in whole or in part in the following embodiments or vice versa.

[0042] Referring next to Figure 13, the containment bag 10 of the present invention is shown, where identical parts are indicated by the same reference numerals. The containment bag 10 has a first opening 12 and a second opening 14, also called a mouth, connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12 and a second ring 20 is provided at the second opening 14. The first ring 18 and the second ring 20 have substantially the same diameter. The rings 18 and 20 are elastic and can bend into a low-profile form that can be inserted through a port / incision wound having a smaller diameter than the rings 18 and 20. The side wall 16 of the bag 10 has a substantially cylindrical tubular shape with a constant diameter which is substantially the same diameter as the rings 18 and 20. The side wall 16 has a central lumen, sometimes called a first compartment 26, between the first opening 12 and the second opening 14. The bag 10 in Figure 13 is bidirectional compared to, for example, the bag 10 in Figure 1A. In this case, the smaller diameter second opening 14 fits more easily into the vaginal or other body openings than in the case of a bag with a larger diameter second opening 14. However, if either of the openings 12 or 14 is too small, it will be difficult to insert the specimen into the bag 10.

[0043] Next, the method of using the containment bag 10 of the present invention will be described with reference to Figures 14A to 14C. In one embodiment, for example, a tubular sleeve bag 10 shown in Figures 1 to 6 and Figure 13 is prepared. A tissue specimen 78, for example, a uterus, is dissected, and the bag 10 is inserted into the body cavity through an abdominal incision or body opening. The bag 10 is positioned so that the first ring 18 is located outside the patient's body at the location of the abdomen or body opening. A surgical instrument 94, for example, a surgical gripper, is inserted into the first opening 12 of the bag 10 and into the lumen of the bag 10. The specimen 78 is grasped and passed through the second opening 14 of the bag 10 and pulled into the lumen of the bag 10 as shown in Figure 14A. The proximal end of the instrument 94 is operated outside the patient's body to open and close the jaws of the gripper at the distal end of the instrument. The specimen 78 is released in the lumen compartment 26 as shown in Figure 14B. Next, the instrument 94 is moved distally to the end of the specimen 78 to grasp the second ring 20 of the bag 10. The second ring 20 is grasped with the gripper 14 and pulled proximally into the lumen compartment 26 as shown in Figure 14B. The second ring 20 is pulled along within the lumen of the bag 10, proximally to the end of the specimen 78 as shown in Figure 14C, and to a surface located outside the patient's body, thereby forming an inwardly facing fold in the side wall 16 within the bag lumen. After being pulled outside the patient's body, the second ring 20 is then positioned to the side of the first ring 18. One or more folds divide the bag 10, forming a first pouch 96 containing the specimen 78 within the bag 10 and a second pouch 98 located adjacent to the first pouch 96. The bag 10 is folded inward, turned inside out, and then folded back along the lumen toward the first ring 18 to form pockets 96, 98. This action also advantageously draws the specimen 78 closer to the first ring 18, where the specimen 78 can be easily visualized and shredded. To assist in shredding, a scope (not shown) is inserted into the second pouch 98 and observed across the side wall 16 to view the specimen 78 inside the first pouch 96. In a modified case, the scope is inserted into the second opening 14 of the bag 10 and into the abdominal cavity to observe the specimen 78 outside the first pouch 96.In another form of this method, after detaching the uterus, the bag 10 is preferably inserted through the vaginal opening, and the bag 10 is preferably positioned so that the first ring 18 is located outside the patient's body at the vagina. This method and the bag 10 can be used with any specimen, body opening or incision, and this method and bag are not limited to the uterus, vaginal opening or abdominal incision. Naturally, the bag can be placed in any incision or body opening and withdrawn from any incision or body opening, including the same incision or a secondary incision.

[0044] Referring next to Figure 15, a storage bag 10 of the present invention is shown, in which identical parts are indicated by the same reference numerals. The storage bag 10 has a first opening 12 and a second opening 14, also called mouths, which are connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12, and a second ring 20 is provided at the second opening 14. One or more of the first and second ends of the bag 10 include a third ring 100, respectively, positioned near the first ring 18 or the second ring 20. For example, in Figure 15, the third ring 100 is positioned near the second end of the bag 10, near the second ring 20. The second ring 20 is positioned at the distal second end of the bag 10, and the third ring 100 is positioned at a distance set for retraction purposes, proximal to the distal second end. The third ring 100, together with the second ring 20, forms a retractor embedded in the bag 10. When positioned within the anatomical structure described above, the second ring 20 is located outside the patient's body, for example, outside the vaginal opening, while the third ring 100 is located inside the patient's body. The second ring 20 is elastic and can be rotated or reversed so that its intermediate sidewall, located between the second ring 20 and the third ring 100, wraps around the second ring 20, thereby retracting the tissue edge at the body opening or incision and facilitating the removal of the specimen contained within the bag 10. Although the bag 10 in Figure 15 is shown to have a truncated cone shape, the use of the third ring 100 is not limited to the bag 10 having this shape, and the third ring can be used in any of the various forms of the bag 10 described herein, such as a double-headed form. Naturally, in another configuration, the third ring 100 may be positioned near the first ring 18, and this third ring is configured to serve the same built-in retraction function. In another configuration, a fourth ring (not shown) is provided adjacent to the first ring 18, and the third ring 100 is positioned near the second ring 20, so that tissue retraction can occur at both ends of the bag 10.

[0045] Referring next to Figure 16, a containment bag 10 as another embodiment of the present invention is shown, where the same reference numerals are used to indicate the same parts. The bag 10 in Figure 16 is similar to the teapot-shaped containment bag configuration in Figures 7A to 7R, which has a neck extension 44. The bag 10 has a first opening 12 and a second opening 14 connected to each other by a side wall 16. A first ring 18 is provided at the first opening 12, and a second ring 20 is provided at the second opening 14. The bag 10 further has a third opening 102 and a fourth ring 104 provided at this third opening 102. The side wall 16 has a base 24 configured to support a tissue sample. The first opening 12, the second opening 14, and the third opening 102 have longitudinal axes that are adjacent to each other or at angles to each other, in which case the first ring 18 defines a first longitudinal central axis perpendicular to the radial plane of the ring 18 and / or the opening, the second ring 20 defines a second longitudinal central axis perpendicular to the radial plane of the ring 18 and / or the opening 14, and the third ring 100 defines a third longitudinal central axis perpendicular to the radial plane of the ring 104 and / or the opening 102. The openings 12 and 14 are eccentric to each other. The base 24 includes a first side 40 and a second side 42 relative to the base 24 and the first opening 12. The second opening 14 is formed in the first side 40 of the bag 10, and the third opening 102 is formed in the second side of the bag 10. The first side portion 40 of the bag 10 preferably has various dimensions, shapes, lengths, and positional locations relative to the side portion 40 and the base portion 24, forming an extended neck 44 that connects the first opening 12 and the second opening 14, and the second side portion 42 of the bag 10 preferably has various dimensions, shapes, lengths, and positional locations relative to the side portion 42 and the base portion 24, forming a neck extension 106 that connects the first opening 12 and the second opening 14. For use, the bag 10 shown in Figure 16 is positioned relative to the anatomical structure such that the first opening 12 is located in the abdominal area, for example, and is inserted through an incision in the umbilical region, with the first ring 18 located outside the patient's body.The second opening 14 functions as an external port positioned at an external abdominal incision or external orifice, such as the vagina, when the second opening 14 and the second ring 20 are located outside the patient's body. The third opening 102 also functions as an external port positioned at an external abdominal incision.

[0046] Figure 17 shows yet another form of the bag 10, further having a fourth opening 108 and a fourth ring 110 positioned at the fourth opening 108. The fourth opening 108 defines a fourth longitudinal central axis perpendicular to the radial plane of the ring 110 and / or the opening 108. The fourth longitudinal axis may or may not be parallel to the first longitudinal axis associated with the first opening. The fourth opening 108 is substantially coaxial with the first opening 12, thereby making the bag 10 in Figure 17 a hybrid bag combining the teapot-shaped bag of Figures 7A-7R and the sleeve-shaped bag of Figures 1-6, 13 and 15. A fourth opening 108 is formed in the base 24 of the bag 10, and the base 24 has various dimensions, shapes, lengths, and positional locations relative to the sides 40 and the base 24, and can form an extension neck 112 that connects the first opening 12 and the fourth opening 108. For use, the bag 10 of Figure 17 is positioned relative to the anatomical structure such that the first opening 12 is located in the abdomen, for example, inserted through an incision in the umbilical region, and the first ring 18 is located outside the patient's body. The second opening 14 acts as an external port, positioned at an external abdominal incision with the second opening 14 and the second ring 20 located outside the patient's body. The third opening 102 also serves as an external port, positioned at an external abdominal opening, for example, the vagina.

[0047] Referring next to Figures 18A and 18B, a storage bag 10 is shown having at least one first opening 12 and a side wall 16 defining at least one first internal compartment 26 accessible through the first opening 12. An elastic first ring 18 is provided at the first opening 12. The bag 10 has at least one clear, transparent glass or plastic window 114 that allows visualization of the contents of the compartment 26 from outside the bag 10 via a scope 88. The window 114 may include a lens, which enhances visualization when the scope 88 is positioned immediately next to the lens, as shown in Figure 18B. The window 114 and / or lens may be flush with the outer side wall 16 of the bag 10 or retracted at the end of an inwardly extending port 116, as shown in Figure 18B. Port 116 is cylindrical and is dimensioned to be slightly larger than the distal end of scope 88. The inwardly extending port 116 provides a more precise visualization of the bag contents and also serves as a resting shelf for scope 88.

[0048] Referring next to Figures 19A and 19B, a storage bag 10 is shown, comprising a side wall 16 defining at least one first opening 12 and at least one first internal compartment 26 accessible through the first opening 12. An elastic first ring 18 is provided at the first opening 12. The bag 10 has at least one port 118 provided in the side wall 16 accessible to the internal compartment 26. The port 118 comprises at least one seal 120. Two or more seals may also be provided in the form of a seal assembly fitted into and connected to the second opening 14. The seal assembly may include a zero seal, which prevents gas and fluid from escaping across the seal when no instrument is inserted through the zero seal. The zero seal may be a double duckbill valve or other valve. The seal assembly may further include an instrument seal that is in close contact with the inserted instrument to prevent fluid and gas from escaping across the seal. Furthermore, a seal shield is preferably provided to protect the seal from damage caused by collisions with instruments. A circumferential plastic reinforcement 122 is preferably provided surrounding the seal 120 and port 118, and this circumferential reinforcement 122 is disc-shaped or funnel-shaped. The reinforcement 122 is made of a plastic that is harder than the side wall 16 of the bag 10. The reinforcement 122 serves as a smooth, funnel-shaped introduction for guiding instruments through the seal 120 and port 118. The reinforcement 122 also serves as a platform for connecting the seal 120 or seal assembly to the bag 10. As shown in Figure 19B, an instrument, such as a scope 88, is inserted through the port 118 to perform a surgical procedure within the bag 10 or to observe a specimen undergoing dissection within the bag. The seal 120 of the bag 10 maintains a pressure difference across the side wall of the bag 10, for example, when the abdomen and / or when the bag 10 is being blown.

[0049] Next, referring to Figures 27-29, the containment bag 10 of the present invention is shown, which includes various means for holding the neck extension 44 in a retracted form to facilitate insertion of the bag 10 into the abdominal cavity. In Figure 27, a perforation 126 is provided in the side wall 16 at a location between the neck extension 44 and the first side of the bag 10. The perforation 126 extends downward so that the first opening 12 of the bag 10 remains interconnected with the second opening 14. The perforation 126 is configured so that the integrity of the bag is not compromised by providing a reinforcing material that prevents further perforation. The bag 10 is then fed into the abdominal cavity, and the perforation 126 is then cut along the perforation 126 in the abdominal cavity by using a surgical instrument or by pulling a tab / tether 38 at the second opening or a tab / tether positioned along the perforation 126. Following the cut along the perforation, the neck extension 44 is positioned within the anatomical structure. In another embodiment shown in Figure 28, a clip 128 is used to hold the neck extension 44 near the first side of the bag 10, thereby facilitating insertion into the abdominal cavity. Once positioned in the patient's body, the clip 128 is removed, and the neck extension 44 is positioned within the anatomical structure. In another embodiment shown in Figure 29, an adhesive 130, such as an adhesive strip, is used to hold the neck extension 44 near the first side 40 of the bag 10 during deployment. The neck extension 44 is pulled to release the adhesive from the neck extension 44, thereby allowing the neck extension 44 to be positioned within the anatomical structure.

[0050] Referring next to Figure 30, a bag 10 of the present invention is shown, in which the neck extension 44 is inverted inside the bag 10 or in the first compartment 26 to facilitate the feeding of the bag 10 into the abdominal cavity. The bag 10 has an un-deployed configuration such that the neck extension 44 is inverted and positioned inside the bag, and as a result, the neck extension 44 does not protrude from the first side portion 40. The tab 38 is preferably pulled outward to put the bag 10 into the deployed configuration. In another configuration shown in Figure 31, a pocket 132 is provided on the outer surface of the bag side wall 16 adjacent to the intersection with the neck extension 44. The neck extension is folded accordion-like and inserted into the pocket opening 134, and then positioned inside this pocket 132 in the un-deployed configuration. While in the un-deployed configuration, the bag 10 is easily fed through an incision or body opening without the neck extension 44 becoming trapped or obstructive. When tab 38 is inside the patient's body, pull it out to extend the neck extension 44 into its deployed form for placement within the anatomical structure.

[0051] Referring next to Figures 32 and 33, the storage bag 10 has a first opening 12 at its proximal end and a second opening 14 at its distal end, which are interconnected by side walls 16. The side walls 16 are gastight and non-porous, and are made of, for example, a soft polymer, forming a continuous tubular thin-walled elongated structure that constitutes the internal lumen. As described above with respect to the tubular sleeve-shaped storage bag 10, an elastic semi-rigid or rigid ring 18 is preferably provided at the first opening 12, and an elastic semi-rigid ring 20 is preferably provided at the second opening 14. The first opening 12 is sized and shaped to allow the insertion of surgical instruments into and through the elongated tubular body lumen. The second opening 14 is sized and shaped to allow surgical instruments in an inserted state to pass through the second opening 14 distally. The second opening 14 further includes a circumferential channel 50 that houses a drawstring 141. The circumferential pull cord 141 is dimensioned and shaped to close the second opening 14 when operated. The operating procedure includes placing a “knot push” tool 150 proximal to a portion of the pull cord 141, and then advancing the tool 150 distally to push the knot portion 152 along the pull cord 141 so that the second opening 14 is eventually closed. Multiple pull cord channels 50 are arranged at preferred intervals along the entire length of the elongated tubular sidewall 16. Providing any number of channels 50 to provide substantially fixed locations for at least the circumferential portion of the pull cord is within the scope of the invention. Other means known to those skilled in the art for arranging the pull cord circumferentially around the sidewall 16, for example, as a belt-like loop located outside or inside the sidewall 16, are within the scope of the invention. Separate pull cords 141, 142, 143, 144, and 145 are provided within each of the circumferential channels 50, with a portion of each pull cord extending along the longitudinal length of the bag 10 toward the proximal end. The longitudinal portion of the pull cord may be located inside the lumen of the bag 10, outside the bag 10, or within a dedicated channel, multiple loops, or tube provided laterally along the length of the bag 10.Each of the pull strings also preferably has a knot portion 152 along its longitudinal orientation. The present invention is not limited to the knot portion 152. A compression grommet may be used, which slides along the pull string to tighten the circumferential pull string portion. Alternatively, a soft plastic rack and a toothed wedge may be used. Each of the pull strings 141, 142, 143, 144, and 145 is preferably acted upon sequentially, starting with the most distal pull string 141 and ending with the most proximal pull string 145. Alternatively, as a modification, the pull strings may be acted upon simultaneously, gradually as needed, or in any order to reduce the diameter of the elongated tubular body 16 and reduce the specimen 78 in the same manner as the closing of the second opening 14 by the knot pusher 150 described above. Figures 33A and 33B illustrate an example of the operation of one pull string 143. Only a portion of the tubular bag side wall 16 is shown in Figures 33A and 33B for illustrative purposes, and the same can be used for any drawstring in the bag 10. Figure 33A shows the knot pusher 150 adjacent to the drawstring 152, with the drawstring 143 extending circumferentially within the channel 50 and longitudinally along the length of the bag 10. The bag 10 has a first diameter at the location of the drawstring 143 within the channel 50. Figure 33B shows the knot pusher 150 advanced distally to tighten the bag 10 and reduce its diameter to a second diameter smaller than the first diameter at the location of the drawstring 143 within the channel 50. In one form of the bag, the second opening 14 is omitted from the bag 10, the specimen is placed inside the first opening 12, and the first opening 12 and the first ring 18 can be pulled back upward through the incision or body opening to begin tightening.

[0052] For use, the second opening 14 of the bag 10 is inserted into a surgical incision or a congenital body orifice and positioned within the body cavity 74. The immobilized anatomical structure 78, such as a tumor, tissue specimen, uterus, or other tissue structure or surgical specimen, is preferably drawn into the second opening 14 using a long, slender surgical gripper, forceps, or the like. Once the specimen 78 is positioned within the long, slender tubular body 16, the second opening 14 is closed by acting on the drawstring 141 associated with the second opening 14. The specimen or isolated mass 78 may, in some cases, be too bulky or oddly shaped, making it difficult to remove through the surgical incision or congenital body orifice. In this case, the surgeon may attempt to reduce the size or reshape the mass 78 so that it can be removed. Several methods exist for doing this. In the first method, while the mass 78 is located inside the containment bag or sleeve 10, it is preferable to slice the mass 78 into manageable pieces using surgical scissors or a knife. The second method is to compress the mass using a drawstring. The third method is to use a mechanical chopping or slicing instrument, often called a shredder. Generally speaking, when performing these steps, great care must be taken to avoid damaging the containment container or sleeve 10. It is preferable to pull the second opening 14 into another incision or body opening to create a closed system before starting the shredding.

[0053] Next, referring to Figures 34 to 36, a method using a containment bag equipped with multiple drawstrings, abdominal belts, or belts will be described. These methods minimize the risk of the side walls 16 of the bag 10 coming into contact with the mechanical cutting element. First, the patient's mass 78 is drawn into the containment container 10 by passing it through either the second opening 14 (if provided) or the first opening 12. Second, the distal second opening 14 (if provided) of the bag 10 is closed in the manner described above by using a knot pusher 150 to push the knot 152 and tightening the circumferential portion of the drawstring 141 around it. Third, as shown in Figure 34A, a cutting or "core-punching" instrument 156 is inserted into the first opening 12 and used to cut or "core-punch" the mass 78 once or more times, while avoiding the risk of the edges 158, 160 of the mass 78 coming into contact with the side walls 16 of the bag 10. Fourth, the cutting or "core-removing" instrument 156 is removed from the container bag 10 as shown in Figure 34B, leaving behind an elongated empty core 162, represented by a dotted line in Figure 34B. Fifth, the multiple drawstrings 141, 142, 143, 144, 145 are individually or collectively applied to tighten the mass 78 inside the container bag 10 to create an elongated shape with a reduced cross-sectional area as a result of the closure of the empty core by tightening the drawstrings, as shown in Figure 34C. Next, the reduced mass 78 is pulled out through the incision or body opening associated with the first opening 12, either by removing the entire bag 10 or by removing the reduced mass 78 from inside the bag 10. The multiple tightening drawstrings 141, 142, 143, 144, and 145 advantageously prevent the mass 78 from shifting distally during removal of the bag 10 through the incision or body opening and forming a bolus at the distal end of the bag 10 or at the closed second opening 14. Thus, the specimen 78 is held in a relatively fixed state by the drawstrings.

[0054] Next, referring to Figures 35A and 36A, a relatively large mass 78 is cored by the core-removing instrument 156, leaving an empty core 162. In Figure 36A, the second opening 14 remains open compared to Figure 35A and is shown in a form located within the favorable surgical environment of the bag 10, for example, placed in another bag. The diameter of the specimen 78 is reduced by acting on the drawstring to effectively tighten and close the empty core 162 as shown in Figures 35B and 36B. If the mass 78 inside remains excessively large or improperly shaped after the drawstrings 141, 142, 143, 144, 145 have been initially acted upon, the cutting or "core-removing" trimming instrument 156 is reinserted to further reduce the mass 78 as shown in Figures 35B and 36B, thereby creating a second empty core 162. Next, the drawstrings 141, 142, 143, 144, and 145 are tightened again by applying force to them a second time, thereby tightening and closing the empty second core 162 as shown in Figures 35C and 36C, further reducing the profile of the contained mass 78 for removal. The specimen 78 is removed together with the bag 10 with the bag 10 in place, or the specimen is removed from inside the bag 10 through the first opening 12 and the incision or body opening. In these cases, the compressibility of the containment bag 10 eliminates the need to completely shred the contained mass or specimen 78 for removal or retrieval, and the edges 158 and 160 of the mass are effectively used as buffer zones to protect the side walls 16 from accidental contact with the core-punching instrument. The edges 158, 160 or some portions of the mass 78 that are in contact with the side wall 16 of the containment container 10 are preferably left intact, thereby avoiding the potential for cutting, tearing, or snagging of the container side wall 16.

[0055] Various embodiments of devices for inserting, deploying and / or retrieving bags to be contained in or integrated within bags and shredding systems, in which the entire system, several parts of the system, or combinations of the system and / or components thereof are configured to serve as means for containing objects to be shredded according to various embodiments of the present invention, are described in U.S. Patent Application No. 08 / 540,795 filed October 11, 1995, No. 11 / 549,701 filed October 16, 2006, No. 11 / 549,971 filed October 16, 2006, No. 12 / 902,055 filed October 11, 2010, and No. 13 / 252,110 filed October 3, 2011, which are cited by reference as if their entire disclosures were described herein. The form of the additional bag is described in detail in U.S. Provisional Patent Applications No. 61 / 970,436, No. 62 / 014,038, and No. 62 / 024,698, filed on 26 March 2014, 18 June 2014, and 15 July 2014, respectively. All of these U.S. Provisional Patent Applications are incorporated herein by reference, and their entire contents are incorporated herein by reference. Furthermore, the same capabilities and their entire contents are incorporated herein by reference, and their entire contents are incorporated herein by reference.

[0056] As can be understood, various modifications can be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting the invention, but rather as merely illustrative of preferred embodiments. Those skilled in the art will envision other modifications that fall within the scope and spirit of the invention.

Claims

1. A tissue containment bag, It has a first opening and a second opening connected to each other by a side wall of a soft material, The side wall constitutes a first internal compartment and a base, and the base is configured to allow a tissue sample to be placed into the first internal compartment through the first opening and to support the tissue sample on the base. The side wall forms an elongated, hollow, sleeve-shaped neck extension that constitutes a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening, the second opening is in fluid communication with the second internal compartment, the second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to the side wall of the first internal compartment at the first side, the neck extension extends laterally away from the first longitudinal axis defined by the radial plane of the first opening when the bag is in a non-flexible form, and the second longitudinal axis is defined by the radial plane of the second opening when the bag is in a non-flexible form. The side wall has a width perpendicular to the first longitudinal axis and a length along the first longitudinal axis at the location of the first internal compartment, and the neck extension has a width perpendicular to the second longitudinal axis and a length along the second longitudinal axis, and the width of the neck extension is smaller than the width of the first internal compartment. The proximal end of the neck extension is located in the first internal compartment, forming an introduction path intersection between the first compartment and the second compartment, in a tissue containment bag.

2. A tissue containment bag, It has a first opening and a second opening connected to each other by a side wall of a soft material, The side wall constitutes a first internal compartment and a base, and the base is configured to allow a tissue sample to be placed into the first internal compartment through the first opening and to support the tissue sample on the base. The side wall forms an elongated, hollow, sleeve-shaped neck extension that constitutes a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening, the second opening is in fluid communication with the second internal compartment, the second internal compartment is in fluid communication with the first internal compartment, and the first internal compartment is in fluid communication with the first opening. The proximal end of the neck extension is connected to the base of the first internal compartment, and the neck extension extends in a direction along a first longitudinal axis determined by the radial plane of the first opening when the bag is in a non-flexible form, and a second longitudinal axis determined by the radial plane of the second opening when the bag is in a non-flexible form. The side wall has a width perpendicular to the first longitudinal axis and a length along the first longitudinal axis at the location of the first internal compartment, and the neck extension has a width perpendicular to the second longitudinal axis and a length along the second longitudinal axis, and the width of the neck extension is smaller than the width of the first internal compartment. The proximal end of the neck extension is located in the first internal compartment, forming an introduction path intersection between the first compartment and the second compartment, in a tissue containment bag.

3. The tissue containment bag according to claim 1 or 2, wherein the diameter of the second opening is smaller than the diameter of the first opening.

4. The tissue containment bag according to any one of claims 1 to 3, further comprising a first ring connected to the side wall at the first opening and configured to keep the first opening in an open position, and a second ring connected to the neck extension at the second opening and configured to keep the second opening in an open position, wherein at least one of the first ring and the second ring is elastically compressible into a low-profile shape to facilitate percutaneous insertion.

5. The tissue storage bag according to any one of claims 1 to 4, wherein the diameter of the neck extension is constant from the proximal end to the distal end.

6. The tissue containment bag according to any one of claims 1 to 5, wherein the diameter of the neck extension is equal to the diameter of the second opening, and the diameter of the neck extension gradually increases toward the proximal end of the neck extension.

7. The tissue storage bag according to any one of claims 1 to 6, wherein the widest width of the neck extension is smaller than the width of the side wall at the first internal compartment.

8. The tissue containment bag according to any one of claims 1 to 7, further comprising a tether connected to the side wall along the length of at least a portion of the neck extension.

9. The tissue containment bag according to any one of claims 1 to 8, further comprising a tether that is connected to the side wall and extends along the neck extension from the second opening to the proximal end of the neck extension.

10. The tissue containment bag according to any one of claims 1 to 9, further comprising a tether connected to the side wall, extending from the second opening along the neck extension to the proximal end of the neck extension and along the length of the side wall to the first opening.

11. The tissue containment bag according to any one of claims 1 to 10, further comprising a tether connected to the side wall along the length of the top portion of at least a part of the neck extension.

12. The tissue storage bag according to any one of claims 1 to 11, further comprising a tab provided along at least a portion of the length of the neck extension and configured to unwind the neck extension when pulled.

13. The tissue containment bag according to any one of claims 1 to 12, wherein the tether has a first end, a second end and the length of the tether, and the second end of the tether extends freely beyond the distal end of the neck extension.

14. The tissue containment bag according to any one of claims 1 to 13, wherein the tether has a first end and a second end, the length of the tether and the second end of the tether extend freely beyond the distal end of the neck extension, and the length of the tether and the first end of the tether extend freely beyond the first opening.

15. A tissue containment bag according to any one of claims 1 to 14, further comprising a channel and a tether provided within the channel.

16. The tissue storage bag according to any one of claims 1 to 15, further comprising an external pocket provided in the side wall and sized and shaped to accommodate the neck extension in a folded form.

17. A tissue containment bag according to any one of claims 1 to 16, wherein the neck extension has a first pocket connected to the outer surface of the neck extension, the first pocket having a first pocket opening on one side of the neck extension facing the proximal end of the neck extension, the neck extension has a second pocket having a second pocket opening located on the opposite side of the neck extension, the second pocket opening facing the distal end of the neck extension, the second pocket being located distal to the first pocket, and the first and second pockets being sized and shaped to receive at least a portion of the distal end of the neck extension.

18. The tissue containment bag according to any one of claims 1 to 17, wherein the neck extension has a channel configured to receive fluid under pressure in order to expand the neck extension from a non-deployed state to an extended deployment state.

19. The tissue storage bag according to any one of claims 1 to 18, wherein the proximal end of the neck extension intersects with the base and also intersects with the first side of the first internal compartment.

20. The tissue storage bag according to any one of claims 1 to 19, wherein the intersection of the neck extension is continuous with the base, in contact with the boundary.

21. The tissue storage bag according to any one of claims 1 to 20, wherein the proximal end of the neck extension is located near the base along the first side.

22. The tissue storage bag according to any one of claims 1 to 21, wherein the intersection of the neck extension is located at the base.

23. The tissue containment bag according to any one of claims 1 to 22, wherein the side wall forms an elongated, hollow, sleeve-shaped second neck extension that constitutes a third internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with a third opening, and the third opening is in fluid communication with the first internal compartment.

24. The tissue storage bag according to any one of claims 1 to 23, further comprising a perforation positioned between the neck extension and the first side portion to hold the neck extension in a form that can be fed out, wherein the perforation is configured to detach at least a portion of the neck extension to an extended and deployed form.

25. The tissue storage bag according to any one of claims 1 to 24, wherein the second longitudinal axis is inclined with respect to the first longitudinal axis when the storage bag is in a non-flexible form.

26. A container, A first opening provided at the first end, A second opening is provided at the second end, The first opening and the second opening are interconnected, and an interior extends between the first opening and the second opening, and the side wall has a diameter, cross-section, and length perpendicular to the longitudinal axis, It has at least one fastener connected to the side wall around the interior at a location between the first opening and the second opening, A container wherein the fastener is configured to reduce the diameter of the side wall at the location where the fastener is installed.

27. The container according to claim 26, further comprising a compressible and elastic ring connected to the side wall at the second opening.

28. The containment container according to claim 26 or 27, further comprising a first compressible and elastic ring connected to the side wall at the first opening and a second compressible and elastic ring connected to the side wall at the second opening.

29. The container according to any one of claims 26 to 28, wherein the side wall has a constant diameter from the first end to the second end.

30. The container according to any one of claims 26 to 29, wherein the side wall has a truncated cone shape.

31. The container according to any one of claims 26 to 30, wherein the first opening is concentric with the second opening along the longitudinal axis.

32. The container according to any one of claims 26 to 31, further comprising a plurality of fasteners arranged at intervals along the length of the side wall, each fastener being connected to the side wall around the interior and configured to reduce the diameter of the side wall at the location where the fastener is installed.

33. The containment container according to any one of claims 26 to 32, wherein at least one of the fasteners is configured to operate at a location outside the containment container so as to reduce the diameter of the side wall.

34. The container according to any one of claims 26 to 33, wherein at least one of the fasteners is a drawstring having a first end and a second end, and a knotting portion located between the first end and the second end.

35. The container according to any one of claims 26 to 34, wherein at least one of the fasteners is operated to reduce the diameter of the side wall by moving the tie portion along the fastener.

36. The container according to any one of claims 26 to 35, wherein at least one of the fasteners has a circumferential portion that is arranged around the interior and substantially perpendicular to the longitudinal axis.

37. The container according to any one of claims 26 to 36, wherein at least one of the fasteners has a longitudinal portion that extends along the longitudinal length of the side wall.

38. A method for deploying a tissue containment bag inside a body cavity, The process includes the step of preparing a tissue storage bag, the tissue storage bag having a first opening and a second opening connected to each other by a side wall of a soft material, the side wall constituting a first internal compartment and a base, the base being configured to allow a tissue sample to be placed into the first internal compartment through the first opening and to support the tissue sample on the base, and the side wall constituting a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening. A long, slender, hollow, sleeve-shaped neck extension is formed, the second opening is in fluid communication with the second internal compartment, the second internal compartment is in fluid communication with the first internal compartment, the first internal compartment is in fluid communication with the first opening, the proximal end of the neck extension is connected to the first internal compartment, the neck extension extends outward from the first internal compartment when in its deployed configuration, and the neck extension has a retractable and retractable configuration. The step includes inserting the tissue containment bag into a body cavity in a dispensing configuration. A method comprising the step of moving the neck extension from the protruding configuration to the configuration deployed within the body cavity.

39. The method according to claim 38, further comprising the step of inverting the neck extension from its distal end into the second internal compartment and then along the second internal compartment into the first internal compartment to create a low-profile feeding configuration in which the neck extension, with the bag retracted, does not extend outward from the first internal compartment.

40. The steps include: preparing a tether that is connected to the neck extension and extends freely beyond the distal end of the neck extension; The method according to claim 38 or 39, further comprising the step of pulling the tether outward to extend the neck extension from the feeding configuration to the deployment configuration.

41. The steps include providing an external pocket on the side wall of the first internal compartment, The steps include: placing the neck extension portion inside the external pocket to make the neck extension portion extendable; The method according to any one of claims 38 to 40, further comprising the step of removing the neck extension from the external pocket and positioning the neck extension in a deployed configuration.

42. A method for removing tissue samples from body cavities, The procedure includes the step of preparing a tissue storage bag, the tissue storage bag having a first opening at a first end, a second opening at a second end, and a side wall having a diameter and cross-section perpendicular to the longitudinal axis that connects the first and second openings and forms the interior extending between the first and second openings, the tissue storage bag having an elastic compressible ring connected to the side wall coaxially with the second opening and configured to hold the second opening in an open position, The step includes inserting the second opening and the ring of the tissue containment bag into the body cavity by passing them through a body opening or incision, The procedure includes the step of passing the tissue sample through the second opening and inserting it into the interior of the tissue storage bag, A method comprising the step of moving the second opening and the ring into the tissue storage bag, passing the tissue sample placed in the storage bag and moving toward the first opening, thereby placing the tissue sample into the storage bag.

43. The method according to claim 42, further comprising the step of moving the second opening and the ring through the first opening.

44. The method according to claim 42 or 43, further comprising the step of inserting a scope into the second opening after performing the step of moving the second opening and the ring through the first opening.

45. After performing the step of moving the second opening and the ring through the first opening, the step of inserting the shredding device into the first opening, The method according to any one of claims 42 to 44, further comprising the step of finely chopping the tissue sample.

46. A method for performing a hysterectomy on a patient, This includes the step of making an abdominal incision to access the body cavity, The step includes making the uterus within the body cavity movable, The procedure includes the step of preparing a tissue containment bag, the tissue containment bag having a first opening and a second opening connected to each other by a side wall of a soft material, the side wall constituting a first internal compartment and a base, the base being configured to allow a tissue sample to be placed into the first internal compartment through the first opening and to support the tissue sample on the base, the side wall forming an elongated hollow sleeve-shaped neck extension constituting a second internal compartment having a proximal end interconnected with the first internal compartment and a distal end interconnected with the second opening, the second opening being in fluid communication with the second internal compartment, the second internal compartment being in fluid communication with the first internal compartment, the first internal compartment being in fluid communication with the first opening, the proximal end of the neck extension being connected to the first internal compartment, and the neck extension extending outward from the first internal compartment when in the deployed configuration. The step includes inserting a tissue containment bag into the body cavity, The step includes inserting the uterus into the first opening of the tissue containment bag, The step includes moving the aforementioned neck extension to form the deployment configuration, The procedure includes the step of drawing the second opening of the tissue storage bag out of the patient through the patient's vaginal canal while the first internal compartment remains located within the body cavity, and the step of drawing the first opening of the tissue storage bag into the abdominal incision while the first internal compartment remains located within the body cavity. Simultaneously, the procedure includes observing the uterus in the first internal compartment through the other of the first or second opening, while reducing the volume of the uterus in the tissue containment bag through either the first or the second opening. A method comprising the step of removing the uterus from the patient.

47. The method according to claim 46, further comprising the steps of reducing the volume of the uterus through the first opening and observing the uterus with a scope inserted through the second opening.

48. The method according to claim 46 or 47, further comprising the step of observing the uterus in the containment bag with a scope inserted through the first opening while reducing the volume of the uterus through the second opening.

49. The method according to any one of claims 46 to 48, further comprising the step of extending the neck extension from a feeding configuration to a deployed configuration.

50. A method for removing tissue samples from body cavities, This includes the step of making an abdominal incision to access the body cavity, The step includes making the tissue specimen within the body cavity movable, The process includes the step of preparing a tissue storage bag, the tissue storage bag having a first opening and a second opening connected to each other by a side wall of soft material, the side wall constituting an internal compartment, the side wall having a first external pocket on one side of the side wall and a second external pocket on the opposite side, the first pocket and the second pocket being located near the second opening, The step includes inserting the tissue containment bag into the body cavity, The step includes passing the tissue sample through the first opening of the tissue storage bag and inserting it into the internal compartment, The process includes the step of folding and rolling the distal side wall of the first pocket and placing the resulting side wall inside the first pocket, A method comprising the step of pushing the first pocket into the second pocket.

51. The method according to claim 50, further comprising the step of folding the side wall near the second opening to the other side to push the first pocket into the second pocket.

52. A method for extracting tissue samples from within a body cavity, The process includes the step of preparing a containment container, the containment container having a first opening at a first end, a second opening at a second end, and side walls connecting the first and second openings, the side walls having a diameter and cross-section perpendicular to the longitudinal axis and defining the length extending inside and between the first and second openings, the containment container having a plurality of fasteners connected to the side walls around the inside and spaced apart from each other along the length of the containment container between the first and second openings, each fastener configured to individually reduce the diameter of the side wall at the location of the fastener when operated, The steps include inserting at least the second opening of the containment container into the body cavity, and passing a tissue specimen having a first diameter through the second opening into the interior of the containment container. The step includes reducing the diameter of the tissue sample to a second diameter by activating one or more fasteners at the location of the tissue sample to reduce the diameter of the containment container, A method comprising the step of removing the tissue sample having a reduced second diameter.

53. The method according to claim 52, further comprising the step of sequentially operating the fasteners to reduce the diameter of the side wall.

54. The method according to claim 52 or 53, further comprising the step of sequentially operating the fastener from the second end to the first end to reduce the diameter of the side wall.

55. The method according to any one of claims 52 to 54, further comprising the step of simultaneously activating the fastener at the location of the tissue sample to reduce the diameter of the side wall.

56. The method according to any one of claims 52 to 55, wherein the fastener is a pull cord that is arranged circumferentially around the interior perpendicular to the longitudinal axis and extends along the length of the container to the first end.

57. The method according to any one of claims 52 to 56, further comprising the step of activating the fastener at a location located outside the body cavity.

58. The method according to any one of claims 52 to 57, wherein the fastener is a pull cord arranged circumferentially around the interior perpendicular to the longitudinal axis and extending along the length of the containment container to the first end, each pull cord having a first end and a second end and a knot located between the first end and the second end, and each pull cord is operated to reduce the diameter of the side wall at the location of the pull cord by moving the knot associated with the pull cord and thereby reducing the length of the circumferential portion of the pull cord.

59. The steps include inserting the core removal device into the interior of the storage bag, The steps include: removing the central part of the tissue sample using the core removal device; The steps include removing the central core from the container, The method according to any one of claims 52 to 58, further comprising the step of reducing the diameter of the side wall of the location of the tissue sample to close the opening in the tissue sample created by the removed central core.

60. The method according to any one of claims 52 to 59, further comprising the step of loosening any one of the activated fasteners.

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