Specimen Retrieval Bags

Numerous tissue extraction devices are available for laparoscopy and thoracoscopy, and many of these are pouchlike and preloaded within a delivery system (Figure 4.24). They are typically made from strong synthetic materials, which can withstand aggressive handling, and have a low incidence of tearing or rupture, which prevents escape of the removed tissue. Before development of retrieval bags, surgeons were required to remove diseased or contaminated tissue through unprotected port sites and mini incisions. The use of a retrieval bag allows extraction of tissue confined within a durable closed pouch, thus reducing the risk of content spillage during extraction. Retrieval bags also prevent contamination of the port or incision site from infected or malignant tissue.^1-4 Examples of homemade cost-effective specimen retrieval bags include fingers of powderless latex gloves, zip-close bags, and condoms^1,2,4 (Figure 4.25A and 4.25B). Most commercially available specimen retrieval bags require 10- to 12-mm cannulas for introduction into the body cavity, but small retrieval bags used with 5-mm cannulas are also available. Typically, the opening of commercially available bags have a rigid expandable rim (Figure 4.24C), which greatly facilitates tissue insertion into the bag. Many of the commercially available bags are deployed from a hollow instrument shaft^1,2,4 (Video Clip 4-1).

For proper removal of a retrieval bag from a body cavity, it is paramount that the tissue to be extracted has settled to the bottom of the bag. Lifting the bag and allowing the specimen to fall to the bottom can accomplish this but at times may not be sufficient. Alternatively, the tissue can be pushed with a grasper to the bottom of the bag. Some commercially available products allow for ­intracorporeal bag closure using an embedded purse string (see Figure 4.24B). The opening of the bag is then guided to the desired exit site (typically a cannula). When the opening of the bag is inside the cannula, the bag and cannula can be pulled from the site together. Smaller bags with less tissue can at time be removed through a larger cannula (12 mm). Bags filled with tissue can be slowly pulled through the incision after the cannula is removed, often without the need to extend the size of the incision. Homemade retrieval bags are often somewhat fragile, and one should be cautious to not tear these bags during extraction from the abdomen.^1,2,4 For larger specimens that cannot fit through the cannula site, either manual or power tissue morcellation or enlargement of the port incision may be performed to facilitate bag and specimen removal. Manual morcellation can be achieved by bringing the bag opening to the enlarged cannula incision and inserting a blunt instrument, such as ring forceps, which is used to disrupt the contained structure. Firmer tissue can be clamped, partially exposed, and circumferentially cored with a scalpel. With manual morcellation, one has to take precaution to not disrupt the integrity of the bag or to contaminate the cannula site. Fluid-filled structures, such as an excised gallbladder, can have their contents removed or aspirated while inside a bag to facilitate extraction. Importantly, one should not attempt to deliberately force or overzealously pull a retrieval bag through a small incision. If there are any concerns about feasibility of extraction, the incision should be extended to enable safe removal of bag and contents.

Suction and Irrigation Devices:

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