Laparoscopy organ retrieval apparatus and procedure

Laparoscopy organ retrieval apparatus and procedures are presented for minimum invasion surgery inclusive of laparoscopic nephrectomy, cholecystectomy and other organ dissection, morsellation removal from the abdomen through a keyhole incision. The apparatus and procedures permit the safe and total removal of an organ from a body cavity in a morsellated condition through the combination utilization of an entrapment envelope sheath. The entrapment envelope having an apparatus for opening and closing, the apparatus controlled from an exterior position of the body cavity wherein the entrapment envelope after entry of the sheath is extruded from the sheath which has been inserted through a laparoscopic port in place in a keyhole surgical opening. The entrapment envelope is constructed of flexible, relatively low bulk fluid impermeable materials having sufficient strength to contain morsellator entry, organ fragmentation and removal.

FIELD OF THE INVENTION 
The invention relates to laparoscopic organ retrieval apparati and 
procedures for minimally invasive surgery dealing with intra-abdominal or 
other body cavity surgery. In another aspect the invention relates to an 
improved method and apparatus of organ entrapment and effective 
fragmentation-evacuation of the dissected and entrapped organ. In yet 
another aspect, the invention relates to laparascopic organ retrieval 
apparati and procedures for containment, dissection, morsellation of 
substantially solid organs such as kidneys utilizing minimal invasive 
surgery. 
BACKGROUND OF THE INVENTION 
A multitude of minimally invasive surgical techniques have recently arisen, 
including such procedures as laparoscopic cholecystectomy and laparoscopic 
nephrectomy which present significant advances in clinical surgery. Until 
recently the laparoscopic approach has been limited either to a diagnostic 
function or to the removal of small amounts of tissue or to thin wall, 
hollow organs such as the gall bladder and appendix. For example, in 
laparoscopic cholecystectomy, a miniature TV camera and surgical 
instruments are inserted through keyhole size punctures in the abdomen. A 
camera displays the patient's internal organs on a monitor which the 
surgeon watches while manipulating the surgical tools to dissect and 
isolate the gall bladder within the abdominal cavity. The possibilities of 
video surgery or telescopic surgery are not limited to gall bladders since 
medical procedures have applied such technology to surgical treatment of 
ulcers, hernias and appendectomies. 
Surgical disciplines dealing with minimally invasive surgery addressing 
intra-abdominal surgery have been impacted by the laparoscope. 
Laparoscopic procedures for gynecology, for which the laparoscope was 
originally designed, include removal of small uterine myomata, tubal 
ligation, and ovariectomy. In general surgery, cholecystectomy, the 
diagnosis of the acute abdomen, herniorrhaphy, and appendectomy all can be 
done laparoscopically. In urology, the diagnosis of the cryptochide 
testicle and more recently pelvic node dissection have been accomplished 
using a laparoscopic approach. 
Laparoscopic cholecystectomy, like open incisional surgery, removes the 
gall bladder in order to cure gall bladder disease such as gall stones, 
i.e. pebble size globs of cholesterol that accumulate in the organ and 
cause painful attacks when they clog certain digestive passageways. 
Patients who undergo laparoscopic surgery not only endure less pain and 
scarring, also experience substantially reduced hospital bed recovery time 
and return to active lives much sooner than patients experiencing open 
cavity surgery. 
Attempts to remove larger solid organs such as kidneys, spleen, liver and 
uterus, have been frustrated by the lack of a rapid tissue morsellator 
apparatus, suitable entrapment envelope and methods for manipulating the 
envelope for receiving and retaining the vigorous morsellation breakup and 
evacuation of the organ tissue. Unlike the malleable gall bladder, which 
lies accessible on the liver, the kidney, for example, is solid, and 
embedded, and in fact entangled in blood vessels. Even with improved 
morsellators, there are increased risks due to the large solid organs 
requiring substantially more energy to particularize and evacuate. 
Possible spillage of infected organ contents or contamination from such 
organ tissue have stalled the development of laparoscopic approaches 
principally due to the difficulties of isolating and bagging the removed 
organ in an entrapment envelope. The strength and quality of the 
entrapment envelope and its maneuverability remains paramount in the full 
development of laparoscopic techniques in order to provide sufficient 
safety expectation which precludes tissue contamination or bacterial 
spillage into the cavity. 
Removal of large solid organs such as kidney laparoscopically, despite 
recent developments and advances in apparatus, continues to need 
improvements in tissue dissection, improvements in the method and 
apparatus for organ entrapment, as well as a means for effective 
fragmentation and evacuation of the entrapped organ. Laparoscopic 
equipment for tissue dissection has been the subject of considerable 
developmental improvement, for example the availability of 
irrigation/aspiration devices, delicate curved and straight forceps, and 
an effective multiload clip applier now enables the surgeon to dissect and 
secure a variety of vascular structures, including the renal vessels. 
Despite these advancements, two interrelated problems still exist before a 
large solid organ such as the kidney can be removed in an efficient and 
safe manner includes organ morsellation and organ entrapment. 
Researchers have utilized farm pigs in their various laparoscopic surgical 
procedures in order to further advance equipment and procedures. A keyhole 
incision was made in the animal in the midline of the abdomen with 
insertion of a telescope filled with a miniature TV camera and associated 
surgical instruments into the abdominal cavity. After appropriate 
isolation, dissection and clamping of the multiple arteries and veins, the 
kidney was elevated from its retroperitoneal bed and dissected therefrom, 
thus being available in the abdominal cavity as a separated, free form 
organ. A plastic or nylon sack was then introduced into the abdominal 
cavity using forceps and the like in order to open the mouth of the sack 
for purposes of inserting into the sack the severed kidney. Various 
difficulties have arisen in trying to insert and manipulate, i.e. open the 
sack and previously have required other keyhole entry for special 
apparatus to perfect the opening and the transfer of the severed kidney 
into the sack. In some procedures a drawstring on the sack was gathered 
using forceps in order to close the sack, which is then partially pulled 
into a sheath. The sheath and related apparatus is then removed from the 
abdomen, leaving the neck of the sack to be manually grasped upon exit of 
the skin of the abdomen. With the kidney suspended in the sack and drawn 
up to the underside of the abdominal wall, the mouth of the sack is 
reopened in order to attempt to morsellate the kidney in the sack and 
thereby extract the entire organ in particulate form from the sack and 
eventually the sack itself. Attempts to morsellate the kidney electrically 
with an orthopedic drill or available morsellation devices have not been 
satisfactory. A Cavitron ultrasonic aspirator was used to fragment and 
aspirate kidneys from a sack, albeit in a very slow procedure. 
Morsellation devices have been used which can expedite the fragmentation 
of the organ. However, such morsellation devices present problems 
regarding the plastic bag, i.e. damage of the bag from the morsellation 
device, thus spillage and contamination of the abdominal cavity. 
Organ entrapment and organ morsellation, especially the large solid organs 
such as kidneys, spleen, liver and the like, continue to be a concern to 
the surgeon because of the safety factor as well as surgical procedure 
complexities and surgical time span. Although manual laparoscopic 
morsellators are available which are designed predominantly for use with 
small tissue items, such apparati are not readily suitable for large solid 
organ morsellation. Other types of electrical or ultrasonic morsellators 
such as orthopedic drills or ultrasonic surgical aspirators, rely on 
active suction to help evacuate the fragmented tissue. Such suction has 
been found to rapidly deplete the CO.sub.2 pressurized peritoneum cavity 
resulting in collapse of the abdominal cavity and loss of visibility. 
A recently issued United States patent, U.S. Pat. No. 5,037,379 issued Aug. 
6, 1991 entitled Surgical Tissue Bag and Method for Precutaneously 
Debulking Tissue, provides yet another attempt to overcome some of the 
procedural and apparatus shortcomings existing in laparoscope organ 
retrieval technology. The '379 Patent teaches a tissue bag comprised of 
two layers of materials, an inner layer of a puncture-resistant material 
and an outer layer of moisture-proof material for containing cells and 
fluid. The bag material is foldable and flexible for insertion through an 
access opening into the surgical site. A draw-string is attached to the 
open end of the bag to close the bag when the tissue is contained therein 
and pulled through the puncture site in the outer surface of the skin. The 
bag is bulky in the way it is formed, the two layers comprising a single 
sheet having opposite first and second ends folded back to contact each 
end to form a folded side of the bag. The rather stiff fold-back portions 
along one side and across the bottom as illustrated in FIG. 1A is touted 
as advantageously causing the open end of the bag to open for receiving 
tissue once inserted into the body cavity. Such a bulky bag mechanism 
appears to be cumbersome and awkward in the sense of manipulating the bulk 
through the keyhole incision as well as manipulation within the body 
cavity. 
In view of these continuing procedural and apparatus shortcomings, the 
present invention presents an improved laparoscopic organ retrieval 
apparatus and procedures for entrapping the organ in an impermeable 
entrapment envelope and means for readily deploying said envelope into the 
abdominal cavity as well as manipulating the opening of the envelope and 
the closing of same upon the insertion of the organ. Such means for 
manipulating the entrapment envelope immediately isolate the diseased 
tissue from the abdominal contents. In addition, the entrapment envelope 
is constructed of sufficiently impermeable materials to allow the use of 
electrical morsellator devices relying on partial suction evacuation and 
substantial cutter head adaptations which allow for the relatively quick 
fragmentation and evacuation of the organ. The entrapment envelope must be 
of a thin, low-bulk material and yet have sufficient strength to withstand 
high speed motor driven morsellation of solid tissue without perforation 
of the envelope, thereby precluding seeding of the abdomen with diseased 
fragments or bacteria from the morsellated tissue. 
SUMMARY OF THE INVENTION 
The laparoscopic organ retrieval apparatus and procedures according to the 
invention focus on an organ retrieval system such as the entrapment 
envelope and the organ morsellator. Body cavity organ retrieval systems 
which provide minimally invasive surgery methodology permit the safe and 
total removal of an organ from a body cavity in a fragmented condition 
through the combination of an entrapment envelope, entrapment envelope 
sheath and entrapment envelope expansion and manipulation means. Following 
the detachment of the organ from its connection to the body within the 
body cavity such as the abdomen, the organ retrieval system entrapment 
envelope is delivered through a laparoscopy port into the body cavity. The 
entrapment envelope is arranged with handling means such as wires and wire 
guides or pneumatic means in the envelope which can be activated once the 
envelope is in a loosened position from the sheath in the CO.sub.2 
inflated body cavity; thus allowing the placement of the organ into the 
opened envelope by appropriate maneuvers. Handling means either through 
wire mechanisms or pneumatic tubing control manipulations of the envelope 
then allows for tightening or closing of the envelope in order that the 
envelope can then be drawn through the keyhole incision by means of the 
wire extensions or other extensions of the envelope until the neck of the 
envelope protrudes above the skin level. The neck of the envelope is then 
slightly open to permit the insertion of an organ retrieval system tissue 
morsellator. The organ retrieval system tissue morsellator is activated by 
attaching a suction means to a suction port and attaching a drive means 
for the morsellator drive shaft and cutting head. A source of vacuum at a 
head or end portion of the morsellator cutting head greatly assist in 
allowing cutting contact with the organ without dangerous plunging motions 
of the morsellator. In the alternative, a hand crank mechanism can be 
utilized in removing non-solid, smaller tissue organs. Irrigation can also 
be attached to the system through an irrigation port to aid in the 
flushing of tissue fragments through the suction device. The suction 
device and morsellator are activated to morsellate the tissues and when 
the morsellation of the organ is complete, the envelope and any remaining 
fragments of tissue are removed through the laparoscopy port. Tissue 
aspirated through the suction system can be trapped in a tissue trapping 
container such as a suction cannister. Tissue can then be removed from the 
trap or container for pathological evaluation. 
When the organ to be removed is a solid organ such as a kidney, the 
morsellator must have the cutting and removal capability for fragmenting 
and removal of such a solid organ within a reasonable time period while 
still being of such a nature as not to rupture or damage the entrapment 
envelope. The entrapment envelope must of course be of highly flexible 
construction and of substantially low bulk while yet exhibiting 
substantial strength to avoid any rupturing or tearing by the morsellator 
during the morsellization process. In addition, the entrapment envelope 
must be readily insertable into the cavity and pliable as to expansion of 
the envelope for receiving the organ and closing of the envelope upon 
receipt of the organ and capable of being drawn through the keyhole 
incision for control and entry of the morsellation procedure. The low 
bulk, highly flexible yet perforation resistive entrapment envelope 
material must be fluid and gas impervious since no body cavity leakage can 
be tolerated.

DETAILED DESCRIPTION OF THE DRAWINGS 
Tissue morsellation entrapment envelopes can be of various shapes and sizes 
and materials depending on the body organs to be retrieved. All envelopes 
are of fluid and gas impervious materials such as nylon, polyester, 
cotton, silk, polypropylene, mesh, and like materials which can be 
laminated, coated on the exterior and/or interior surfaces with further 
rubberized laminants or plastic coatings. The organ retrieval system in 
accordance with the present invention combines the use of such envelopes 
having various handling means for inserting into the body cavity through a 
sheath for readily opening the entrapment envelope with a mechanism within 
the body cavity as well as readily closing said envelope after insertion 
of the severed organ. These entrapment envelopes along with various 
morsellator cutter heads combined to present an organ retrieval system 
which can be custom tailored to specific laparoscopic organ retrieval 
procedures. In one embodiment a tissue morsellator is comprised of a 
hollow tube of metal, plastic or molded polymer or the like with a tissue 
envelope guard extending slightly beyond the end of a morsellator cutting 
means with an aspiration port and irrigation port at the opposite end. The 
cylindrical tube morsellator can contain a rotary helix for transporting 
the morsellated organ particles from the cutter head, the proximal end, of 
the helix to an aspirator at the distal end. The cutter or cutting head 
can be arranged in a variety of single and double blade apparati utilizing 
a side port on the morsellator cylindrical end portion. In another 
embodiment the cutter may be recessed and positioned in an open end of the 
morsellator cylindrical body utilizing vacuum control for pulling organ 
tissue into contact with the cutter blade. In yet another embodiment the 
cutter head is exposed through a side window with the morsellator 
cylindrical body closed at the end. 
The morsellator cylindrical body has supports at the proximal and distal 
ends for axial support of the helix and the cutter when the side port 
cutter apparatus is used. The distal end of the morsellator tube has a gas 
and liquid tight seal and the axis of helix projects far enough for the 
attachment of a hand crank or motor drive means. The proximal end of the 
helix, the cutter end, can be provided in one embodiment with a 
semi-circular axial guard which projects 5-10 mm from the end of the tube 
in order to protect the entrapment envelope and to provide axial support 
for the helix and cutter. Near the distal end of the morsellator tube is a 
vacuum discharge for the fragmented organ tissue. Irrigation fluid may be 
introduced in aid of transport of a morsellated tissue. The vacuum 
discharge port conducts the morsellated organ into a tissue trapping 
vacuum chamber. The inlet to the trapping chamber is provided with a mesh 
bag in which the organ tissue is trapped. This bag and its contents are 
suitable for removal enabling pathological examination of the tissue 
particles. 
Use procedures of the organ retrieval apparatus involve the collapsed 
impervious entrapment envelope being introduced into the patient abdomen 
through a keyhole and a laparoscopic port utilizing a sheath tube which 
houses the envelope thus avoids damage or contamination of the envelope 
before introduction to the body cavity. The entrapment envelope is 
projected into the body cavity and the detached organ is manipulated into 
an opened entrapment envelope, the envelope being connected to expansion 
and closure means such as wire guides or pneumatic handling means. The 
entrapment envelope opening and closing means are comprised of tubular 
guides defining the circumference of an opened portion of the entrapment 
envelope, the tubular guides being in communication with the entrapment 
envelope when the envelope is within the body cavity. The tubular guides 
being controlled from a position exterior of the body cavity, for example 
the tubular guides being suitable for receiving a wire member in 
combination with pneumatic means. In the case of pneumatic tubular means, 
the entrapment envelope contains such means extending from the entrapment 
envelope opening circumference to form expansion loops around the 
perimeter of the unopened portion of the envelope for expanding and 
opening the envelope. The entrapment envelope can also further utilize 
tubular staves extending from the entrapment envelope opening 
circumference to form expansion loops around the parameter of the unopened 
portion of the envelope. In a related manner the envelope can be closed 
once the organ is inserted into the envelope and the mouth of the envelope 
being retrievable through the keyhole incision. The morsellator tube is 
then inserted into the open neck of the envelope, the envelope being 
secured for morsellation removal of the organ. In one embodiment the 
envelope guard at the proximal end of the morsellator tube prevents damage 
to the envelope and consequently possible abdominal infection as the helix 
and cutter are rotated to fragment the detached organ. In other 
morsellator embodiments, other means are employed to safeguard the 
envelope, for example, vacuum control such that the envelope will not be 
pulled into the cutter. The helix transports the morsellated organ to the 
discharge vacuum port where the vacuum, optionally aided by the admission 
of irrigation fluid, transports the morsellated organ tissue to an organ 
trapping vacuum container. 
For purposes of promoting an understanding of the principles of the 
invention, reference will now be made to the embodiments illustrated in 
the drawings and specific language will be used to describe same. It will 
nevertheless be understood that no limitation of the scope of the 
invention is hereby intended, as alterations and further modifications of 
the illustrated device and such further applications of the principles of 
the invention as illustrated therein being contemplated as would normally 
occur to one skill in the art to which the invention relates. 
Referring to FIG. 1, there is shown a partial front elevational view of a 
human body with various organs in phantom, said body having a surgical 
keyhole opening suitable for laparoscopic procedures. The body cavity 2 
shows in phantom lungs 4, liver 6, pancreas 8, kidneys 10 and bladder 12. 
The keyhole body surgical opening 14 provides for minimum invasion 
surgical techniques utilizing laparoscopy organ retrieval apparatus and 
procedures. Such procedures allow for example a kidney 10 to be removed 
surgically through keyhole body surgical opening 14 which is substantially 
smaller than the dense tissue kidney. Minimum invasion surgical techniques 
utilizing a keyhole body surgical opening 14 for kidney 10 or gall bladder 
removal avoids extensive surgical incision lengths and expedites the 
patient's recovery not only in terms of hospital bed time but also return 
to active life. 
FIG. 2 presents a partial side elevational view of a human body with a 
laparoscopic port and sheath inserted therein, both elements being 
inserted into the body abdominal cavity which has been inflated. The human 
body cavity 2 which has been inflated by CO.sub.2 or some other suitable 
gas allows use of the laparoscopic port 16 which provides gas pressure 
means 18 and inflation of the body cavity 2 for purposes of telescope or 
miniature television and surgical instrument manipulations. Once a body 
organ has been surgically severed from its body attachments, for example 
kidney 10, the surgically isolated kidney is held in the body cavity until 
an entrapment envelope 22 is introduced to the inflated body cavity 
through sheath 20. Sheath 20 is inserted through the laparoscopic port 16 
and provides means for deploying the entrapment envelope 22. The 
entrapment envelope 22 is further equipped with envelope expansion means 
24 and related envelope expansion means guides 26 as shown in FIG. 3. An 
enlarged sectional view as presented in FIG. 3 shows the body skin line 
with the laparoscopic port 16 in place and the sheath 20 having a sheath 
cap 21 inserted therein with the entrapment envelope 22 entering the body 
cavity 2 through the sheath 20. Envelope expansion means 24 can be 
comprised of wires operating through envelope expansion mean guides 26 or 
in the alternative pneumatic tubing or a combination of both. In addition, 
the expansion means 24 can be used to assist opening the bag through stave 
slots or additional pneumatic tubing which are placed along the bag closed 
portion. 
A related view is shown in FIG. 4 wherein an enlarged sectional view 
presents the entrapment envelope being fully inserted into the inflated 
body cavity and opened for receiving surgically removed body organs. The 
entrapment envelope is fully expanded with the envelope expansion mean 
guides being projected into a fully opened receiving mode through envelope 
expansion means 24. FIGS. 4a and 4b provide another embodiment of an 
enlarged sectional view presenting the entrapment envelope fully inserted 
into the inflated body cavity and opened by pneumatic or by staved means 
for receiving surgically removed body organs. In FIG. 4a pneumatic means 
are utilized for expanding the envelope expansion opening means guides 26 
in communication with entrapment envelope 22 additional expansion 
pneumatic means 27. The pneumatic means 27 communicate with means guides 
26 through tubular means 29. In FIG. 4b an alternative opening embodiment 
is shown utilizing expansion means guides 26 in cooperation with tubular 
stave means 31 in order to open the entrapment envelope 22 and assist in 
holding the entrapment envelope 22 in an opened position until withdrawn 
from the body cavity. Upon removal of the laparoscopic port 16, sheath 20, 
the entrapment envelope 22 is substantially closed by envelope expansion 
and enclosure means 24 with the entrapment envelope open end 30 being 
pulled through the keyhole body surgical opening 14 into position for 
introduction of the morsellator guide 32 having a skin gripping surface 
34. The morsellation guide 32 allows and assists in entry and operation of 
the morsellator device 36 which is shown in operational position in FIG. 
6. The positioning port 35 in combination with the morsellator device 36 
provides a stop which allows the morsellator device 36 to be inserted into 
the body cavity a maximum, controlled distance. The expanded outer 
diameter of the morsellator device 36, as shown in combination with the 
morsellator vacuum port 40 connection, serves as a penetration depth stop 
for the morsellator. FIG. 6 is an enlarged sectional side view similar to 
FIG. 5 with a positioning port or guide 32, entrapment envelope 22 and 
isolated kidney 10 being particulized and removed by the laparoscopic 
morsellator. The morsellator device 36 contains a drive shaft 38 which is 
exposed for manual or mechanical drive means. The morsellator device 36 
has a morsellator vacuum tissue port 40 and can utilize an irrigation port 
(not shown) for assisting in the removal of particulate tissue matter from 
the morsellator device 36. In FIG. 6 a cutting head 42 is shown with auger 
shaft, the morsellator device having a fenestration 44 proximal to the 
cutting head 42. Morsellized tissue 46 is shown being separated and fed 
through the morsellator device 36 having a channel in communication with 
morsellator vacuum tissue port 40. 
The morsellator shaft 48 as shown in FIGS. 7 and 8 is provided with a 
bushing 50 and a rotational shaft guide means or bearing means 52 at the 
morsellator device blunt, closed end. A vacuum and irrigation channel 54 
provides communication between the morsellator device fenestration 44, 
cutting head 42 and the morsellator vacuum tissue port 40. FIG. 7 presents 
a side view of the laparoscopic morsellator in isolation and FIG. 8 
presents an enlarged sectional view of an alternative embodiment utilizing 
an open-ended cutting head. The open end morsellator device head 56 as 
shown in FIG. 8 has an open end 58 with a cutting head 68 recessed 
therein. The cutting head 68 is provided with cutting elements 70 and a 
hollow vacuum channel 72 which pulls the organ tissue into contact with 
the cutting elements 70 and also provides a conduit communication for the 
fragmented tissue for removal through morsellator vacuum tissue port 40. 
The organ entrapment envelope 22 system is comprised of several components. 
These components include the entrapment envelope sheath 20 and 
laparoscopic port 16 as illustrated in the drawings. The sheath 20 can be 
constructed of clear plastic construction and is of approximately the same 
size as the inside diameter of the laparoscopic port 16 in order that the 
sheath 20 fits through, for example, a 12 mm port. Depending upon the size 
of the organ to be retrieved, the entrapment envelope 22 and respective 
introduction sheath 20 will be of slightly different sizes in order to be 
fitted through appropriate size laparoscopic ports. In any case the 
keyhole body surgical opening 14 remains applicable for providing minimum 
invasion surgical techniques. The envelope sheath 20 can be closed at 
either end with closure means in order to prevent contamination of the 
envelope before introduction to the cavity, thus aiding in sterilization 
process. The envelope 22 is introduced into the sheath 20 and is 
prepackaged in the sheath 20 for later use. Upon introduction of the 
sheath 20 and the totally contained entrapment envelope 22 within the 
sheath 20 to the body cavity 2, the entrapment envelope 22 is totally 
protected from any handling damage or procedural exposure that might cause 
damage to the entrapment envelope 22 during the introduction through the 
laparoscopic port 16. 
As is illustrated in the drawings, the sheath 20 extends beyond the end of 
the laparoscopic port 16 which again protects the entrapment envelope 22 
from cutting or damage as the envelope is extruded through the end of the 
sheath which projects beyond the end of the port. 
The distal end of the introduction sheath 20 has a perforated cap as shown 
in FIGS. 3 and 4 through which protrudes plastic or wire tubing which runs 
through the neck of the entrapment envelope in a circumferential manner. 
Such tubing can also be pneumatic in nature for opening of the entrapment 
envelope 22 and are operable through entrapment envelope 20 expansion and 
closure means guides 26. The guides 26 are hollow and will accommodate 
wires of various lengths and thicknesses to aid in the opening of the 
mouth of the entrapment envelope after introduction through the 
laparoscopic port. This introduction sheath 20 and the cap over the end of 
the sheath with its perforations for the plastic tubing and associated 
wire mechanisms or pneumatic means are of sufficient size to prevent the 
loss of pneumoperitoneum or the escape of gas through the introduction 
sheath. The wire and the plastic tubing or guides can be subsequently 
removed prior to actual morsellation. 
Once the entrapment envelope 22 is advanced through the sheath 20 and the 
laparoscopic port 16, the tubing or guides 26 as well as wire aid or 
pneumatic aid is utilized in the advancement of the envelope through the 
introduction sheath and into the abdominal cavity where it can be grasped 
by appropriate laparoscopic graspers and further opened if needed to 
accommodate the placement and entrapment of the severed organ. Once the 
entrapment envelope 22 has been introduced into the abdomen and the organ 
has been placed into the entrapment envelope 22, the introduction sheath 
20 is removed as well as the laparoscopic port 16. Traction is maintained 
on the plastic tubing/guides 26 and wire or pneumatic means to prevent the 
accidental dislodgement of the envelope during removal of the port 16 and 
sheath 20. The edges of the envelope are pulled through the keyhole 
surgical opening 14 in the fascia of the abdomen until the entire neck of 
the envelope is exteriorized. After the neck of the envelope is positioned 
through the skin 28, the interior of the envelope is then entered with a 
tissue morsellator guide 32 as shown in FIG. 6. The tissue morsellator 
device 36 is then advanced through the guide 32 and tissue morsellation 
removal commences. The tissue morsellator device guide 36 is of sufficient 
diameter to allow the placement of the tissue morsellator device with a 
small air space between the inside diameter wall of the guide and the 
outside wall diameter of the tissue morsellator device 36. Such 
dimensional relations prevent the creation of the vacuum within the organ 
entrapment envelope during the morsellation process. Prevention of such a 
vacuum prevents injury to the wall of the entrapment envelope 22 during 
the morsellation process. The entrapment envelope 22 according to the 
invention provides tubing or guides 26 relative to the neck of the 
envelope which have attachment means to accommodate the plastic 
tubing/guides 26 and wire stiffeners and/or pneumatic stiffeners. 
The envelopes can be constructed of a variety of materials, including 
various laminated materials. However, the entrapment envelopes must be 
impervious to body fluids and gasses and be of reasonable low bulk and of 
sufficient flexibility to allow for encapsulation in the sheath and 
readily open from such a compressed encapsulation once inserted into the 
body cavity. 
In one morsellator embodiment as shown in FIG. 7, an angled fenestration at 
an end portion of the morsellator device provides cutting access to the 
organ tissue while the end of the morsellator device is blunt and 
occluded. The tissue being morsellated is drawn into the device through 
the fenestration on the end portion side. The morsellator device consists 
of a specifically designed cutting head mounted on an auger shaft. The 
blunt end of the morsellator prevents the accidental passage of the 
cutting head beyond the end of the morsellator, thus preventing damage to 
the organ entrapment envelope. The cutting head auger shaft is seated in a 
small dimple at the end of the morsellator shaft so as to prevent wobble 
of the cutting head while rotating. The tissue morsellation process is 
aided by the application of suction or vacuum to the tissue port of the 
device. The application of up to about 30 inches of mercury vacuum can be 
applied to aid in drawing tissue into the cutting head fenestration 
without danger of damage to the entrapment envelope. Furthermore, the 
vacuum assist in evacuation of morsellated particles of tissue as 
particles are cut by the cutting head. An irrigation port can be added for 
the continuous or intermittent irrigation of the cutting head and the 
auger mechanism to further speed the process of tissue removal. 
Morsellator shafts can be constructed of different sizes according to 
different types of ports and cutting heads. Various cutting heads can be 
utilized in accordance with the invention inclusive of recessed open-end 
morsellator device cutting heads in the nature of a cheese grater cutting 
element with a central shaft vacuum means as shown in FIG. 8. In another 
embodiment open end cutting heads can utilize envelope protection 
extensions such as an arc mean over the open end of the morsellator device 
containing an end cutting head. Morsellator cutting heads can be designed 
for specific use depending on the nature, location, diversity and size of 
the body part to be removed. Through the use of vacuum means for removing 
the morsellated tissue, the morsellation of even dense body portions 
removes the requirement of constant plunging to morsellate the tissue. The 
vacuum pulls the body portion to the morsellator cutting head. 
The morsellator device for dense tissue organs such as kidneys are driven 
by an electric motor means which has the capacity for at least about 2,000 
rpm on the drive shaft on the auger in order to provide efficient and 
rapid morsellation and removal of tissue. At these rpms and the sudden 
cutting loads on the cutting heads, bushings and appropriate fittings and 
other supports are necessary to prevent vibration of the morsellizer 
shaft. An auger type cutting head with hooked tips used in combination 
with an angled fenestration can also be used. The angle of the cutting 
auger equals the angle of the windows and the auger is useful in 
combination with various cutting heads for further pulverization of 
tissue. 
An enlarged isolation view of another morsellator cutting device is shown 
in FIG. 9. Cutting edges 74 are relatively flat razor-type edges which 
terminate in upturned cutting edge tips 78. Direction of rotation is 
indicated by arrow 76 and such a cutting edge would be utilized in a 
morsellation device head similar to FIG. 8. The cutting edges 74 can be 
adapted with raised trailing edges 80 which assist in directing the flow 
of tissue and fluid away from the plane of the cut. A vacuum will be 
pulled as shown in FIGS. 6 and 7 through morsellizer vacuum tissue port 40 
and the shaft of the morsellation device itself. 
A modified morsellating device 36 is shown in FIG. 10. The morsellating 
device 36 of FIG. 10 is similar to the device shown in FIG. 6; however, 
the morsellation guide 32 utilizes bag hooks 82 for holding the bag in 
place during morsellation. The bag during morsellation operations has a 
tendency to travel back into the cavity, thus the need for such bag hooks 
82. The morsellation guide 32 also is adapted with gripping teeth 84 which 
are in a slanted configuration for assisting in holding body tissue 
contained in the bag during morsellation. The body tissue has a tendency 
to rotate due to the various cutter head spinning actions. The morsellator 
head gripping teeth 86 are also effective in reducing or eliminating 
tissue spin. If the body part contained in the bag for morsellation 
removal spins, then the cutting action of the exposed cutting edges is 
reduced or eliminated. In another embodiment, a morsellator guide gripping 
pad 88 can be utilized under the morsellation guide 32 for providing 
additional stability of the morsellation guide during morsellation device 
usage. 
In FIG. 11, an enlarged top perspective view of the positioning of the 
morsellation guide is shown in isolation. The morsellation guide 32 
presents the morsellation guide bag hooks 82 with the hooks turned inward 
from the peripheral of the morsellation guide 32 top portion since the 
morsellation guide 32 is inserted into the bag opening once the bag 
opening has been pulled through the patient incision. Counterclockwise 
slanted morsellation guide gripping teeth are illustrated which hold upon 
contact the tissue mass which is being morsellated, preventing rotation of 
the mass due to the force and speed of the cutting member of the 
morsellation device. 
A typical procedure for the laparoscopic organ retrieval of, for example, a 
kidney involves the surgical opening of a keyhole through which is 
inserted a laparoscopic port having gas communication means for inflating 
the body cavity with CO.sub.2 or other suitable gases. The laparoscopic 
port allows for entry of telescope or miniature television and surgical 
instruments for manipulation and severing of specific organs and isolating 
same for introduction into an entrapment envelope. A sheath containing the 
entrapment envelope is inserted through the laparoscopic port and beyond 
the end of the laparoscopic port inside the body cavity. The entrapment 
envelope is then introduced to the inflated body cavity beyond the sheath 
opening with envelope expansion and closure means being attached to the 
entrapment envelope and extending through the laparoscopic port to the 
exterior of the body cavity. The entrapment envelope is open to receive 
the severed and isolated kidney which is in the body cavity. Prevention of 
inflation gas escaping is through utilization of dimensional relationships 
of the sheath and port and sheath cap means. The entrapment envelope and 
severed, entrapped organ is positioned upon removal of the sheath and the 
laparoscopic port in order to expose the opening of the entrapment 
envelope to the exterior of the body cavity through the keyhole incision. 
The entire neck of the entrapment envelope is presented to the exterior of 
the body cavity and a morsellizer guide is utilized in the neck of the 
envelope for introduction of the morsellizer device into the envelope for 
morsellizing and removing the kidney. Morsellized tissue is removed 
through vacuum and in the alternative fluid irrigation means which are in 
communication with the cutting head and exterior vacuum port. Upon removal 
of the morsellator device, the entrapment envelope and any remaining 
tissue therein is removed through the keyhole fascia opening. 
While the invention has been illustrated and described in detail in the 
drawings and foregoing description, the same is to be considered as 
illustrative and not restrictive in character. It being understood that 
only exemplary embodiments have been shown and described and that all 
changes and modifications that come within the spirit of the invention are 
deemed to be protected.