Abstract:
A surgical apparatus for positioning within a tissue incision to access an underlying body cavity and remove a tissue specimen therefrom includes a wound retractor having a specimen bag attached thereto. The wound retractor includes a proximal ring, a distal ring, and a film extending therebetween defining a longitudinal passage therethrough. The specimen bag is attached to the distal ring of the wound retractor and permits placement of a tissue specimen to be removed from the body therein.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/336,047 filed May 13, 2016, the entire disclosure of which is incorporated by reference herein. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates generally to surgical apparatuses for use in minimally invasive surgical procedures, such as endoscopic and/or laparoscopic procedures, and more particularly, the present disclosure relates to a surgical apparatus including both a wound protection device and a specimen retrieval bag for collecting body tissue(s) and/or body fluid(s) during these procedures. 
       BACKGROUND 
       [0003]    Minimally invasive surgery, such as endoscopic surgery, reduces the invasiveness of surgical procedures. Endoscopic surgery involves surgery through body walls, for example, viewing and/or operating on the ovaries, uterus, gall bladder, bowels, kidneys, appendix, etc. There are many common endoscopic surgical procedures, including arthroscopy, laparoscopy, gastroentroscopy and laryngobronchoscopy, just to name a few. In these procedures, trocars are utilized for creating incisions through which the endoscopic surgery is performed. Trocar tubes or cannula devices are extended into and left in place in the abdominal wall to provide access for endoscopic surgical tools. A camera or endoscope is inserted through a trocar tube to permit the visual inspection and magnification of the body cavity. The surgeon can then perform diagnostic and/or therapeutic procedures at the surgical site with the aid of specialized instrumentation, such as forceps, graspers, cutters, applicators, and the like, which are designed to fit through additional cannulas. To protect the opening from accidental penetration by the surgical instruments, wound retractors and wound protectors are often placed across the opening. 
         [0004]    When removing certain tissue from the body cavity, for example tumor tissue, it is important that the tumor tissue does not come into contact with healthy or uninvolved tissue, so as in this way to avoid metastasis and avoid harming the patient. Minimally invasive surgical procedures, however, may be limited where large size tumors or large masses of tissue have to be removed from a body cavity. If tumor tissue or tissue parts have to be removed, they may be introduced into an “extraction bag,” also referred to herein as a “specimen bag,” at the site where the tumor or diseased tissue has been detached from the surrounding tissue, after which the specimen bag is withdrawn from the body, normally through a trocar or similar device, thereby minimizing contact of the diseased tissue with healthy tissue. 
         [0005]    In some instances, depending upon the volume of tissue being removed from the body, the tissue within the specimen bag must be broken up prior to removal from the body to allow for the specimen bag and its contents to pass through the opening used to conduct the endoscopic procedure. 
         [0006]    Improved wound retractors and specimen bags for use in minimally invasive surgical procedures remain desirable. 
       SUMMARY 
       [0007]    The present disclosure is directed to surgical apparatuses and kits for use in minimally invasive surgery. The surgical apparatus includes a wound retractor having a specimen bag attached thereto, for placement of diseased tissue therein. In embodiments, the kit of the present disclosure includes the surgical apparatus, a morcellating trocar for breaking up tissue prior to its removal from the body, and an optional cannula. 
         [0008]    A surgical apparatus of the present disclosure includes, in embodiments, a wound retractor including a proximal ring, a distal ring, and a film disposed between the proximal ring and the distal ring. The surgical apparatus also includes a specimen bag attached to the distal ring of the wound retractor. 
         [0009]    In embodiments, the proximal ring of the wound retractor defines a generally circular opening and is deformable. Similarly, the distal ring of the wound retractor may also define a generally circular opening and is deformable. 
         [0010]    In some embodiments, the film of the wound retractor defines an adjustable length between the proximal ring and the distal ring. 
         [0011]    In certain embodiments, the specimen bag is attached to the distal ring of the wound retractor by a method such as adhesive bonding, welding, heat-sealing, and combinations thereof. 
         [0012]    In embodiments, the proximal ring, the distal ring, or both, possess a tether thereon. 
         [0013]    A kit on the present disclosure includes, in embodiments, a surgical apparatus including a wound retractor having a proximal ring, a distal ring, a film disposed between the proximal ring and the distal ring, and a specimen bag attached to the distal ring of the wound retractor. The kit of the present disclosure also includes a morcellating trocar and an optional cannula. 
         [0014]    In embodiments, the morcellating trocar includes a proximal portion, a distal portion, and an elongate shaft between the proximal portion and the distal portion, the elongate shaft having blades on an interior surface at the distal portion projecting into a lumen of the elongate shaft, and the proximal portion of the elongate shaft possessing a rotation knob for rotating the elongate shaft. 
         [0015]    Methods of the present disclosure include, in embodiments, introducing into a body opening a surgical apparatus including a wound retractor having a proximal ring, a distal ring, a film disposed between the proximal ring and the distal ring, and a specimen bag attached to the distal ring of the wound retractor, by inserting the surgical apparatus through the body opening into the body cavity. A tissue specimen is then passed through the proximal ring, the film and the distal ring of the surgical apparatus into the specimen bag, after which the proximal ring is removed from the body cavity through the body opening so that the film is adjacent tissue encompassing the body opening. The proximal ring is then pulled away from the distal ring such that the distal ring is brought into abutment with an inner surface of the tissue surrounding the body opening, and the proximal ring is rolled about itself such that the film is furled about the proximal ring and tensioned. The proximal ring is further rolled to retract the incision and bring the proximal ring into abutment with an outer surface of the tissue. The tissue specimen is then removed from the specimen bag. 
         [0016]    In embodiments, the methods of the present disclosure further including breaking up the tissue specimen prior to removing the tissue specimen from the specimen bag. 
         [0017]    In certain embodiments, the methods of the present disclosure further include introducing a cannula through the proximal ring, the film, and the distal ring into the specimen bag prior to removing the tissue specimen from the specimen bag. A morcellating trocar is then introduced through the cannula into the specimen bag, followed by introduction of a grasping element through the morcellating trocar into the specimen bag. The grasping element grasps the tissue specimen therein, and the grasping element is then pulled proximally while activating the morcellating trocar to break up the tissue specimen as it is removed from the specimen bag. 
         [0018]    In some embodiments, the cannula possesses an anchoring balloon which is inflated to anchor the cannula in the body opening. In certain embodiments, the specimen bag is also inflated prior to removal of the tissue specimen therefrom. 
         [0019]    In embodiments, the morcellating trocar includes a proximal portion, a distal portion, and an elongate shaft between the proximal portion and the distal portion, the elongate shaft having blades on an interior surface at the distal portion projecting into a lumen of the elongate shaft, and the proximal portion of the elongate shaft possessing a rotation knob for rotating the elongate shaft. Activating the morcellating trocar includes rotating the elongate shaft so that the tissue specimen is cut by the blades as the tissue specimen passes through the morcellating trocar. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]    Various embodiments are described herein with reference to the drawings wherein: 
           [0021]      FIG. 1  is a perspective view of the components of a kit of the present disclosure; 
           [0022]      FIG. 2  is a perspective view of a surgical apparatus of the present disclosure, including a specimen bag affixed to a wound retractor; 
           [0023]      FIG. 3  is a perspective view of a morcellating trocar of the present disclosure; 
           [0024]      FIG. 4  is an enlarged view of the indicated area of detail shown in  FIG. 3 ; 
           [0025]      FIG. 5  is a cross-sectional view of the distal end of the morcellating trocar in accordance with the embodiment of  FIG. 3 ; 
           [0026]      FIG. 6  is a perspective view of a patient&#39;s body, showing a wound, incision, and tissue specimen to be removed  320  from the body cavity; 
           [0027]      FIG. 6A  is a perspective view showing the partial removal of a surgical apparatus of the present disclosure through an incision into a body cavity; 
           [0028]      FIG. 6B  is a perspective view of a surgical apparatus of the present disclosure in a body cavity, adjacent tissue to be removed from the body cavity; 
           [0029]      FIG. 7  is a perspective view of a surgical apparatus in accordance with the embodiment of  FIG. 2 , showing the wound retractor inserted into an incision in tissue and the specimen bag within the body cavity; 
           [0030]      FIG. 8  is a perspective view of a surgical apparatus in accordance with the embodiment of  FIG. 7 , showing a cannula inserted through the wound retractor into the specimen bag; 
           [0031]      FIG. 9  is a perspective view of a surgical apparatus in accordance with  FIG. 8 , showing a morcellating trocar of the present disclosure inserted through the cannula into the specimen bag; 
           [0032]      FIG. 10  is a perspective view of a grasping element deployed through the morcellating trocar in accordance with the embodiment of  FIG. 9 , beginning to remove tissue from the specimen bag; and 
           [0033]      FIG. 11  is a perspective view of a grasping element removing tissue through the morcellating trocar in accordance with the embodiment of  FIGS. 9-10 . 
       
    
    
     DETAILED DESCRIPTION 
       [0034]    The present disclosure provides a surgical apparatus for use in minimally invasive procedures. As used herein with reference to the present disclosure, minimally invasive surgical procedures encompass laparoscopic procedures and endoscopic procedures, and refer to procedures utilizing scopes or similar devices having relatively narrow operating portions or a small incision in the skin. 
         [0035]    The aspects of the present disclosure may be modified for use with various methods for retrieving tissue specimens during minimally invasive procedures. Examples of minimally invasive procedures include, for example, cholecystectomies, appendectomies, nephrectomies, colectomies, splenectomies, and the like. 
         [0036]    As used herein, the term distal refers to the portion of a surgical apparatus, including a wound retractor and specimen bag of the present disclosure, which is farthest from the user, while the term proximal refers to that portion of the surgical apparatus of the present disclosure which is closest to the user. 
         [0037]    The surgical apparatus of the present disclosure includes a wound retractor with a specimen bag affixed thereto. The wound retractor component includes a sleeve member possessing at least two rings, including a proximal ring and a distal ring with a film between the two rings. The specimen bag component is attached to the distal ring of the wound retractor. In use, the entire surgical apparatus is passed through an incision and placed within the body, and tissue to be removed therefrom, referred to in embodiments as a “tissue specimen”, is passed through the wound retractor component and placed within the specimen bag. The proximal ring of the wound retractor component is then removed from the body cavity and placed adjacent the skin on the outside of the body adjacent the incision, with the distal ring of the sleeve member and specimen bag remaining within the body, so that the film extends through the incision and is adjacent the tissue encompassing the incision into the body. These apparatuses are suitable for use in any procedure where access to the interior of the body is limited to one or more relatively small incisions, as in minimally invasive procedures. 
         [0038]    Kits of the present disclosure include both the surgical apparatus described above, as well as a manual morcellating trocar. The manual morcellating trocar may be placed through the wound retractor of the surgical apparatus and introduced into the specimen bag containing the tissue specimen, whereby the manual morcellator is activated to break up the tissue specimen within the specimen bag permitting removal of the tissue specimen from the body through the wound retractor. Kits of the present disclosure may also include an optional cannula for introducing the morcellating trocar into the specimen bag. 
         [0039]    Embodiments of the present disclosure will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. 
         [0040]      FIG. 1  illustrates a kit of the present disclosure including a surgical apparatus  10  in accordance with the present disclosure. The surgical apparatus  10  encompasses both the wound retractor  100  and the specimen bag  200 . The kit of the present disclosure also includes a morcellating trocar  300  and, optionally, a cannula  400  for introducing the morcellating trocar  300  into a patient&#39;s body. 
         [0041]    The surgical apparatus  10 , including the wound retractor  100  and the specimen bag  200 , is adapted for insertion into wound “W” through an incision “I” (as illustrated in  FIG. 6 ). The incision “I” may be a single incision, e.g., through the abdominal or peritoneal lining, or a naturally occurring orifice (i.e. mouth, anus, or vagina). 
         [0042]    Turning to  FIG. 2 , the wound retractor  100  includes a proximal ring  120 , a distal ring  140 , and a generally cylindrical film  130  disposed therebetween. The surgical apparatus  10  further defines a longitudinal axis “L” shared by the proximal ring  120 , the distal ring  140 , and the film  130 , as well as the specimen bag  200 . It is envisioned that the proximal ring  120  and the distal ring  140  may each be detachably coupled or permanently attached to a proximal end portion  132  and a distal end portion  134 , respectively, of the film  130  by any means known in the art, e.g., glue, suture, impulse welding, chemical or mechanical bonding, an over molding process, etc. In some embodiments, the proximal ring  120 , film  130 , and distal ring  140  are monolithically integrated such that the wound retractor  100  is a unitary structure. Attachment of the film  130  to the rings  120 ,  140  can be continuous around the rings  120 ,  140  or may be discontinuous, provided the rings  120 ,  140  are sufficiently secured to the film  130  to allow the film  130  to be rolled about the proximal ring  120  as described below. 
         [0043]    The proximal ring  120  and the distal ring  140  are axially aligned along longitudinal axis “L” with the film  130  disposed therebetween, as noted above. The proximal ring  120  has a generally circular configuration that defines a circular opening  122  (see  FIG. 1 ) and is rollable, such that the proximal ring  120  can be rolled towards or away from the distal ring  140  along the longitudinal axis “L”, which results in the film  130  being furled or unfurled about the proximal ring  120 . The distal ring  140  also has a generally circular configuration that defines a generally circular opening (not shown). 
         [0044]    It is envisioned that the proximal ring  120  and the distal ring  140  may be fabricated from resilient materials such that the proximal ring  120  and the distal ring  140  may temporarily deform into a generally oblong configuration during insertion of the wound retractor  100  through an incision “I” ( FIG. 6 ) while reverting to a generally circular configuration during use. For example, thermoplastic polyurethanes sold under PELLETHANE®, offers flexibility and a wide range of hardnesses. The proximal ring  120 , for example, may be fabricated from PELLETHANE® 2363-80A, PELLETHANE® 2363-90A, a 50/50 composition of PELLETHANE® 2363-80A and PELLETHANE® 2363-90A, or any alternatives known in the art. The distal ring  140  may be fabricated from, for example, PELLETHANE® 2363-90A for the extra small and small size, PELLETHANE® 2363-55D for the medium and large size, a 50/50 composition of PELLETHANE® 2363-90A and PELLETHANE® 2363-55D for the extra-large size, or any alternatives known in the art. The proximal ring  120  and the distal ring  140  may be fabricated from the same or different materials. 
         [0045]    The film  130  defines a generally cylindrical shape to form a lumen between the proximal ring  120  and the distal ring  140 . The circular configuration of the proximal and distal rings  120  and  140 , respectively, maintains the film  130  in an expanded state to maintain the lumen in a non-collapsed state. The film  130  is coupled to the proximal ring  120  at the proximal end portion  132  and is coupled to the distal ring  140  at the distal end portion  134 , such that the film  130  does not slide or move relative to a surface of either the proximal ring  120  or the distal ring  140 . The film  130  may be fabricated from a clear, non-elastomeric material, e.g., a polyurethane. 
         [0046]    The length “X” between the proximal ring  120  and the distal ring  140  is adjustable. More specifically, the length “X” can be decreased by rolling the proximal ring  120  towards the distal ring  140  to furl the film  130  about the proximal ring  120 . Similarly, the length “X” can be increased by rolling the proximal ring  120  away from the distal ring  140  to unfurl the film  130  from about the proximal ring  120 . As discussed above, as the proximal ring  120  is rolled towards or away from the distal ring  140 , the film  130  furls or unfurls about the proximal ring  120 . It should be appreciated that as the film  130  is furled about the proximal ring  120 , it reduces the length “X” of the film  130 , so the tension in the film between the proximal ring  120  and distal ring  140  is increased to provide a radially outward force within the incision “I”. 
         [0047]    It is envisioned that the wound retractor  100  may come in a variety of sizes to appropriately fit and accommodate a range of incision diameters. For example, for an extra small wound retractor, the outer diameter of the proximal ring  120  and the distal ring  140  may be about 2.5 inches; for a small wound retractor, the outer diameter of the proximal ring  120  and the distal ring  140  may be about 3.9 inches; for a medium sized wound retractor, the outer diameter of the proximal ring  120  and the distal ring  140  may be about 5.1 inches; for a large wound retractor, the outer diameter of the proximal ring  120  and the distal ring  140  may be about 7.5 inches; and for an extra-large wound retractor, the outer diameter of the proximal ring  120  and the distal ring  140  may be about 9.4 inches. 
         [0048]    Specimen bags of the present disclosure are made of flexible and durable materials within the purview of those skilled in the art, in embodiments, polymeric materials. The specimen bags are inflatable and capable of allowing a surgeon to introduce cutting devices into the specimen bag to reduce the size of the tissue specimen therein, thereby facilitating removal of the specimen bag from the body. Materials used to form the specimen bags are antistatic, pyrogen-free, non-toxic and sterilizable. In embodiments, materials used to form the film portion of the wound retractor described above may be used to form the specimen bag. In other embodiments, the specimen bag is formed of materials that are different from those used to form the film of the wound retractor. The specimen bag may be opaque or clear. 
         [0049]    As depicted in  FIG. 2 , the specimen bag  200  may be joined to the distal ring  140  of the wound retractor at the distal portion  134  of the film  130  by methods within the purview of those skilled in the art, including, but not limited to, adhesive bonding, welding, heat-sealing, combinations thereof, and the like. Alternatively, the specimen bag  200  can be integrally formed with the film  130 , in embodiments of the same material. 
         [0050]    Both the proximal ring  120  and the distal ring  140  may be collapsed from the generally circular configuration to a generally oblong configuration (not shown) for insertion, along with the specimen bag  200 , through incision “I”. More specifically, as the practitioner squeezes opposing sides of the proximal ring  120  and the distal ring  140  radially inwards, the generally circular openings of the proximal ring  120  and the distal ring  140  are deformed from the generally circular configuration to a generally oblong configuration (not shown) such that the proximal ring  120  and the distal ring  140  assume a smaller profile for ease of insertion through incision “I”. Once inserted, the practitioner releases the proximal ring  120  and distal ring  140  and the resiliency of the material urges the proximal ring  120  and the distal ring  140  towards their generally circular configurations. 
         [0051]    In embodiments, where the tissue specimen “T” within the specimen bag  200  is too large to pass through the wound retractor  100  ( FIG. 8 ), a morcellator can be inserted into the specimen bag for morcellating the tissue specimen. As used herein, the term morcellator refers to a surgical instrument for cutting, mincing up, liquefying, or morcellating, tissue into smaller pieces. Care should be taken not to damage the specimen bag to prevent resected tissue from entering into a body cavity, e.g., the abdominal cavity. 
         [0052]    Referring to  FIGS. 3-5 , the kit of the present disclosure includes a morcellating trocar  300 . The morcellating trocar  300  has an elongate shaft  310  defining a lumen  314 . The elongate shaft  310  has a distal portion  312 , with blades  320 ,  330  on the interior surface thereof projecting into the lumen  314  of the elongate shaft  310  along line  5 - 5  ( FIG. 4 ). In embodiments, a proximal portion  316  of the elongate shaft  310  has a rotation knob  340  thereon for rotating the elongate shaft  310 . 
         [0053]    Kits of the present disclosure also include an optional cannula  400  for introducing the morcellating trocar  300  through the wound retractor  100  and into the specimen bag  200 . Turning to  FIG. 8 , the cannula  400  has an elongate shaft  410  including inflation ports  420 ,  430  for introducing inflation gases into both an anchoring balloon  440  located at a distal portion  412  of the elongate shaft  410  and the specimen bag  200 . The anchoring balloon  440  can be inflated to secure the distal portion  412  of the cannula  400  within the body cavity. 
         [0054]    The anchoring balloon  440  at the distal portion  412  of the elongate shaft  410  of the cannula  400  may be inflated with any medical grade fluid, such as saline, CO 2 , or any other fluid. The anchoring balloon  440  may be inflated using a syringe, mechanically or manually operated pump, or other means. The inflation port  420  for inflating the anchoring balloon  440  may be used with one-way valves, check valves, or any other valve arrangement for inflating the anchoring balloon  440 . 
         [0055]    Once the anchoring balloon  440  has been inflated to secure the distal portion  412  of the cannula  400  within a body cavity and within the specimen bag  200 , the specimen bag  200  can be inflated. In order to inflate the specimen bag  200 , a source of inflation pressure is releasably attached to the inflation port  430  and pressurized fluid is introduced through the inflation port  430  and communicated along axis  3 - 3  (as depicted in  FIG. 1 ) of the elongate shaft  410  of the cannula  400  to the specimen bag  200 . 
         [0056]      FIG. 8  shows the cannula  400  introduced through the wound retractor  100  into the specimen bag  200  for inflating the specimen bag  200 .  FIG. 8  also depicts the introduction tube  450  for introducing inflation gases (arrows) into the inflation port  430  and the gases travelling from the inflation port  430  through the elongate shaft  410  into the specimen bag  200  possessing tissue specimen “T” therein. 
         [0057]    With reference to  FIGS. 6-11 , a method of operating the surgical apparatus  10  in accordance with the present disclosure will be described. As shown in  FIGS. 6A and 6B , the surgeon first collapses and deforms the proximal ring  120  and the distal ring  140  of the wound retractor  100  into an oblong configuration for insertion into wound “W” through incision “I”. Once the wound retractor  100  and the specimen bag  200  are placed through incision “I” and the proximal ring  120  and the distal ring  140  are released, the proximal ring  120  and distal ring  140  resume their generally circular configuration so that the surgical apparatus  10  is adjacent the tissue specimen “T” to be removed from the body cavity. The surgeon can then introduce tissue specimen “T” through the proximal ring  120 , the film  130 , and the distal ring  140  into the specimen bag  200  by use of a forceps, grasper, or any other suitable medical device. 
         [0058]    Once tissue specimen “T” has been introduced into the specimen bag  200 , the surgeon then collapses and deforms the proximal ring  120  using a forceps, grasper, or similar instrument. In other embodiments, the proximal ring  120  has a tether thereon (not shown), which may be pulled proximally by the surgeon to remove the proximal ring  120  from the body cavity. 
         [0059]    As shown in  FIGS. 6A and 7 , the proximal ring  120  is removed from the body cavity through incision “I” so that it rests on the outer skin  4  adjacent incision “I” and the surgeon adjusts the film  130  and the proximal ring  120 , e.g., pulling the proximal ring  120  proximally to tension the film  130 , such that the distal ring  140  comes into abutment with an inner surface  8  of wound “W”. The distal ring  140  is positioned adjacent the inner surface  8  of wound “W”, and reverts to the generally circular configuration so that the generally circular opening of distal ring  140  is parallel to the inner surface  8  of the wound ( FIG. 7 ). 
         [0060]    With the distal ring  140  in abutment with the inner surface  8  of wound “W”, the proximal ring  120  is rolled distally towards the distal ring  140  and the outer surface  4  of wound “W” to a desired position, such that the film  130  is furled about the proximal ring  120  (not shown) and thereby tensioned. 
         [0061]    Once the wound retractor  100  and the specimen bag  200  are in position, surgical tools and instruments may pass through the wound retractor  100  with the distal ring  140  in abutment to the inner surface  8  of wound “W”, and the proximal ring  120  rolled to a desired position and/or brought into abutment to the outer surface  4  of wound “W”. The wound retractor  100  may be tensioned further to provide retraction of incision “I”, increasing the incision diameter. 
         [0062]    Where the tissue specimen “T” in the specimen bag is too large to be removed through the incision, the morcellating trocar  300  may be introduced through the wound retractor  100  into the specimen bag  200 . While the morcellating trocar  300  may be introduced directly through the wound retractor  100  into the specimen bag  200 , in embodiments, as depicted in  FIG. 8 , the cannula  400  is first introduced through the wound retractor  100  and into the specimen bag  200 . Inflation gases are introduced through the inflation port  420  on the cannula  400  to inflate the anchoring balloon  440 . Once the anchoring balloon  440  has been inflated, inflation gases are introduced through the inflation port  430  on the cannula  400  to inflate the specimen bag  200 . 
         [0063]    Upon inflation of the specimen bag  200 , the morcellating trocar  300  is introduced through the cannula  400  into the specimen bag  200 . ( FIG. 9 .) The distal ring  140  of the wound retractor  100  and the inflation of specimen bag  200  prevent the specimen bag  200  from coming into contact with the knife blades  320 ,  330  within the lumen  314  of the elongate shaft  310  of the morcellating trocar  300 . 
         [0064]    As depicted if  FIG. 10 , a forceps  500 , or any other grasper device, may then pass through the morcellating trocar  300  into the specimen bag  200  and grasp the tissue specimen “T” therein. Although not shown, in embodiments it may be necessary to utilize a funneled introducer to constrain the forceps  500  in the center of the elongate shaft  310  of the morcellating trocar  300  so that the forceps  500  do not damage the knife blades  320 ,  320 . 
         [0065]    The anchoring balloon  440  on the cannula  400  helps stabilize the tissue specimen “T” during removal of the tissue specimen “T” from the specimen bag  200 . As the forceps  500  are pulled proximally (indicated by arrows “Y” in  FIG. 10 ) to remove tissue specimen “T” from the specimen bag  200 , the tissue specimen “T” passes proximally through the morcellating trocar  300 . As the tissue specimen “T” passes through the trocar  300 , the elongate shaft  310  of the morcellating trocar  300  may be rotated within the cannula  400  as indicated by arrows “Z” in  FIGS. 10 and 11  by the proximal rotation knob  340 . Alternatively, or additionally, the surgeon may rotate the forceps  500  or any other grasper as the tissue specimen “T” is removed from the specimen bag  200 . 
         [0066]    Pulling tissue specimen “T” through the distal end  312  of the morcellating trocar  300  will bring tissue specimen “T” to be removed from the specimen bag  200  into contact with the blades  320 ,  330 . Rotating the elongate shaft  310  with the proximal rotation knob  340  as tissue specimen “T” is pulled proximally into contact with the blades  320 ,  330  within the lumen  314  of the elongate shaft  310  of the morcellating trocar  300  will continually cut the tissue specimen “T” into a double helical pattern to allow it to fit through the smaller diameter of the elongate shaft  310 . The cut tissue specimen may thus pass through the elongate shaft  310  of the morcellating trocar  300  as it is removed from the specimen bag  200 . In embodiments, if tissue specimen “T” to be removed separates and portions thereof remain in the specimen bag  200  as tissue specimen “T” is cut by the blades  320 ,  330 , the surgeon may grab those additional pieces of tissue with a forceps or other grasper, and/or use a vacuum source for removal of any remaining portion of the tissue specimen “T” from the specimen bag  200 . In other embodiments, the volume of the tissue specimen “T” in the specimen bag  200 , as well as any fluids from the tissue specimen “T”, may be reduced to a point that specimen bag  200 , with any remaining tissue and/or fluids therein, may pass through incision “I” without need for any further morcellation. 
         [0067]      FIG. 11  depicts the tissue specimen “T” which has been cut by the blades  320 ,  330  to permit removal of tissue specimen “T” through the morcellating trocar  300  (tissue travelling through the trocar is demonstrated by arrows “A”) from the specimen bag  200 . 
         [0068]    In other embodiments, not shown, power morcellators may be used with the wound retractor/specimen bag of the present disclosure. 
         [0069]    Once a sufficient amount of tissue specimen “T” is removed from the specimen bag  200  to facilitate removal of the specimen bag  200  through incision “I”, the inflation gases are withdrawn from the specimen bag  200 , and from the anchoring balloon  440 . The surgeon then collapses and deforms the distal ring  140  using a forceps, grasper, or similar instrument. In other embodiments, the distal ring  140  has a tether thereon (not shown), which may be pulled proximally by the surgeon to remove the distal ring  140  from the body cavity. 
         [0070]    The film  130 , distal ring  140 , and specimen bag  200  are then removed from the body cavity through incision “I”. 
         [0071]    After the specimen bag  200  is removed, any tissue remaining therein can be removed from the specimen bag  200  for further examination or the specimen bag  200  can be discarded. 
         [0072]    The specimen bags of the present disclosure provide safe tissue extraction at the end of minimally invasive surgical procedures. Diseased tissue may be removed from the body without seeding of spilled tissue cells inside the abdomen. The design of the wound retractor/specimen bags of the present disclosure, with the morcellating trocar described above, allows for the surgeon to break up tissue without tearing the specimen bag and possibly releasing tissue contents back into the body of the patient. It is further envisioned that the methods of using the specimen bags of the present disclosure may be modified to accommodate needs of a given procedure and/or the preferences of the surgeon. It is further envisioned that the embodiments disclosed herein may be used to remove any tissue or object from the body. 
         [0073]    It will be understood that various modifications may be made to the embodiments disclosed herein. For example, other methods for introducing specimen bags of the present disclosure into the body of a patient may be used. Additionally, other specimen bag shapes may be used. Further, the terminology of similar components with the various embodiments should not be construed as specific to any particular embodiment. Thus, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.