Patent Publication Number: US-2021186474-A1

Title: Methods and Devices for Removing a Tissue Specimen from a Patient

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Patent Application No. 62/315,514, filed Mar. 30, 2016, which is incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The present invention, according to some embodiments, relates to methods and devices for removing a tissue specimen from a patient. More particularly, some embodiments of the present invention relate to methods for removing a tissue specimen using a bag that can be evacuated of gas to compress the tissue specimen. In further embodiments, the present invention relates to a bag that can be used for tissue specimen removal in accordance with the methods described herein. In other embodiments, the present invention relates to a clip which may be used to create a hermetic seal around a suctioning device. 
     BACKGROUND OF THE INVENTION 
     Certain surgical procedures, for example, lobectomy, nephrectomy, cystectomy, etc., involve the removal of a tissue specimen from the interior of a patient&#39;s body. The tissue specimen to be removed may include, for example, an organ or portion thereof that is damaged, diseased, or tumorous. The affected tissue may be surgically cut and removed from the body using either conventional or minimally invasive surgery. 
     Conventional surgery (i.e., open surgery) requires large areas of the patient&#39;s body to be cut open in order to provide the surgeon with access to the affected tissue. In contrast, minimally invasive surgery (e.g., laparoscopy, endoscopy) utilizes narrow, elongated instruments to access the affected tissue through relatively small incisions. It is often preferable to use minimally invasive surgical techniques in order to reduce trauma and recovery time for the patient. Some techniques involve, for example, inserting a specimen bag into the patient&#39;s body through an access incision, placing the bag around the tissue to be removed, and withdrawing the bag containing the tissue from the patient&#39;s body. The specimen bag may include a drawstring closure and may further be connected to specialized equipment for manipulating the bag. Various surgical techniques and devices have been described, for example, in U.S. Pat. Nos. 5,037,379, 5,215,521, 8,172,772, 8,486,087, 8,777,961, 9,005,215, U.S. Patent Application Publication No. US 2004/0138587 A1, U.S. Patent Application Publication No. 2009/0124927 A1, U.S. Patent Application Publication No. US 2012/0232423 A1, U.S. Patent Application Publication No. US 2013/0184536 A1, U.S. Patent Application Publication No. 2013/0325025 A1, each of which is incorporated by reference herein in its entirety. 
     A difficulty that may be encountered during certain minimally invasive surgical procedures occurs when the tissue specimen to be removed is significantly larger than the access incision. Under these circumstances the access incision may be enlarged or a new incision may be required in order to allow passage and retrieval of the tissue specimen, however, such steps would increase the trauma to the patient. Another method involves cutting or morcellating the tissue specimen into smaller pieces in the specimen bag until the fragmented tissue can be removed through the access incision. However, this method can result in further complications, such as rupturing of the specimen bag by the cutting or morcellating tool. Moreover, when the tissue being cut or morcellated is cancerous, there may also be an increased risk of spreading cancer cells during such procedures. 
     A further method for tissue removal is described in Mitsuhiro Kamiyoshihara et al., “A useful technique for specimen extraction from the thorax: the vacuum-packing method,” European Journal of Cardio-Thoracic Surgery, 0 (2012) pp. 1-3, which is also incorporated herein by reference in its entirety. According to this method a sucker is inserted into the opening of the specimen bag to suck out liquid and air from the bag in order to collapse the bag containing the tissue specimen, the collapsed bag being withdrawn from the patient as the bag is being suctioned. Since the sucker extends through the bag opening, a drawback of the method described by Kamiyoshihara et al. is that it may be difficult to create and sustain a sufficient seal to allow for proper vacuuming to occur. Having to add binding material around the bag and sucker to create a proper seal adds further to the complication of the procedure. Moreover, there is a risk that insertion of the sucker or other tools into the bag could puncture or tear the bag. 
     SUMMARY OF THE INVENTION 
     The present invention, according to some embodiments, provides methods and bags for removing a tissue specimen from the body of a patient that can avoid some of the difficulties and drawbacks described above. As used herein, a patient may refer to a human patient, or in other embodiments, patient may also refer to non-human animals, for example, veterinary patients. In some embodiments, the tissue specimen is an internal organ or a portion thereof, for example, a portion of the patient&#39;s lung. In some embodiments, the tissue specimen includes a tumor, cyst, cancer, or other diseased tissue. The tissue specimen to be removed may be located in a cavity in the body of the patient, for example, the chest cavity or abdomen. 
     While embodiments described herein are discussed in the particular context of removing a tissue specimen from a patient, it should be appreciated that the present invention is not necessarily limited to this use. Certain methods and bags of the present invention may be more generally adapted for retrieving other objects, including non-biological objects. In some embodiments, the present invention includes a general method for retrieving an object from a first side of a barrier through an opening in the barrier. In some embodiments, the object to be retrieved has a dimension which is larger than a broadest dimension of the opening. In some embodiments, the object is a soft, flexible and/or compressible object. In some embodiments, a method according to the present invention includes introducing a bag at least partially through the opening from a second side of the barrier to the first side of the barrier, the bag comprising an open end and a port. In some embodiments, at least the open end of the bag is introduced through the opening to the first side of the barrier. In some embodiments, the method further includes positioning the object to be retrieved into an interior of the bag by passing the object through the open end of the bag, sealing the open end of the bag, removing gas from the interior of the bag through the port while the object is contained in the interior of the bag, and entirely withdrawing the bag containing the object from the first side of the barrier to the second side of the barrier through the opening. In some embodiments, the open end of the bag includes a closure device configured to hermetically seal the open end of the bag. In some embodiments, the closure device includes interlocking components configured to form a hermetic seal, for example, a zipper closure. In further embodiments, the port includes a one-way gas valve configured to prevent or at least retard gas from entering the interior of the bag through the port. In some embodiments, the port is configured to be coupled with a suctioning device which is configured to remove the gas from the interior of the bag through the port. In some specific embodiments, the object may be a tissue specimen of a patient (e.g., lung tissue), the barrier may be a body wall of the patient (e.g., chest cavity wall), and the opening may be an incision made in the body wall. 
     In further embodiments of the present invention, a method for removing a tissue specimen from a patient includes introducing a bag at least partially into a cavity in the body of the patient, the bag having an open end and a port having a valve, positioning the tissue specimen to be removed from the patient into an interior of the bag by passing the tissue specimen through the open end of the bag, sealing the open end of the bag, removing gas from the interior of the bag through the port while the tissue specimen is contained in the interior of the bag, and withdrawing the bag containing the tissue specimen from the cavity. In some embodiments, inserting the bag at least partially through a first incision in a body wall defining the cavity. In some embodiments, introducing the bag at least partially into the cavity includes inserting the bag into the cavity through a sleeve. In some embodiments, the bag may be inserted into the cavity in a folded or rolled state. In other embodiments, the bag may be inserted through the first incision into the cavity by hand without the use of any tools. In some embodiments, at least the open end of the bag is positioned within the cavity when the tissue specimen is inserted through the open end of the bag. 
     In some embodiments, the method further includes withdrawing the open end of the bag from the cavity prior to sealing the open end of the bag. In some embodiments, sealing the open end of the bag includes hermetically sealing the open end of the bag. In some embodiments, the open end of the bag includes a closure device configured to hermetically seal the open end of the bag. In some embodiments, the closure device is configured to be closed by hand without the use of any tools or additional binding material. In some embodiments, the closure device includes interlocking components configured to form a hermetic seal, for example, a zipper closure. In yet other embodiments, the open end of the bag may be heat sealed or sealed with adhesive. 
     In some embodiments, the port of the bag is positioned outside of the cavity when the gas is removed from the interior of the bag through the port. As used herein, a gas refers to a substance in a gas phase, including vapors. In some embodiments, the port includes a one-way gas valve configured to prevent or at least retard gas from entering the interior of the bag through the port. In some embodiments, the port can be coupled with a suctioning device which is configured to remove the gas from the interior of the bag through the port. The suctioning device may be, for example, a hand-held vacuum gun or other vacuum source. In certain embodiments, no portion of the suctioning device is inserted into the interior of the bag. In some embodiment, removing gas from the interior of the bag reduces the volume of the interior of the bag. In some embodiments, the suctioning device or vacuum source is uncoupled from the port of the bag prior to entirely withdrawing the bag containing the tissue specimen from the cavity. In some embodiments, entirely withdrawing the bag containing the tissue specimen from the cavity includes withdrawing the bag from the cavity through the first incision. In some embodiments, withdrawing the bag from the cavity through the first incision does not require enlarging the first incision. 
     In further embodiments, the bag may include a spring element configured to open the open end of the bag. In some such embodiments, the spring element is a loop or portion thereof made from an elastic material which extends at least partially around the open end of the bag. The spring element may be made from, for example, an elastic metal, alloy, plastic, polymer, or composite material. In some embodiments, the spring element is compressed prior to introducing the bag at least partially into the cavity in the body of the patient. The bag may also be coiled prior to introducing the bag at least partially into the cavity in the body of the patient. After the bag is introduced into the cavity, the spring element may be allowed to spring open in order to open the open end of the bag prior to positioning the tissue specimen into the interior of the bag. In further embodiments, the spring element may be separated from the bag prior to sealing the open end of the bag. In some embodiments, the spring element is separated from the bag after positioning the tissue specimen to be removed from the patient into the interior of the bag. In some such embodiments, the bag includes a tear line positioned between the spring element and the closure device, the tear line being configured to allow the spring element to be torn off of the bag. The tear line may be, for example, a line of perforations on the wall of the bag. After the spring element is removed from the bag, the closure device may be sealed and the gas evacuated from the interior of the bag through the port to compress the bag and the tissue specimen contained therein. 
     The present invention, according to additional embodiments, provides a method for removing an object from a cavity which includes introducing a bag at least partially into a cavity, the bag comprising an open end, positioning an object to be removed into an interior of the bag by passing the object through the open end of the bag, inserting a suctioning device into the interior of the bag through the open end of the bag, positioning a clip in an open configuration around the bag and the suctioning device, transitioning the clip to a closed configuration to hermetically seal the bag around the suctioning device, removing gas from the interior of the bag with the suctioning device while the object is contained in the interior of the bag, and entirely withdrawing the bag containing the object from the cavity. In some such embodiments, the bag does not need to include a closure device for hermetically sealing the bag. Moreover, the bag does not need to include a port for coupling with a suction device. In some embodiments, the object is a tissue specimen (e.g., lung tissue) of a patient, and the cavity is a body cavity of the patient. In some embodiments, the clip includes a first leg and a second leg, and transitioning the clip to the closed configuration includes moving the first leg and the second leg towards each other. In certain embodiments, the first leg and the second leg are connected by a hinge portion (e.g., a living hinge) configured to allow the first leg and the second leg to pivot toward each other. In some embodiments, the clip further includes a closure (e.g., a latch) for securing the first leg and the second leg together in the closed configuration. In some embodiments, the first leg and the second leg are shaped to define an opening between the first leg and the second leg in the closed configuration, the opening being sized and configured to receive the suctioning device. In some embodiments, at least one of the first leg and the second leg includes a concavely curved internal surface which at least partially defines the opening. In some such embodiments, positioning the clip in an open configuration around the bag and the suctioning device comprises positioning the concavely curved internal surface around a portion of the suctioning device. The suctioning device may include a catheter and, in some embodiments a cuff may be placed around at least a portion of the catheter. In these embodiments, the concavely curved internal surface of the first or second leg of the clip may be positioned around the cuff. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing summary, as well as the following detailed description of the invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, there are shown in the drawings embodiments which are presently preferred. It should be understood, however, that the invention can be embodied in different forms and thus should not be construed as being limited to the embodiments set forth herein. 
         FIG. 1  shows a tissue specimen bag according to an embodiment of the present invention; 
         FIG. 2  shows the tissue specimen bag of  FIG. 1  being introduced through an incision into a cavity in the body of a patient using a sleeve according to one embodiment of the present invention; 
         FIG. 3  shows a tissue specimen passing through the open end of the specimen bag of  FIG. 2  according to one embodiment of the present invention; 
         FIG. 4  shows the tissue specimen of  FIG. 3  fully positioned within the interior of the tissue specimen bag according to one embodiment of the present invention; 
         FIG. 5  shows the open end and port of the tissue specimen bag of  FIG. 4  withdrawn from the cavity according to one embodiment of the present invention; 
         FIG. 6  shows the tissue specimen bag of  FIG. 5  after sealing the open end of the bag according to one embodiment of the present invention; 
         FIG. 7  shows the tissue specimen bag of  FIG. 6  where a vacuum source has been coupled to the port according to one embodiment of the present invention; 
         FIG. 8  shows the tissue specimen bag of  FIG. 7  being deflated by the vacuum source according to one embodiment of the present invention; 
         FIG. 9  shows the tissue specimen bag of  FIG. 8  being withdrawn from the cavity through the incision according to one embodiment of the present invention; 
         FIG. 10  shows a tissue specimen bag having a spring element at an open end according to a further embodiment of the present invention; 
         FIG. 11  shows the tissue specimen bag of  FIG. 10  partially coiled around the spring element according to one embodiment of the present invention; 
         FIG. 12  shows a tissue specimen passing through the open end of the specimen bag of  FIG. 10  according to one embodiment of the present invention; 
         FIG. 13  shows the tissue specimen of  FIG. 12  fully positioned within the interior of the tissue specimen bag according to one embodiment of the present invention; 
         FIG. 14  shows the tissue specimen bag of  FIG. 13  with the spring element being separated from the open end according to one embodiment of the present invention; 
         FIG. 15  shows the tissue specimen bag of  FIG. 14  where a vacuum source has been coupled to the port according to one embodiment of the present invention; 
         FIG. 16A  shows a perspective view of a clip for a tissue specimen bag according to a further embodiment of the present invention in an open configuration; 
         FIG. 16B  shows a perspective view of the clip of  FIG. 16A  in a closed configuration; 
         FIG. 17A  shows the clip of  FIG. 16A  in the open configuration being positioned around a tissue specimen bag and a suction device according to one embodiment of the present invention; 
         FIG. 17B  shows the clip of  FIG. 17A  in a closed configuration around the tissue specimen bag and the suction device; 
         FIG. 18A  shows a cross-sectional view of the clip of  FIG. 16A  in the open configuration being positioned around a tissue specimen bag and a suction device according to one embodiment of the present invention; 
         FIG. 18B  shows a cross-sectional view of the clip of  FIG. 16A  in a closed configuration around the tissue specimen bag and the suction device; 
         FIG. 19  shows a tissue specimen within the interior of a tissue specimen bag which is partially positioned within a cavity of a patient according to one embodiment of the present invention; 
         FIG. 20  shows a suction device inserted into the interior of the tissue specimen bag of  FIG. 19  according to one embodiment of the present invention; 
         FIG. 21  shows the clip of  FIG. 16A  in a closed positioned around the tissue specimen bag and suction device of  FIG. 20  according to one embodiment of the present invention; 
         FIG. 22  shows the tissue specimen bag of  FIG. 21  being deflated by the suction device according to one embodiment of the present invention; 
         FIG. 23  shows the deflated tissue specimen bag of  FIG. 22  withdrawn from the cavity according to one embodiment of the present invention; 
         FIG. 24  shows the clip of  FIG. 16A  having an elastic layer according to one embodiment of the present invention; 
         FIG. 25  shows the suction device of  FIG. 17A  provided with a cuff according to one embodiment of the present invention; 
         FIG. 26  shows a perspective view of a clip for a tissue specimen bag according to a further embodiment of the present invention in a closed configuration; 
         FIG. 27  shows an end view of the clip of  FIG. 26  in an open configuration; 
         FIG. 28  shows the clip of  FIG. 26  in a closed positioned around a tissue specimen bag and suction device inserted into the tissue specimen bag according to one embodiment of the present invention; and 
         FIG. 29  shows the tissue specimen bag of  FIG. 28  being deflated by the suction device according to one embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     The present subject matter will now be described more fully hereinafter with reference to the accompanying Figures, in which representative embodiments are shown. The present subject matter can, however, be embodied in different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided to describe and enable one of skill in the art. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety. 
     Referring to the drawings in detail, wherein like reference numerals indicate like elements throughout, there is shown in  FIGS. 1-9 , a bag configured for tissue specimen removal generally designated  100 , in accordance with an exemplary embodiment of the present invention. As illustrated in  FIG. 1 , bag  100  includes an open end  102  and a closed end  104  opposite open end  102 . The walls of bag  100 , which extend between open end  102  and closed end  104 , define an interior space and may be constructed from thin, flexible plastic film, for example, polyethylene, nylon, vinyl, ripstop, etc. Bag  100  may have any suitable shape when fully extended, for example, cylindrical, conical, rectangular, etc. In some embodiments, bag  100  may be tapered at closed end  104 . Other bag shapes, for example, as described in the references incorporated herein may also be utilized according to further embodiments of the present invention. The walls of bag  100  are preferably waterproof and may be completely sealed at their edges except for open end  102  according to some embodiments. Open end  102  provides access to the interior space of bag  100  and, in some embodiments, includes a closure device  106  that is configured to close and seal open end  102 . Closure device  106  may be integral to bag  100 . Closure device  106 , in some embodiments, may include interlocking components configured to form a hermetic seal. For example, in some embodiments, closure device  106  is a zipper closure that is configured to produce an airtight seal. In some embodiments, bag  100  does not include or require a drawstring closure. In further embodiments, the walls of bag  100  are provided with a port  108 , which may be configured to allow gas to exit from the interior of bag  100 . In some embodiments, port  108  is positioned proximate open end  102 . In some embodiments, port  108  is positioned on bag  100  between closure device  106  and closed end  104 . In some embodiments, only a single port is provided on bag  100 . In other embodiments, bag  100  may include a plurality of ports. Port  108 , in some embodiments, is further provided with a valve, for example, a one-way gas valve that is configured to prevent or retard gas from re-entering into the interior of bag  100  through port  108 . 
     Non-limiting example configurations for closure devices, valves, and materials that may be adapted for use in bag  100  according to some embodiments of the present invention are described in U.S. Pat. Nos. 5,332,095, 5,881,881, 7,784,160, 7,874,731, 8,202,002, and U.S. Patent Application Publication No. US 2009/0257688 A1, all of which are incorporated herein by reference in their entireties. Unlike the bags described in these references, however, bag  100  according to embodiments of the present invention may be particularly configured for surgical use. In some embodiments, for example, bag  100  is sterilized such that bag  100  is free of bacteria, fungi, or other viable microorganisms. In some embodiments, bag  100  is sterilized with radiation, heat, steam, chemical treatments, or a combination thereof. In some embodiments, bag  100  is provided with an anti-microbial substance or coating. In yet further embodiments, bag  100  may be provided with a radiopaque element to allow for visualization using radiographic or fluoroscopic imaging techniques. For example, open end  102  or another portion of bag  100  may be provided with a radiopaque marker or thread such that the surgeon can determine the presence, location, and/or orientation of bag  100  inside the patient&#39;s body through radiographic or fluoroscopic imaging. 
     In some embodiments, bag  100  is sufficiently flexible to be tightly folded or rolled such that bag  100  can be fit through a small incision and into a cavity in the body of a patient. In some embodiments, bag  100  may be folded or rolled inside a sleeve that is configured to introduce bag  100  through the incision and into the cavity.  FIG. 2  shows bag  100  being introduced at least partially into a cavity  10  in the body of a patient through an incision  14  in a body wall  12  according to one embodiment of the present invention. Tissue specimen  200  to be removed from the patient is located within cavity  10 . For example, cavity  10  may be a thoracic cavity of the patient, body wall  12  may represent the chest wall, and tissue specimen  200  may represent a portion of lung tissue which has been cut from the patient. As shown in this embodiment, bag  100  may be introduced through incision  14  and into cavity  10  using a sterile sleeve  300 . Sleeve  300 , according to some embodiments, may be a tube, trocar, or endoscopic instrument having an end  302  that is sized and configured to pass through incision  14  and into cavity  10 . In some embodiments, bag  100  is packaged within sleeve  300  until use. End  302  of sleeve  300  may include a radiopaque marker to allow for radiographic or fluoroscopic imaging. Once end  302  of sleeve  300  is sufficiently positioned within cavity  10 , bag  100  may be pushed or pulled out of sleeve  300  through end  302  and into cavity  10 . In other embodiments, bag  100  may be inserted through incision  14  without the use of a sleeve. For example, in some embodiments, a surgeon may fold or roll bag  100  into a size compact enough to be inserted through incision  14  by hand or by using a tool, such as laparoscopic forceps. In some embodiments, bag  100  is not affixed to any tools when bag  100  is introduced into cavity  10 . 
     Referring now to  FIGS. 3 and 4 , tissue specimen  200  may be passed through open end  102  and positioned into the interior of bag  100  while bag  100  is positioned within cavity  10 . In some embodiments, one or more removable tools  400 , for example laparoscopic forceps, may be optionally used to assist with positioning tissue specimen  200  within the interior of bag  100 . For example, one or more tools  400  may be used to spread open end  102  wider and/or push tissue specimen  200  through open end  102  into the interior of bag  100 . Such one or more tools  400  are preferably separable from bag  100  and not affixed to bag  100 . Once tissue specimen  200  is positioned within the interior of bag  100 , open end  102  may be sealed. In some embodiments, open end  102  may be sealed within cavity  10 . In other embodiments, it may be preferable to withdraw open end  102  from cavity  10  prior to sealing open end  102 . Withdrawing open end  102  from cavity  10  may facilitate sealing of open end  102  according some of these embodiments since the surgeon may have better access to open end  102 . In some embodiments, the one or more tools  400  (e.g., forceps) are used to pull open end  102  of bag  100  out of cavity  10  through incision  14  in body wall  12 . In other embodiments, open end  102  may be pulled out of cavity  10  by hand, without the use of any additional tools. 
       FIG. 5  shows bag  100  at least partially withdrawn from cavity  10 . In particular, open end  102  has been withdrawn from cavity  10  through incision  14  while a portion of bag  100  containing tissue specimen  200 , which may be too large to fit through incision  14 , remains within cavity  10 . In some embodiments, port  108  may also be withdrawn from cavity  10  such that both open end  102  and port  108  are positioned outside of cavity  10 . In some embodiments, a cutting tool or morcellator (not shown) may optionally be introduced into the interior of bag  100  through open end  102  in order to cut tissue specimen  200  into smaller fragments. However, as discussed above, such steps may not be preferred and may not be necessary according to embodiments of the present invention. In some embodiments, no cutting or morcellation of tissue specimen  200  occurs while tissue specimen  200  is in the interior of bag  100 . 
     After open end  102  of bag  100  is positioned outside of cavity  10 , open end  102  may be sealed using closure device  106  as shown in  FIG. 6 . As discussed above, closure device  106  is particularly configured to hermetically seal open end  102 . Unlike the drawstring closure used previously in the art which may not be able to achieve a hermetic seal, in some embodiments, closure device  106  includes interlocking components, for example, a zipper closure. Closure device  106  may be configured to be closed by hand to form a hermetic seal without the use of additional tools or binders according to some embodiments. In some embodiments, closure device  106  is capable of being unsealed and resealed such that open end  102  may be reopened and resealed if needed. In other embodiments, open end  102  may be permanently sealed such that bag  100  must be cut or torn to open bag  100 . In some such embodiments, for example, open end  102  may be heat sealed. In yet other embodiments, open end  102  may be sealed with adhesive (e.g., cyanoacrylate glue). 
     With reference now to  FIGS. 7 and 8 , after open end  102  has been hermetically sealed, gas may be removed from the interior of bag  100  through port  108 . In some embodiments, a vacuum source  500  may be coupled with port  108  in order to suction gas from the interior of bag  100  through port  108 . In some embodiments, vacuum source  500  is coupled with port  108  on the exterior of bag  100 . Vacuum source  500  may include, for example, a hand-held vacuum gun or other suitable suctioning device known in the art. In other embodiments, liquids (e.g., blood or other bodily fluids) that may be contained in bag  100  can also be withdrawn through port  108  by vacuum source  500 . A liquid trap (not shown) may be provided to collect any liquids removed through port  108  according to some embodiments. In some embodiments, only gas is removed from bag  100  during the suctioning. In some embodiments, no portion of the suctioning device is inserted into the interior of bag  100 . In some embodiments, removing gas from the interior of bag  100  causes compression of bag  100  and tissue specimen  200  contained therein. For example, where tissue specimen  200  includes lung tissue, gas contained in the lung tissue can be evacuated during suctioning to cause collapse and compression of the lung tissue. In some embodiments, removing gas from the interior of bag  100  reduces the volume of tissue specimen  200  by at least 10%, by at least 20%, by at least 25%, by at least 30%, by at least 35%, by at least 40%, by at least 45%, by at least 50%, by at least 55%, by at least 60%, by at least 65%, by at least 70%, by at least 75%, or by at least 80%. Preferably, the volume of tissue specimen  200  is sufficiently reduced to allow for tissue specimen  200  within bag  100  to pass through incision  14  without having to enlarge incision  14  according to some embodiments. In some embodiments, however, where tissue specimen  200  cannot be sufficiently compressed by suctioning alone (e.g., where tissue specimen  200  contains very stiff or solid materials), enlargement of incision  14  may be necessary before bag  100  can be completely withdrawn from cavity  10 . 
       FIG. 9  shows bag  100  containing tissue specimen  200  being withdrawn from cavity  10  through incision  14  after sufficient suctioning. Bag  100  may be pulled by hand out of cavity  10  through incision  14 , according to some embodiments. In some embodiments, vacuum source  500  may be uncoupled from port  108  prior to entirely withdrawing bag  100  from cavity  10 . In other embodiments, bag  100  may be completely withdrawn while vacuum source  500  is still coupled with port  108 . As discussed above, in some embodiments port  108  includes a valve which is configured to prevent or at least retard gas from re-entering into the interior of bag  100  through port  108 . The valve is preferably a one-way gas valve and may, for example, have any suitable configuration known in the art. The presence of a valve in port  108 , in some embodiments, helps maintain bag  100  and tissue specimen  200  in the compressed state even while vacuum source  500  has been removed from port  108 . In some embodiments, a cap or other component (not shown) may be provided to seal port  108  after suctioning to prevent further gas and/or liquid from passing through port  108 . Once bag  100  and tissue specimen  200  is removed from cavity  10 , tissue specimen  200  may be disposed of in any suitable manner or retained for later analysis. In some embodiments, closure device  106  may be unsealed to provide access to tissue specimen  200  after removal from the patient&#39;s body. In other embodiments, bag  100  may be cut or torn open to provide access to tissue specimen  200 . 
     In further embodiments, a bag according to the present invention may include a spring element that is, for example, configured to facilitate opening of the bag during use inside the patient&#39;s body. Such a spring element may help ease insertion of the tissue specimen into the bag in some embodiments by helping to keep the open end of the bag open. In certain embodiments, the spring element may be removed from the bag after the tissue specimen has been inserted into the bag. 
       FIG. 10  shows a bag  600  having a spring element  610  which may be positioned at or proximate open end  602  according to one embodiment of the present invention. Spring element  610  may be attached to the exterior of bag  600 , attached to the interior of bag  600 , or positioned within the material which forms the walls of bag  600 . In some embodiments, spring element  610  is not affixed to any additional tools. Bag  600 , in some embodiments, further includes a closed end  604  that is opposite open end  602 , a closure device  606  configured to seal bag  600 , and a port  608  which may be analogous to and similarly configured as respective elements  104 ,  106 ,  108  described above in relation to bag  100 . Other characteristics and features described above regarding bag  100  (e.g., materials, shape, sterilization, construction, etc.) may also be present in bag  600 . In some embodiments, closure device  606  is situated between spring element  610  and closed end  604 . In some embodiments, closure device  606  is positioned on bag  600  between spring element  610  and port  608 . In yet further embodiments, bag  600  optionally includes a tear line  612  between closure device  606  and spring element  610  which may assist with removal of spring element  610  from bag  600  as will be described further below. 
     Spring element  610 , in some embodiments, includes a resilient material that is shaped and configured to facilitate opening of bag  600  at open end  602 . In some embodiments, spring element  610  is configured to cause open end  602  of bag  600  to spring open after insertion into the patient&#39;s body. In some embodiments, spring element  610  may be compressed to facilitate insertion of bag  600  into the body of the patient. According to some embodiments, spring element  610  may be shaped to have a generally curved configuration in an uncompressed state. In some embodiments, spring element  610  includes an elastic material that is formed into a loop or a portion of a loop that extends at least partially around open end  602  of bag  600 . In some embodiments, spring element  610  extends around the entire open end  602  of bag  600 . In other embodiments, spring element  610  extends only along a portion of open end  602  of bag  600 . In some embodiments, for example, spring element  610  is made from an elastic wire or band that is formed into a compressible spring loop or portion thereof that at least partially extends around open end  602  of bag  600 . In some embodiments, spring element  610  is made from an elastic metal or alloy (e.g., spring steel, shape memory alloy, etc.). In other embodiments, spring element  610  is made from an elastic plastic, polymer, or composite material. Preferably spring element  610  is made from a sterilizable material, e.g., a material which can withstand the sterilization process without degrading or substantial loss of elasticity. 
     Referring now to  FIG. 11 , in some embodiments, spring element  610  may be compressed to allow for the remainder of bag  600  to be coiled around spring element  610  as illustrated. In some embodiments, coiling bag  600  facilitates insertion of bag  600  into the patient&#39;s body by making bag  600  more compact. In some embodiments, bag  600  in the coiled configuration may be further packaged in a sterile sleeve (e.g., sleeve  300  described above) that in turn may be used to introduce bag  600  through an incision and into a cavity in the patient&#39;s body. 
       FIG. 12  shows bag  600  after insertion into cavity  10  through an incision  14  in a body wall  12  according to one embodiment. Once inserted into cavity  10 , bag  600  may be uncoiled within cavity  10 . In some embodiments, the spring force of spring element  610  is sufficient to cause bag  600  to uncoil at least partially. In some embodiments, spring element  610  further causes open end  602  of bag  600  to spring open due to its elastic nature. In some embodiments, uncoiling of bag  600  and/or opening of open end  602  may be assisted with the use of one or more separate tools (not shown), for example, laparoscopic forceps. As discussed above, in some embodiments, spring element  610  is configured to help keep open end  602  open while bag  600  is positioned within cavity  10 . By keeping open end  602  open during use, it may be easier for the surgeon to place tissue specimen  200  into bag  600 , as illustrated in  FIG. 13 . 
     In some embodiments, after tissue specimen  200  has been positioned within bag  600 , spring element  610  may be separated from bag  600 . In some embodiments, spring element  610  is removed from bag  600  to allow for closure device  606  to seal bag  600 . In some embodiments, open end  602  of bag  600  may be withdrawn from cavity  10  prior to separating spring element  610  from bag  600 . In other embodiments, spring element  610  may be separated from bag  600  while inside cavity  10  and then subsequently withdrawn from cavity  10  (e.g., using forceps).  FIG. 14  shows spring element  610  being separated from bag  600  according to one embodiment of the present invention. According to this embodiment, bag  600  optionally includes tear line  612  situated between spring element  610  and closure device  606  and which is configured to allow spring element  610  to be torn away from the portion of bag  600  containing tissue specimen  200 . In some embodiments, tear line  612  allows spring element  610  to be torn away without the need for additional or specialized tools. In some embodiments, for example, tear line  612  is a line of perforations on the walls of bag  600 . In some embodiments, tear line  612  is a groove or scored line where the thickness of the walls of bag  600  may be reduced in order to facilitate tearing. In other embodiments, spring element  610  may be cut from bag  600  using a cutting tool (e.g., scalpel, knife, scissors, etc.). The cutting tool may be used to cut bag  600  between spring element  610  and closure device  606  to separate spring element  610  from the remainder of bag  600 , however care should be taken to avoid cutting or puncturing bag  600  anywhere between closure device  606  and closed end  604 . As shown in  FIG. 14 , a portion of bag  600  which originally included open end  602  may be separated along with spring element  610 . For ease of explanation, open end  602   a  represents the open end of bag  600  following the separation and removal of spring element  610  and may be located where bag  600  was torn or cut. After separation of spring element  610  from bag  600 , the use of bag  600  may follow the same procedure described above with respect to bag  100  shown in  FIGS. 5-9 . 
     In some embodiments, following separation of spring element  610  from bag  600 , closure device  606  may be closed to seal bag  600  in a manner similar to that described for closure device  106  of bag  100  above. In some embodiments, closure device  606  is withdrawn from cavity  10  (e.g., through incision  14 ) prior to closing closure device  606 . In some embodiments, closure device  606  is particularly configured to hermetically seal bag  600 . In some embodiments, closure device  606  includes interlocking components, for example, a zipper closure. Closure device  606  may be configured to be closed by hand to form a hermetic seal without the use of additional tools or binders according to some embodiments. In some embodiments, closure device  606  is capable of being unsealed and resealed such that bag  600  may be reopened and resealed if needed. In other embodiments, open end  602   a  may be permanently sealed such that bag  600  must be cut or torn to open bag  600 . In some such embodiments, for example, open end  602   a  may be heat sealed. In yet other embodiments, open end  602   a  may be sealed with adhesive (e.g., cyanoacrylate glue). 
     Similar to the procedure described above with regards to bag  100 , after bag  600  has been hermitically sealed, gas may be removed from the interior of bag  600  through port  608 . As shown in  FIG. 15 , in some embodiments a vacuum source  500  may be coupled with port  608  in order to suction gas from the interior of bag  100  through port  608 . In some embodiments, port  608  has been withdrawn from cavity  10  (e.g., through incision  14 ) prior to coupling vacuum source  500  with port  608 . In some embodiments, vacuum source  500  is coupled with port  608  on the exterior of bag  600 . Vacuum source  500  may include, for example, a hand-held vacuum gun or other suitable suctioning device known in the art. In other embodiments, liquids (e.g., blood or other bodily fluids) that may be contained in bag  600  can also be withdrawn through port  608  by vacuum source  600 . A liquid trap (not shown) may be provided to collect any liquids removed through port  608  according to some embodiments. In some embodiments, only gas is removed from bag  600  during the suctioning. In some embodiments, no portion of the suctioning device is inserted into the interior of bag  600 . In some embodiments, removing gas from the interior of bag  600  causes compression of bag  600  and tissue specimen  200  contained therein. For example, where tissue specimen  200  includes lung tissue, gas contained in the lung tissue can be evacuated during suctioning to cause collapse and compression of the lung tissue. In some embodiments, removing gas from the interior of bag  600  reduces the volume of tissue specimen  200  by at least 10%, by at least 20%, by at least 25%, by at least 30%, by at least 35%, by at least 40%, by at least 45%, by at least 50%, by at least 55%, by at least 60%, by at least 65%, by at least 70%, by at least 75%, or by at least 80%. Preferably, the volume of tissue specimen  200  is sufficiently reduced to allow for tissue specimen  200  within bag  600  to pass through incision  14  without having to enlarge incision  14  according to some embodiments. In some embodiments, however, where tissue specimen  200  cannot be sufficiently compressed by suctioning alone (e.g., where tissue specimen  200  contains very stiff or solid materials), enlargement of incision  14  may be necessary before bag  600  can be completely withdrawn from cavity  10 . 
     Once bag  600  containing tissue specimen  200  has been sufficiently compressed to pass through incision  14 , bag  600  may be pulled by hand out of cavity  10  through incision  14 , according to some embodiments. In some embodiments, vacuum source  500  may be uncoupled from port  608  prior to entirely withdrawing bag  600  from cavity  10 . In other embodiments, bag  600  may be completely withdrawn while vacuum source  500  is still coupled with port  608 . As with port  108  of bag  100 , in some embodiments port  608  includes a valve which is configured to prevent or at least retard gas from re-entering into the interior of bag  600  through port  608 . The valve is preferably a one-way gas valve and may, for example, have any suitable configuration known in the art. The presence of a valve in port  608 , in some embodiments, helps maintain bag  600  and tissue specimen  200  in the compressed state even while vacuum source  500  has been removed from port  608 . In some embodiments, a cap or other component (not shown) may be provided to seal port  608  after suctioning to prevent further gas and/or liquid from passing through port  608 . Once bag  600  and tissue specimen  200  is removed from cavity  10 , tissue specimen  200  may be disposed of in any suitable manner or retained for later analysis. In some embodiments, closure device  606  may be unsealed to provide access to tissue specimen  200  after removal from the patient&#39;s body. In other embodiments, bag  600  may be cut or torn open to provide access to tissue specimen  200 . 
     In certain embodiments, a bag for use according to the present invention (e.g., bag  100 ,  600 ) does not need to have an integral closure device (e.g., a zipper closure) for hermetically sealing the open end of the bag. In some such embodiments, the open end of the bag may instead be hermetically sealed with tape, sutures, ties, elastic bands, or other binding material. In other such embodiments, a device which is separate from the bag, such as a separate clamping device may be used to close and hermetically seal the open end of the bag. 
     The present invention, according to some embodiments, provides a clip which may be used to hermetically seal a bag that does not necessarily have an integral closure device capable of hermetically sealing the bag, e.g., certain conventional specimen bags. In some embodiments, a clip according to the present invention may be particularly configured to hermetically seal the bag while a suction device is inserted into the interior of the bag through the opening of the bag. One such example is illustrated in  FIGS. 16A-18B , which shows a clip  700  which may be used to hermetically seal a bag  800  according to certain embodiments of the present invention. Clip  700 , in some embodiments, includes a first leg  702  and a second leg  704  which are movable with respect to each other between an open configuration ( FIGS. 16A, 17A, 18A ) and a closed configuration ( FIGS. 16B, 17B, 18B ). Bag  800  may be received between first and second legs  702 ,  704  in the open configuration ( FIGS. 17A, 18A ). In the closed configuration, according to some embodiments, first leg  702  and second leg  704  are configured to clamp against the walls of bag  800  in order to form a hermetically seal at a portion of bag  800 . 
     In some embodiments, first leg  702  and second leg  704  are connected to each other by a hinge portion  706  which may be configured as any sort of hinge capable of allowing first and second legs  702 ,  704  to pivot towards or away from each other. In some embodiments, for example, hinge portion  706  may include a pin about which first and second legs  702 ,  704  rotate. In other embodiments, hinge portion  706  may be a living hinge wherein hinge portion  706  is a flexible area between first and second legs  702 ,  704 . In some embodiments, first and second legs  702 ,  704  are separate pieces which are connected by hinge portion  706 . In other embodiments, first and second legs  702 ,  704  and hinge portion  706  are integrally formed from a single piece of material. First and second legs  702 ,  704  may be made from any materials suitable for securely clamping against bag  800 , for example, metals, plastics, polymers, composite materials, etc. In some embodiments, first and second legs  702 ,  704  are rigid or substantially rigid. In some embodiments, first and second legs  702 ,  704  may have a degree of flexibility. In certain embodiments, for example where clip  700  is used for tissue specimen removal, clip  700  is sterilized. In some embodiments, clip  700  may be further provided with an anti-microbial substance or coating. 
     In further embodiments, clip  700  may further include a closure  708  which is configured to maintain first and second legs  702 ,  704  in the closed configuration. In some embodiments, closure  708  may be configured as a latch, hook, snap fitting, or any other suitable mechanical feature capable of securing first leg  702  relative to second leg  704  in the closed configuration. In some embodiments, closure  708  may include a protrusion which extends from one of first leg  702  or second leg  704  (as illustrated) and which is configured to contact and engage with the other leg in the closed configuration. In some embodiments, closure  708  may include a first feature on first leg  702  (e.g., hook) which engages with a second feature (e.g., loop) on second leg  704  to secure first and second legs  702 ,  704  together. In some embodiments, closure  708  includes features on first and second legs  702 ,  704  which are configured to interlock. In some embodiments, closure  708  may be positioned at or proximate a free end of first leg  702  and/or second leg  704  which is opposite hinge portion  706 . In other embodiments, closure  708  may include a device separable from clip  700 . For example, in some embodiments, closure  708  may include a separate clamping device or fastener which may be applied to first and second legs  702 ,  704  in the closed configuration. 
     In some embodiments, clip  700  is configured to hermetically seal bag  800  while a suction device is inserted into the interior of bag  800 . Clip  700 , for example, may be configured to hermetically seal bag  800  around and/or against the suction device. In some embodiments, clip  700  provides a clearance (e.g., a gap, aperture, or opening) between first and second legs  702 ,  704  in the closed configuration which is sized to receive the suction device. In the illustrated embodiments, for example, first leg  702  includes a first collar portion  710  and second leg  704  includes a second collar portion  712  which together define an opening  714  that may be shaped and sized to receive a suction device  900  in the closed configuration ( FIG. 17B, 18B ). In some embodiments, at least one of first leg  702  and second leg  704  includes a concavely curved internal surface which at least partially defines opening  714 . Suction device  900 , may be, for example, a hollow suction catheter connected to a vacuum source and extending into the interior of bag  800  through open end  802  of bag  800 . Suction device  900  may include a tip  902  positioned in the interior of bag  800  and be configured for removing gas from the interior of bag  800 . In some embodiments, opening  714  is shaped and sized to hermetically seal bag  800  against or around a portion of suction device  900 . First and second collar portions  710 ,  712  may have internal surfaces that are concavely curved to define the shape and size of opening  714 . For example, first and second collar portions  710 ,  712  may have semicircular internal surfaces such that opening  714  is generally circular according to some embodiments, though other shapes may also be utilized in other embodiments. In some embodiments, first and second collar portions  710 ,  712  make up only a portion of first and second legs  702 ,  704 . In some embodiments, first and second collar portions  710 ,  712  comprise less than half, less than a third, or less than a fourth of the length of first and second legs  702 ,  704 . As shown in  FIGS. 16A-18B , other portions of first and second legs  702 ,  704  may be generally planar according to some embodiments, though they are not necessarily limited to this shape. Moreover, while in the illustrated embodiments first and second collar portions  710 ,  712  are shown to be closer to hinge portion  706  than to closure  708 , it should be understood that first and second collar portions  710 ,  712  may be positioned at other locations along first and second legs  702 ,  704 , for example, at the middle of first and second legs  702 ,  704 , or proximate closure  708 . 
     With reference now to  FIGS. 19-23 , a use of clip  700  in the removal of a tissue specimen according to an embodiment of the present invention will now be described.  FIG. 19  shows bag  800  containing a tissue specimen  200  and positioned partially within cavity  10 . Cavity  10  may, for example, be a thoracic cavity of the patient, body wall  12  may represent the chest wall, and tissue specimen  200  may represent a portion of lung tissue which has been cut from the patient. Similar to the embodiments described above with respect to bags  100 ,  600 , bag  800  may have been introduced and into cavity  10  through incision  14  using a sterile sleeve (e.g., sterile sleeve  300  previously described). Other techniques known in the art for introducing a specimen bag into a body cavity may also be used in other embodiments. In particular, open end  802  of bag  800  has been withdrawn from cavity  10  through incision  14  while closed end  804  and a portion of bag  800  containing tissue specimen  200 , which may be too large to fit through incision  14 , remains within cavity  10 . Bag  800  may be generally configured similar to bags  100 ,  600  described above. Unlike bags  100 ,  600 , bag  800  may not include any ports (e.g., ports  108 ,  608 ) and may not include a closure device at open end  802  according to some embodiments. In some embodiments, bag  800  may be a conventional tissue specimen bag. In further embodiments, bag  800  may include a drawstring closure at rim  806 , but the drawstring closure may not be configured to hermetically seal bag  800 . 
     As shown in  FIG. 20 , a suction device  900  may then be inserted at least partially into the interior of bag  800  through opening  802 . As described above, suction device  900 , in some embodiments, may be a suction catheter having a tip  902  and connected to a vacuum source which is configured to remove gas from the interior of bag  800 . Care should be taken such that suction device  900  does not puncture or rupture the walls of bag  800 . After suction device  900  has been positioned within bag  800 , clip  700  may be positioned around a portion of bag  800  which extends out of cavity  10  to form a hermetic seal as described above with respect to  FIGS. 17A-18B . In particular, bag  800  may be positioned between first and second legs  702 ,  704  of clip  700  while clip  700  is in the open configuration. First and second legs  702 ,  704  can then pivoted toward each other to the closed configuration and secured with closure  708 , causing clip  700  to clamp against the walls of bag  800  to create a hermetic seal. In certain preferred embodiments, clip  700  can be transitioned from the open configuration to the closed configuration by hand without the need for any additional tools. Furthermore, clip  700  preferably can be used to seal bag  800  without any additional materials being wrapped or tied around bag  800  (e.g., sutures, string, tape, etc.). Moreover, clip  700  should be positioned such that suction device  900  is received in between first and second collar portions  710 ,  712  through opening  714  when clip  700  is in the closed configuration. A portion of bag  800  surrounding suction device  900  will be hermetically sealed against suction device  900  by clip  700  according to these embodiments. In other embodiments, clip  700  may be placed around bag  800  before suction device  900  is inserted into bag  800 . In these embodiments, suction device  900  may then be inserted through open end  802  of bag  800  and through opening  714  of clip  700  while clip  700  is in the closed configuration around bag  800 . 
     Once clip  700  is properly positioned around bag  800  and suction device  900 , the vacuum source can be activated to suction gas from the interior of bag  800  through suction device  900 . In preferred embodiments, only gas is removed from the interior of bag  800  by suction device  900 . Nevertheless, suction device  900  may further include a trap (not shown) connected between tip  902  and the vacuum source to capture non-gas materials (e.g., liquid) that may be suctioned by suction device  900 . In some embodiments, removing gas from the interior of bag  800  causes compression of bag  800  and tissue specimen  200  contained therein, as illustrated in  FIG. 22 . For example, where tissue specimen  200  includes lung tissue, gas contained in the lung tissue can be evacuated during suctioning to cause collapse and compression of the lung tissue. In some embodiments, removing gas from the interior of bag  800  reduces the volume of tissue specimen  200  by at least 10%, by at least 20%, by at least 25%, by at least 30%, by at least 35%, by at least 40%, by at least 45%, by at least 50%, by at least 55%, by at least 60%, by at least 65%, by at least 70%, by at least 75%, or by at least 80%. Preferably, the volume of tissue specimen  200  is sufficiently reduced to allow for tissue specimen  200  within bag  800  to pass through incision  14  without having to enlarge incision  14  according to some embodiments. In some embodiments, however, where tissue specimen  200  cannot be sufficiently compressed by suctioning alone (e.g., where tissue specimen  200  contains very stiff or solid materials), some enlargement of incision  14  may be necessary before bag  800  can be completely withdrawn from cavity  10 .  FIG. 23  shows bag  800  containing tissue specimen  200  withdrawn from cavity  10  through incision  14  after sufficient suctioning. Bag  800  may be pulled by hand out of cavity  10  through incision  14 , according to some embodiments. After removal of bag  800  from cavity  10 , closure  708  may be disengaged to unclip clip  700  and allow removal of clip  700  from bag  800 . Suction device  900  may then be withdrawn from the interior of bag  800 , and tissue specimen  200  may then be removed from bag  800  for further examination or disposed of along with bag  800 . 
       FIG. 24  shows a variation of clip  700  according to a further embodiment of the present invention. In this embodiment, clip  700  includes at least one elastic layer  716 ,  718  provided on an internal surface of at least one of first leg  702  and second leg  704 . In some embodiments, the at least one elastic layer  716 ,  718  may be positioned on an internal surface of first or second collar portions  710 ,  712 . The elastic layer  716 ,  718  may be made from, for example, foam, rubber, silicone, elastomer, or other elastic material. In some embodiments, providing elastic layer  716 ,  718  may assist in forming a tighter seal against bag  800  and/or suction device  900 . Moreover, in some embodiments, lining the first or second collar portions  710 ,  712  with the elastic layer  716 ,  718  may allow opening  714  to accommodate suction devices of different sizes. 
     With reference to  FIG. 25 , suction device  900  may be provided with a cuff  904  that surrounds at least a portion suction device  900 . In some embodiments, cuff  904  may be positioned around the portion of suction device  900  which is intended to be received within opening  714  of clip  700 . In some embodiments, cuff  904  may be configured to create a tighter fit within opening  714  to improve the hermetic seal with bag  800 . Cuff  904  may also be provided to increase the size (e.g., diameter) of suction device  900  if opening  714  is too large to create a sufficient seal around suction device  900 . In use, according to some embodiments, the concavely curved internal surface of first and/or second legs  702 ,  704  which defines opening  714  may be positioned around the cuff  904  when clip  700  is positioned around bag  800  and suction device  900 . Cuff  904 , in some embodiments, may also be made from an elastic material, such as foam, rubber, silicone, etc. 
       FIGS. 26 and 27  show a clip  1000  in accordance with yet another embodiment of the present invention. In some embodiments, clip  1000  includes a first leg  1002  and a second leg  1004  which are connected by a hinge  1006  and which are configured to move relative to each other between an open configuration ( FIG. 27 ) and a closed configuration ( FIG. 26 ) in a manner that may be similar to that described above with regards to clip  700 . Hinge  1006  may be configured as any sort of hinge capable of allowing first and second legs  1002 ,  1004  to pivot towards or away from each other. In some embodiments, for example, hinge portion  1006  may include a pin about which first and second legs  1002 ,  1004  rotate. In other embodiments, hinge portion  1006  may be a living hinge wherein hinge portion  1006  is a flexible area between first and second legs  1002 ,  1004 . In some embodiments, first and second legs  1002 ,  1004  are separate pieces which are connected by hinge portion  1006 . In other embodiments, first and second legs  1002 ,  1004  and hinge portion  1006  are integrally formed from a single piece of material. First and second legs  1002 ,  1004  may be made from any suitable materials, for example, metals, plastics, polymers, composite materials, etc. In some embodiments, first and second legs  1002 ,  1004  are rigid or substantially rigid. In some embodiments, first and second legs  1002 ,  1004  may have a degree of flexibility. In certain embodiments, for example where clip  1000  is used for tissue specimen removal, clip  1000  is sterilized. In some embodiments, clip  1000  may be further provided with an anti-microbial substance or coating. Similar to the embodiment shown in  FIG. 24 , clip  1000  may further include at least one elastic layer provided on an internal surface of at least one of first leg  1002  and second leg  1004 . 
     As with some embodiments of clip  700 , clip  1000  may further include a closure  1008  which is configured to maintain first and second legs  1002 ,  1004  in the closed configuration. In some embodiments, closure  1008  may be configured as a latch, hook, snap fitting, or any other suitable mechanical feature capable of securing first leg  1002  relative to second leg  1004  in the closed configuration. In some embodiments, closure  1008  may include a protrusion which extends from one of first leg  1002  or second leg  1004  (as illustrated) and which is configured to contact and engage with the other leg in the closed configuration. In some embodiments, closure  1008  may include a first feature on first leg  1002  (e.g., hook) which engages with a second feature (e.g., loop) on second leg  1004  to secure first and second legs  1002 ,  1004  together. In some embodiments, closure  1008  includes features on first and second legs  1002 ,  1004  which are configured to interlock. In some embodiments, closure  1008  may be positioned at or proximate a free end of first leg  1002  and/or second leg  1004  which is opposite hinge portion  1006 . In other embodiments, closure  1008  may include a device separable from clip  1000 . For example, in some embodiments, closure  1008  may include a separate clamping device or fastener which may be applied to first and second legs  1002 ,  1004  in the closed configuration. 
     Unlike clip  700  as illustrated in  FIGS. 16A-18B , substantially the entire length of first and second legs  1002 ,  1004  may be shaped to define an opening  1010  in the closed configuration which is sized and shaped to hermitically seal bag  800  around suction device  900 . In some embodiments, at least one of first leg  1002  and second leg  1004  includes a concavely curved internal surface which at least partially defines opening  1010 . For example, as shown in  FIG. 26 , substantially the entire length of first and second legs  1002 ,  1004  between hinge portion  1006  and closure  1008  may be curved such that clip  1000  is generally configured as a hollow cylinder in the closed configuration. 
     In some embodiments, clip  1000  may be used in a manner similar to clip  700  as described above in connection with  FIGS. 19-23 . For example, as shown in  FIG. 28 , clip  1000  may be positioned around a portion of bag  800  which extends out of cavity  10  to form a hermetic seal. In particular, bag  800  may be positioned between first and second legs  1002 ,  1004  of clip  1000  while clip  1000  is in the open configuration. First and second legs  1002 ,  1004  can then pivoted toward each other to the closed configuration and secured with closure  1008 , causing clip  1000  to clamp around and/or against the walls of bag  800  to create a hermetic seal around suction device  900 . Where suction device  900  includes a cuff  904  as described above, the concavely curved internal surface of first and/or second legs  1002 ,  1004  which defines opening  1010  may be positioned around the cuff  904  when clip  1000  is positioned around bag  800  and suction device  900 . In certain preferred embodiments, clip  1000  can be transitioned from the open configuration to the closed configuration by hand without the need for any additional tools. Furthermore, clip  1000  preferably can be used to hermetically seal bag  800  around suction device  900  without any additional materials being wrapped or tied around bag  800  (e.g., sutures, string, tape, etc.). Once clip  1000  is properly positioned around bag  800  and suction device  900  such that a hermetic seal is formed, the vacuum source can be activated to suction gas from the interior of bag  800  through suction device  900 . 
     In some embodiments, removing gas from the interior of bag  800  causes compression of bag  800  and tissue specimen  200  contained therein, as illustrated in  FIG. 29 . For example, where tissue specimen  200  includes lung tissue, gas contained in the lung tissue can be evacuated during suctioning to cause collapse and compression of the lung tissue. In some embodiments, removing gas from the interior of bag  800  reduces the volume of tissue specimen  200  by at least 10%, by at least 20%, by at least 25%, by at least 30%, by at least 35%, by at least 40%, by at least 45%, by at least 50%, by at least 55%, by at least 60%, by at least 65%, by at least 70%, by at least 75%, or by at least 80%. Preferably, the volume of tissue specimen  200  is sufficiently reduced to allow for tissue specimen  200  within bag  800  to pass through incision  14  without having to enlarge incision  14  according to some embodiments. In some embodiments, however, where tissue specimen  200  cannot be sufficiently compressed by suctioning alone (e.g., where tissue specimen  200  contains very stiff or solid materials), some enlargement of incision  14  may be necessary before bag  800  can be completely withdrawn from cavity  10 . 
     Similar to the other embodiments described above, after bag  800  containing tissue specimen  200  may be withdrawn from cavity  10  through incision  14  after sufficient suctioning. Bag  800  may be pulled by hand out of cavity  10  through incision  14 , according to some embodiments. After removal of bag  800  from cavity  10 , closure  1008  may be disengaged to unclip clip  1000  and allow removal of clip  1000  from bag  800 . Suction device  900  may then be withdrawn from the interior of bag  800 , and tissue specimen  200  may then be removed from bag  800  for further examination or disposed of along with bag  800 . 
     It should be understood that various changes, substitutions, and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. It should also be apparent that individual elements identified herein as belonging to a particular embodiment may be included in other embodiments of the invention. Moreover, the scope of the present application is not intended to be limited to the exemplary embodiments of the processes, machines, manufactures, compositions of matter, means, methods and steps that are shown and described, but it is intended to cover modifications within the spirit and scope of the present invention as defined by the claims. As one of ordinary skill in the art will readily appreciate from the disclosure herein, processes, machines, manufactures, compositions of matter, means, methods, or steps that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present invention.