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Prior to physical removal of the tissue‐occupied retrieval bag from a body cavity, the tissue to be extracted should be adjusted to the bottom of the bag. This can often be achieved by simply elevating the bag and allowing the weight of the tissue to shift its position deeper inside of the bag. In scenarios with less working space, an instrument is used to push the tissue to the bottom of the bag.

Some commercially available products allow for intracorporeal bag closure using an embedded purse string around the opening (see ssss1b). The long tethers of the purse string are withdrawn out of body cavity through the desired exit site (typically a cannula), pulling the closed specimen bag along with them. Once the opening of the bag is within the cannula, the bag and cannula can be pulled from the site as a single unit. Bags with small tissue volumes can often be successfully removed through a larger cannula (12 mm). Bags with large tissue volumes can often be slowly pulled through the incision after the cannula is removed without the need to extend the size of the incision. If the specimen is too large for the cannula incision, manual or power tissue morcellation of the tissue within the bag, or enlargement of the port incision, may be performed to facilitate removal. Manual morcellation is performed by bringing the bag opening to the enlarged cannula incision and using a blunt‐tipped standard surgical forceps (eg. carmalt, ring) to disrupt the contained tissues into smaller, more pliable tissue. Firmer tissue can be clamped, partially exteriorized, and surgically debulked without disruption of the specimen bag. Fluid‐filled structures, such as an excised gallbladder, can have their contents removed or aspirated while inside a bag to facilitate extraction. Surgeons should avoid overzealously pulling or forcing a retrieval bag through an insufficient incision. When in doubt, the incision should be extended to enable safe removal of the occupied bag without undue risk of disruption and subsequent contamination. In particular, homemade retrieval bags are often more fragile and care is required to avoid tears during extraction from the abdomen [3, 4, 6].