Abstract:
An improved smoke evacuation system ( 10 ), a method for removing gaseous byproducts of surgical procedures, and noxious vapors from chemicals, is provided. The smoke, and vapor evacuation system includes a vacuum head ( 18 ) positioned at a surgical site or incorporated into a workstation. The vacuum head includes a plenum ( 28 ), a plenum support for preventing the plenum from collapsing when a vacuum or low pressure is established therein, and is adapted to facilitate the use of the system in a variety of surgical or commercial procedures at a variety of surgical sites or commercial workstations.

Description:
The present application claims priority to a U.S. provisional patent application Ser. No. 60/082,125, filed Apr. 17, 1998. 
    
    
     BACKGROUND 
     This invention relates to equipment, systems and methods for the removal of gaseous and/or substantially gaseous material. Such material includes, but is not limited to aerosol byproducts of surgical procedures, including procedures involving cutting, heating or burning. More particularly, the present invention relates to an evacuator or vacuum head for an evacuation system that efficiently removes smoke, vapor, or plumes released by chemicals or produced by the use of lasers, sonic cutting and/or cautery at a surgical site. 
     Heating and/or burning of tissue during surgical procedures has become commonplace. An unwanted byproduct of such heating and/or burning, however, is the smoke generated thereby. Smoke plumes can obscure the surgeon&#39;s field of vision and the odor generated is unpleasant and distracting to the entire surgical team and to the patient, if awake. Moreover, the smoke plume may contain infectious agents that present a danger to persons in the operating room, and which can leave a lingering contamination within the operating area. Chemical vapor (e.g., such as that produced by the cleaning of computer parts) is, likewise, irritating to the respiratory tract of those who inhale it and may be carcinogenic. 
     Smoke evacuation and filtering systems have been developed to remove smoke plumes from surgical sites and chemical vapors from the work environment. Such systems typically include a hose connected to a vacuum source or generator and a suction wand connected to the hose. Various filtration systems have been used in conjunction with such vacuum generators to remove odor and infectious agents. Typically, the wand and hoses of known evacuation and filtration systems have required the constant attention or activity of an attendant to hold the wand or the nozzle of the hose close to the surgical site. Another problem is that the flow of air through the hose nozzle and the suction motor are sources of excessive and unwanted noise in the operating room or at the workstation. 
     More recently, at least in part to address the problems with wands, smoke evacuation systems may include an end effector that can be held in place at a surgical site without the constant attention of a nurse or other attendant. At least one such evacuation system and end effector is disclosed in U.S. Pat. No. 4,921,492 (Schultz et al.), the disclosure of which patent is incorporated herein by reference. Schultz et al. disclose an end effector for removing the gaseous byproducts of laser surgery from a surgical site. The end effector includes a flexible hose and a pliable vacuum head adhesively attachable in airtight relationship around a surgical site. The vacuum head includes a generally annular plenum for drawing plumes away from the surgical site from around a 360° arc. A porous plenum support prevents the flexible plenum from collapsing in the presence of a vacuum, and diffuses the vacuum around the entire periphery of the plenum. 
     U.S. Pat. No. 5,015,243 (Schifano) discloses another smoke evacuator including a flexible suction head for surrounding an operative site to draw smoke and air from around a perimeter of the site as smoke is produced. In one embodiment, the suction head is a doughnut shaped tubular member including a plurality of radial openings on an interior surface of the tubular member that faces the operative site. Schifano teaches that the tubular ring member may be circular or oval, and that it need not completely surround the operative site as long as air is drawn substantially in a surrounding fashion. 
     While smoke evacuation systems and end effectors of the Schultz et al. and Schifano type are well-suited for their intended purposes, there is room for improvement. For example, while the end effectors are pliable or flexible to conform to a surface to which they are attached, neither discloses a skeletal stiffening structure or frame for helping to maintain a conformed shape. Such a skeleton or frame would be valuable to adapt end effectors or vacuum heads for smoke evacuation for use on or near irregular physical features such as, for example, the ear, nose, mouth, or in the area of joints. It would also be advantageous if the generally central, site access opening of such end effectors could be varied in size to accommodate different sizes of incisions and different procedures, and if end effectors could be made available with the intake opening or openings in various locations, so that a particular end effector could be selected depending on the procedure to be performed. It would be advantageous if end effectors were available in a generally elongated, tubular shape bendable into a selected configuration by the user, and wherein the shaped or bent effectors would tend to remain in the selected configuration. It would also be advantageous if an end effector or vacuum head could be integrated with the widely used customary surgical drapes or drape material, or incorporated into part of a workstation that would contain noxious chemical fumes. 
     SUMMARY 
     The present invention provides an evacuator well-suited for removing or evacuating smoke, chemical vapors, aerosols, gaseous or generally gaseous material and fluids, including fluids with entrained particles or other material. It is well-suited for use in removing such substances from surgical sites, workstations and manufacturing assemblies or processing sites. 
     The needs outlined above are in large measure solved by a smoke evacuation system and method, including an evacuator, in accordance with the present invention. The embodiments described herein are designed to efficiently and quietly remove smoke or other aerosols, including smoke or bioaerosols generated during surgical procedures, and can be used at a surgical site without constant attention or manipulation by the surgeon or an attendant. They would also remove vapor from the work site. 
     An improved smoke evacuation system and method for removing gaseous byproducts of surgical or commercial procedures is provided by the present invention. The smoke evacuation system includes a vacuum head positionable at a surgical or other work site. The vacuum head includes a plenum, and a plenum support for preventing the plenum from collapsing when a vacuum or low pressure is established therein, and is adapted to facilitate the use of the system in a variety of surgical procedures at a variety of surgical sites. 
     In one embodiment, the present invention comprises a vacuum smoke evacuator head for coupling to a vacuum source for withdrawing generally gaseous byproducts, including smoke, fine particulate matter, air and the like, from a surgical or commercial site. The smoke evacuator head is substantially made of a generally pliable or flexible material and defines a plenum. A plenum support is carried within the plenum to provide support to the plenum and to prevent the plenum from collapsing when a vacuum or relatively low pressure area is established therein. The smoke evacuator head includes an open intake facing and/or intake openings, and may be positioned adjacent to or in a surgical site. An adhesive may be carried by the head for maintaining it in a selected position or location relative to the surgical site. 
     In one embodiment, the smoke evacuator head includes at least one access opening which may be selectively expanded in size. Typically, the access opening may be generally centrally located in the vacuum head, and has an initial peripheral edge which may be moved generally concentrically outwardly by selectively removing one or more removable, generally concentric peripheral portions extending substantially around the opening. Also typically, the opening, whether the initial size or one of the expanded sizes, may be covered or sealed before use by a removable film. 
     In another embodiment, the smoke evacuator vacuum head includes a skeletal stiffening member or positioning frame whereby the head may be configured and tends to remain in the selected configuration. The skeletal structure may comprise a single, flexible elongated member formed of a suitable material which may be bent or twisted, yet has sufficient rigidity to retain the selected bend or twist. The skeletal structure may be internal or external, and may comprise a single, elongated member, a single annular member, a plurality of axially aligned members, a number of parallel and/or branch members or a combination thereof. This embodiment may be well-suited for use in regions of the body having rather irregular surfaces such as joints, the ear, nose or mouth. 
     In another embodiment, the smoke evacuator may comprise a generally tubular body having two ends, one of which is adapted to be connected to another smoke evacuator vacuum head or to a coupling, such as a hose, for operably coupling the tubular body to a vacuum source. The other end may be free. The body may have one or more regions comprising openings or an open facing for admitting smoke and the like when a vacuum or low pressure is established in the body. In this embodiment, the body may have a stiffening element or a skeletal structure to allow the body to easily bend and remain in a particular shape for use in different situations. This embodiment of the vacuum head may be well-suited for use, as an adjunct or alone, in deep incisions or wounds during surgical procedures. 
     In yet another embodiment, the smoke evacuator vacuum head forms a plenum including a substantially open facing portion for being positioned generally adjacent to a smoke or aersol producing site. In one embodiment, wherein the plenum has a top, outwardly facing wall, is generally annular and includes a generally central access opening, the periphery of the opening being formed by an inner wall, the open facing may be formed in and/or adjacent to the inner wall comprising, for example, a bevel and/or a portion of the top wall. This embodiment is well-suited for use in surgical procedures during which a flap or ridge of skin or tissue may be formed, for example, around or as a result of the incision. Such procedures include plastic surgery procedures and mastectomies, for example, where the vacuum induced in the plenum may tend to pull skin flaps or tissue into it, particularly when the skin flap or tissue is held straight up. 
     In another embodiment, the evacuation system of the present invention comprises an evacuation hose for detachably connecting a vacuum generator or source and a vacuum head that generally surrounds a surgical site. The vacuum head is substantially made of a generally pliable or flexible material and defines a plenum having a generally central opening. A porous plenum supporting material is carried within the plenum to provide a degree of rigidity to the plenum and to prevent the plenum from collapsing when a vacuum or relatively low pressure area is established therein. The plenum includes an open facing region adjacent to the central opening. An adhesive may be carried by the skin contacting wall of the vacuum head for maintaining the vacuum head in place at a surgical site. 
     An embodiment and feature of the present invention is the concept of a foam supported channel of selectable cross-sectional area incorporated or integrated with a surgical drape, wherein the channel may be used to convey smoke and/or other aerosol debris away from a surgical site. 
     Any of the embodiments of the smoke evacuation system or vacuum head described herein may be provided in sterile form and in a color acceptable in an operating room environment. 
     In one embodiment, the smoke evacuation system of the present invention comprises a vacuum head end effector including generally contiguous, concentric areas or regions, which may be oval, formed or separated by generally concentric perforations whereby the areas may be selectively removed to correspond with required length of an incision or procedural area. 
     In one embodiment, the end effector in accordance with the present invention would have a pre-provided generally central and oval cutout of specific predetermined dimensions, the purpose of which would be to form a primary or initial work area, and to more easily allow the surgeon or attendant to remove surrounding peripheral oval sections to expand the original opening. 
     In one embodiment, each removable section of the vacuum head may be provided with a paper backed adhesive running on one surface of the sections. The paper backing would be removed once the size of the field or work area is determined, thereby allowing the remaining portion of the vacuum head and/or drape to affix to the patient&#39;s prepped skin or to the medical drape covering the intended site of the surgery. 
     In some embodiments, one or more manifold-like connection handles or tubes would extend from the foam filled channel or vacuum head to convey the smoke and vapor mixture from the operative site into a conduit and then to a collection, filtration and/or deodorization device wherein the mixture may be processed and the air may be returned to the room. 
     In some embodiments, the skin of the drape may cover the end effector, the manifold and the drape in continuity. In these and other embodiments, the manifold(s) may be provided to include either straight, i.e., parallel, and/or curved extension lips or walls that extend into or on either side of the plenum support that supports the outer walls of the plenum or evacuator vacuum head. The purpose of these lips or walls would be to prevent the possible kinking, narrowing or other form of occlusion by the covering skin of the drape at the plenum support/manifold interface or junction. This occlusion might be caused by the downward force placed on the manifold by the attached tubing that usually trails or falls to the floor of the operating room. In some instances, when suction or reduced pressure is applied without the lip extensions in place, the skin can invaginate and cover the entrance orifice of the manifold. 
     Another embodiment includes a chamber or gathering site for the evacuated smoke as it leaves the foam-filled channel or the plenum toward the exit site of the manifold or connection nozzle. The chamber is attached to the lip extensions or walls (described in the previous paragraph) at one end and forms or is attached to an exit port at the other end. The chamber and/or exit port may be adapted to increase flow velocities by including an area of decrease cross-sectional area. The exit port from which the smoke mixture leaves the smoke evacuator may be coupled to a typical conduit or hose. 
     Any of the embodiments disclosed herein may be formed by a wall or skin which may be made of the same as the material of a surgical drape. The skin typically would be fire retardant or resistant, and any of the embodiments may be preferably composed of bio-compatible material and be capable of disposition as such materials are typically disposed of. 
     It should be appreciated that features of any of the embodiments of the present invention may be selectively combined to adapt the smoke evacuator vacuum head for a variety of situations and surgical procedures. 
     Other features and advantages of the smoke evacuation device and method of the present invention will become more fully apparent and understood with reference to the following description and appended drawings and claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a fragmentary, perspective view of a smoke evacuation system including an vacuum head end effector; 
         FIG. 2  is a front elevational view of the end effector shown in  FIG. 1 , with parts broken away for clarity; 
         FIG. 3  is a top perspective view of an embodiment of the end effector vacuum head in accordance with the present invention; 
         FIG. 4  is a side elevational view of the end effector vacuum head depicted in  FIG. 3 ; 
         FIG. 5  is an exploded perspective view of another embodiment of the present invention; 
         FIG. 6  is a perspective view of the embodiment depicted in  FIG. 5 ; 
         FIG. 7  is a perspective view of another embodiment of the present invention; 
         FIG. 8  is a fragmentary perspective view of another embodiment of the present invention; 
         FIG. 9   a  is a fragmentary perspective view of another embodiment of the present invention; 
         FIG. 9   b  is a fragmentary perspective view of another embodiment of the present invention; 
         FIG. 10  is a fragmentary perspective view of another embodiment of the present invention; 
         FIG. 11  is a perspective view of another embodiment of the present invention; 
         FIG. 12  is a perspective view of another embodiment of the present invention; 
         FIG. 13  is a perspective view of another embodiment of the present invention; 
         FIG. 14  is a perspective view of another embodiment of the present invention; 
         FIG. 15  is a perspective view of two embodiments of the present invention as they might be used in conjunction; 
         FIG. 16  is a perspective view of another embodiment of the present invention; 
         FIG. 17  is a perspective view of another embodiment of the present invention; 
         FIG. 18  is a perspective view of another embodiment of the present invention; and 
         FIG. 19  is a perspective view of an embodiment of the invention in use in a workstation. 
     
    
    
     DETAILED DESCRIPTION 
     The accompanying Figures and this description depict and describe embodiments of the smoke evacuation system and method of the present invention, including the smoke evacuator vacuum head, and features and components thereof. As used herein, the terms “evacuator”, “smoke evacuator”, “end effector”, “vacuum head” and like terms are intended to encompass a structure or structures into which gaseous or generally gaseous material, such as aerosols, smoke or vapor, is drawn when the structure is operably coupled to a source of low pressure or vacuum and placed generally adjacent to a site producing the gaseous or generally gaseous material. As used herein the term surgical field is intended to encompass places where an incision is to be made in the skin or where other surgical operations or procedures are to be performed. With regard to means for fastening, mounting, attaching or connecting the components of the present invention to form the device and system as a whole, unless specifically described otherwise, such means are intended to encompass conventional fasteners such as machine screws, nut and bolt connectors, machine threaded connectors, snap rings, hose clamps such as screw clamps and the like, rivets, nuts and bolts, toggles, pins and the like. Components may also be connected by adhesives, glues, welding, ultrasonic welding, and friction fitting or deformation, if appropriate. Unless specifically otherwise disclosed or taught, materials for making components of the present invention may be selected from appropriate materials such as metal, metallic alloys, natural and manmade fibers, vinyls, plastics and the like, and appropriate manufacturing or production methods including casting, extruding, molding and machining may be used. 
     Any references to front and back, right and left, top and bottom and upper and lower are intended for convenience of description, not to limit the present invention or its components to any one positional or spacial orientation. 
     Referring to  FIGS. 1 and 2 , a smoke evacuation system  10  in accordance with the above-noted Schultz et al. patent is depicted. The system includes an end effector  12  detachably connected to a suitable vacuum generator and filtration assembly  14 . In one embodiment, the end effector  12  may include a flexible hose  16  coupled to a vacuum head  18  by a generally tubular manifold-like handle  20 . In one embodiment, the vacuum head  18  includes a generally flat body  22  having a top wall  24 , bottom wall  26  and outer sidewall  27  extending between the top wall  24  and bottom wall  26 . The body  22  is preferably formed from a nonporous, pliable synthetic resin so that it will conform to the surface surrounding the surgical site. The top, bottom, and side walls  24 ,  26 ,  27  together substantially define a generally annular, internal plenum  28 . The walls form an outer skin of the plenum  28  and may be composed of a medical grade, pliable, substantially non-porous material. The material of choice may be a synthetic, or it may be a natural material, such as fibrous material, e.g., cellulose or cotton fiber based material, such as presently used in surgical drapes and/or towels. The material of choice may be with or without flame-retardant characteristics. Preferred synthetic materials may be selected from open-celled foams, urethane film, spun lace polyester, nonwoven polyurethane tape and the like. 
     The top wall  24  includes an access aperture  32 , and the bottom wall  26  includes access aperture  34 , typically aligned and/or substantially congruent with the top wall access aperture  32 . Preferably, a layer or adhesive  36  is carried by the top wall  24 , and a clear film  38  is removably carried in place over the top access aperture  32  by the adhesive  36 . Preferably, the bottom wall  26  includes a first adhesive layer  40  and a clear film  42  removably carried by the first adhesive layer  40 . A second adhesive layer  44 , which may have an antiseptic embedded therein, is carried by the bottom wall clear film  42 . A sterile, peel-off shield  46  is removably carried by the antiseptic adhesive layer  44 . 
     It will be appreciated that, upon application of a vacuum to the body  22 , the top and bottom wall  24 ,  26  would be urged together, thereby reducing the volume of the plenum  28 . Therefore, in the end effector  18  depicted in  FIGS. 1 and 2 , and in the embodiments of the invention described herein, an inner core plenum support  48  formed from a porous material such as foam urethane, or another appropriate reticulated, open-cell foam material, a supporting matrix, or the like, is carried within plenum  28 , to provide the body  22  with some rigidity without substantially detracting from the flexibility of the vacuum head  18 . The inner core  48  comprises an inner plenum supporting structure  48  that permits the flow of air and smoke into the plenum  28  while blocking the ingress of larger materials such as tissue or surgical materials. Preferably, the inner core support  48  should be made of a synthetic or natural material that is hydrophobic so that it will resist absorption of fluids often present in the operative field. A reticulated open cell foam of a size between 5 and 25 pores per inch (ppi) is well-suited for the inner core. In another embodiment, the plenum support core  48  may be molded and/or may be formed contiguously with the outer skin, and may be provided with a plurality or matrix of airflow shafts or channels. 
     Whether the shape of vacuum head  18  is generally circular, generally oval or a different shape, it will be noted that the plenum  28  provides for evacuation of generally gaseous material substantially around a complete 360° arc. 
       FIGS. 3 and 4  depict an embodiment of the smoke evacuator  18  of the present invention, wherein the central access aperture  32  is expandable to form a larger size aperture or opening  50  by removing a peripheral portion  52  of the evacuator vacuum head  18  from around the originally provided access aperture  32 . The top and bottom walls  24 ,  26  and the plenum support material  48  may include a line of weakness  56 , be scored, cut or partially cut to define the removable portion  52  and to facilitate its removal. A selected number of generally concentric removable portions may be provided. The line of weakness, scoring, cut or perforations  56  may be substantially concentric and congruent with respect to the initial access aperture  32 , or they may be adapted to expand the initial access aperture in a selected direction or into a selected shape, e.g., they may comprise one or more arcs of weakness beginning and ending at the peripheral edge of the access opening (see, for example, lines of weakness a and b shown in  FIG. 6 ). (In describing this and other embodiments, features in common with the end effector depicted in  FIGS. 1 and 2 , and with other embodiments of the invention, are and will be commonly referenced.) 
       FIGS. 5 ,  6  and  12  depict another embodiment of the smoke evacuator vacuum head  18  of the present invention, wherein the vacuum head  18  is provided with a variable size access aperture, and is integrated with a surgical drape  60  comprising a relatively large, flexible, generally cloth-like sheet material. Such a drape or drapes are widely used to establish or set off a surgical field, may be generally transparent, and may be formed by a PVC material or the like. They may carry an adhesive on one surface for connection to the skin of a patient, typically, four strips of adhesive to define a periphery. One surface of the drape may have an adhesive thereon for attachment to the vacuum head end effector  18 . Integration of the vacuum head end effector  18  of the present invention may be accomplished by providing a drape or piece of drape material with an opening, placing the end effector  18  over the opening, and attaching or sealing the edges of the end effector  18  to the drape (see  FIG. 6 ). The bottom wall of the end effector  18  may be omitted, in which case the top or outside side wall  24  may be joined to the drape, whereby the drape forms the bottom wall, completing the plenum  28  and encompassing the open-cell, reticulated foam forming the plenum support  48 . In use, the integrated drape and end effector  18  may be placed over an intended incision site with the access opening aligned with the site. A tab  64  may be grasped and pulled to permit access to the site. If a larger incision site opening is required initially, or if the incision site needs to be expanded or extended, another tab  66  may be grasped and pulled to remove a peripheral portion  52 , thereby enlarging, specifically lengthening, the opening. As depicted in  FIG. 12 , the pre-cut access opening covering is provided with as many tabs as convenient to facilitate grasping and pulling the covering away from the end effector  18 . Pulling one of the tabs releases the pre-perforated covering skin and allows the pre-cut foam  48  to be removed. 
       FIG. 7  (and others, including  FIGS. 15 and 16 ) depict another embodiment of the present invention wherein a wire-like skeletal member  70  is provided. The skeletal member  70  is flexible and bendable to the degree that it may be manipulated, bent or twisted into a desired shape, yet it is inflexible or rigid enough to retain its bent or twisted shape. It may be located in the plenum  28  as shown, or it could be appropriately secured to the exterior of the end effector  18 . 
       FIG. 7 , and  FIGS. 8–10 , depict embodiments of the present invention wherein the walls of the plenum  28  defining the access opening or aperture is an open facing  74 , and wherein the open facing  74  extends into the top wall  24  of the plenum  28 . As shown in  FIGS. 7 and 8 , the access opening wall is substantially completely an open facing  74  which extends upwardly at an angle or bevel  76  into the top wall. The bias or angle into the top wall may be from 10 to 60 degrees, with 45 degrees well-suited for many procedures.  FIGS. 9   a  and  9   b  depict two unbeveled embodiments, and  FIG. 10  depicts an embodiment wherein the inside wall of the plenum  28  is substantially continuous, only the bevel  76  comprising the open facing portion of the plenum  28 . These embodiments generally are well-suited for use in surgical procedures involving a flap or ridge of tissue which, if the top wall or a portion thereof was not adapted to provide an intake for gaseous material, might occlude the open facing, blocking or at least interfering with the flow of the gaseous material into the plenum  28 . The embodiment depicted in  FIG. 10  may be further adapted for particular surgical procedures, such as procedures involving the breast, by providing a sealing means, such as an adhesive, on the inside rim or wall  29  of the plenum  28  so it can be adhered or sealed in place to the breast with a portion of the breast extending through the access opening. 
       FIG. 11  depicts a drape/smoke evacuator embodiment of the present invention wherein dual vacuum coupling attachment handles are provided. Such an embodiment may be well-suited for procedures requiring large incisions, such as spinal procedures, thoracotomy, large abdominal incisions and the like. In one embodiment, the evacuator embodiment of  FIG. 11  may be used as a stand alone device without a drape as depicted in  FIG. 11 . 
       FIGS. 13 and 14  depict another embodiment of the smoke evacuator of the present invention wherein the plenum  28  is formed by a substantially continuous wall, which may be a single piece of extruded material or which may be formed from joined top, bottom and side walls. In this embodiment, the vacuum head  18  and the plenum  28  have a generally tubular, straight, elongated shape with two free ends, one end  80  of which may be closed and the other end  82  which may be adapted to be coupled to another embodiment of the end effector  18  of the invention, as shown in  FIG. 14 . The end  82  adapted to be coupled is provided with a sharpened, cannula-like member  84  for penetrating the wall of the plenum  28  as shown in  FIG. 14 . The end  82  may be flattened or otherwise adapted to be similarly attached to suction tubing or to the above described channel. In one embodiment (not shown), the cannula-like member  84  is not sharpened as depicted in  FIG. 13 . In other embodiments (not shown), this embodiment of the invention may be adapted for direct coupling to a hose or other fitting, or may include or be attached to a manifold or handle  20  generally similar to that shown in  FIG. 1 , for coupling to a hose or other fitting. Note that  FIG. 14  also depicts that the stiffening skeletal member  70 , shown in two of its possible locations, may be used to configure and position the generally tubular smoke evacuator  18  embodiment, or a portion thereof, in a relatively deep incision or wound. 
       FIG. 15  depicts an embodiment of the smoke evacuator of the present invention adapted for spinal operations or other procedures wherein a relatively long incision may be used. The plenum  28  is formed in the shape of two generally parallel tubular members  88 ,  90 , each having substantially continuous top, bottom, outside and end walls, and an inside wall comprising an open facing  74 . Each embodiment of the invention may include a generally enlarged internal plenum space adjacent to the manifold port or handle  20 . In the evacuator of  FIG. 15 , for example, the top wall  24  and bottom wall  26  are extended to form an enlarged plenum space  100  adjacent the manifold port or handle  20 , such that the suction force generated at the manifold or handle  20  is more evenly dispersed, including throughout the plenum and along the open facing  74 . Such a feature may be included in any of the embodiments of the invention described herein. Note that, as in all the embodiments described herein, the malleable, skeletal stiffening member  70 , which might be formed of nitinol or similar “memory” material, may be incorporated to facilitate re configuring this embodiment to, for example, the configuration shown in phantom. This embodiment of the vacuum head  18  may have a single connection manifold or nozzle  20  as shown, or it may be adapted to have two manifolds with a circuit adapter to permit them both flow into a single ⅞″ vacuum hose (see, for example,  FIG. 11 ). Such circuit adapters are readily available as standard catalog items for respiratory therapy and anaesthesia. 
       FIG. 16  depicts an embodiment of the smoke evacuator  18  well-suited for use in dental surgery, e.g., a “bite-block” embodiment. It should be appreciated that the smoke evacuator  18  maybe provided in any configuration suitable for use in or around the mouth, and that substantially the entire skin or walls forming this embodiment would preferably be non-absorbent. 
       FIGS. 17 and 18  depict an embodiment wherein a generally tubular vacuum head  18  comprises an internal plenum region adjacent to the manifold port or handle  20  and two plenum arms  90 ,  92 . The two plenum arms  90 ,  92 , which, as in  FIGS. 17 and 18 , may be two free arms, may be curled or curved to substantially surround a surgical site. An advantage of this embodiment is that the plenum arms  90 ,  92  with their free end are flexible, whereby the head  18  is made more flexible so it may more easily assume and conform to the shape of the underlying tissue. The arms  90 ,  92 , and thus the head  18 , may move in various directions according to the layout of adjacent tissues. Because, in one embodiment, one surface of the vacuum head  18  of  FIGS. 17 and 18  may have an adhesive attached thereto for attachment to a drape, it may be desirable to have one embodiment wherein the ends  90 ,  92  face one direction when viewed from the top and another embodiment wherein the ends  90 ,  92  face the other direction. These embodiments may provide for the flexibility needed for various surgical procedures, including procedures on bilateral, mirror image structures or tissues. 
     In use, it should be understood that operation of all the embodiments disclosed herein may be generally similar. The vacuum head  18 , or the drape  60  with the vacuum head  18  integrated, is detachably affixed to the skin surrounding a surgical site by peeling off the sterile peel-off shield  46  and pressing the adhesive layer  44  carried by the bottom wall  26  of the body  22  against the skin. It will be appreciated that the flexible vacuum head  18  permits a complete, airtight seal of the bottom wall  26  against the skin or any skin covering (such as a clear drape). The films  28 ,  42  carried by the top and bottom walls  24 ,  26 , respectively, can be entirely removed. Upon actuation of the vacuum source  14 , air is drawn into the plenum  28 , and is transported through the flexible hose  16  and into the filter (not shown) in the vacuum source  14 . The porous plenum support  48  carried within plenum  28  prevents plenum  28  from collapsing under the influence of the vacuum. The plenum support  48  also may be adapted to enhance the effect of diffusing the vacuum around or through the plenum  28 , thereby enhancing the drawing air into the plenum  28  around its entire periphery or open facing, rather than solely in the vicinity of handle  20 . Moreover, drawing air through the larger opening presented by the plenum  28  reduces the noise created by the flow of air into hose  16 . Gaseous or aerosol material produced at the surgical site is thereby drawn into the plenum  28  and evacuated through flexible hose  16 . The plenum support  48 , due to its porous nature, also may act as a filter as the smoke is drawn through it. 
     Referring back to  FIG. 1 , surgical instruments can be manipulated through the tear line T in clear film  38  and/or through the access opening  32 . Alternatively, the clear film  38  can be completely removed. It will be appreciated that the vacuum, and drawing effect, presented by the plenum  28  to the surgical site may be increased by leaving the clear film  38  in place. 
     The end effector(s)  18  of the present invention may be extruded from a single piece of material, e.g., the body  22 , tubular handle  20 , flexible hose  16 , and in some embodiments, a filter and connector, may be formed from a unitary piece of synthetic resin or similar extrudable material. The end effector(s)  18  of the present invention may be advantageously and hygienically disposed of after a single use, without the necessity of handling contaminated material. 
     In another use of the invention, the embodiments of the vacuum head  18  may be used at a workstation or the like, or on or in a containment vessel or the like, in order to remove fumes or smoke. Such workstations and vessels may be used, for example, for cleaning components in the computer industry or for performing experiments or tasks in which noxious fumes are emitted.  FIG. 19  shows such a use. The workstation  110  may have hand holes  112 , with or without suitable sealing collars  113  or attached gloves (not shown), through which a technician or user may put their gloved or ungloved hands. The vacuum head  18  may be positioned in, adjacent to or on the workstation  110 , for example, as depicted, it may be coupled to an exterior surface of the workstation enclosure adjacent to an opening in the wall defining the workstation. It may also be coupled to an interior surface. When a suction force is applied to the vacuum head  18 , the vacuum head  18  receives smoke or fumes from the inside of the workstation. In one embodiment, an air supply may be pumped into the workstation  110  through a hose  114  to help urge the vapors, aerosols or gaseous material toward the vacuum head  18 . Such an air supply may provide air at any given rate; one such rate for a typical-sized work station may be 30 cubic feet per minute. 
     The present invention may be embodied in other specific forms without departing from the essential spirit or attributes thereof. The described embodiments should be considered in all respects as illustrative, not restrictive.