Abstract:
A surgical fastener applying apparatus includes an anvil half-section and a cartridge-receiving half-section including an elongated channel member having a pair of opposed openings defined through sidewalls thereof. A disposable assembly including a single use loading unit and a single use firing unit is configured to be releasably supported within the cartridge-receiving half-section. The disposable assembly includes a stationary housing for supporting the firing unit which includes a distal extension for supporting the single use loading unit. The stationary housing includes a pair of flared tabs configured to be releasably received within the openings of the cartridge-receiving half-section to releasably engage the disposable assembly within the cartridge-receiving half-section.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional of U.S. patent application Ser. No. 10/540,197, filed Jun. 20, 2005, which is a National Stage Entry under 35 U.S.C. §371(a) of International Patent Application No. PCT/US03/41068, filed on Dec. 22, 2003, which claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 60/435,223, filed on Dec. 20, 2002, now expired, the entire content of each of the applications identified above being incorporated by reference herein. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to surgical instruments, e.g., surgical fastener or stapler apparatus and, more particularly to circular surgical staplers for performing surgical procedures, including but not limited to rectal mucosectomies, rectal anopexies, anastamoses, hemorrhoidectomies, or the like. In addition the present disclosure relates to methods of performing such surgical procedures. 
         [0004]    2. Background of Related Art 
         [0005]    Various types of surgical fastener applicators and/or staplers are known for the application of fasteners or staples to tissue in order to join adjacent tissues. For example, it is known to use various types of staplers in gastric and esophageal surgery, in both classic or modified gastric reconstructions performed end-to-end, end-to-side, or side-to-side, as well as for performing a hemorrhoidectomy. 
         [0006]    Hemorrhoids are a mass of dilated veins in swollen tissue at the margin of the anus or nearby within the rectum. Typically, hemorrhoids are caused by chronic straining for example from constipation and/or childbirth. The plexus of vascular tissue beneath the epithelial lining of the anal canal is called the corpus cavemosus recti or anal cushion. The plexus connect arteries to veins without intervening capillaries thus creating the vascular component of the anal cushions. These arteriovenous channels control the size of the anal cushions by regulating the blood volume flowing through them. Chronic straining damages the submucosal fibroelastic connective and the anal cushions protrude into the anal canal and may produce painless bleeding (first degree hemorrhoids). Prolapsed hemorrhoids lying outside the anal canal may become strangulated by the internal sphincter activity with possible thrombosis of the venous plexus (fourth-degree hemorrhoids). This condition may result in gangrene with the risk of abscess formation. 
         [0007]    Hemorrhoids can be of two types, external and internal. A ribbed dentate line is located about 2.5 to 3 cm in from the exterior of the anus and marks the change from the anus to the rectum. Hemorrhoids are found in the anal area before this line. Internal hemorrhoids generally are found in the rectal area before this line and external hemorrhoids generally are external of the anal ring. Internal hemorrhoids are generally formed from arteriovenous anastomoses or connections that reside in a submucosal space within the wall of the rectum, approximately 2.5 to 5 cm in from the exterior of the anus. Due to its proximity to the anus, internal hemorrhoids can protrude from the wall of the rectum in either one localized area, more than one localized area, or circumferentially around the rectum and in certain severe cases, the internal hemorrhoids can protrude out of the anus. 
         [0008]    A wide variety of surgical methods have been suggested for the treatment of severe internal hemorrhoids. One method is a closed hemorrhoidectomy. According to this method a retractor is inserted into the anus to obtain access to a hemorrhoidal site. The surgeon then clamps the hemorrhoid with alligator clamps, ligates the vessels, and dissects the hemorrhoid from the rectal wall with a scalpel or scissors. Once the hemorrhoid is removed, the surgical site is sutured closed. The retractor is then rotated to another position and the remaining hemorrhoids are treated in a similar manner until all of the hemorrhoids have been removed. 
         [0009]    Another method for the removal of internal hemorrhoids is an open hemorrhoidectomy. According to this procedure, rather than using a retractor, the anus is gently dilated with two fingers and forceps are placed at the mucocutaneous junction of each primary hemorrhoid. The hemorrhoids are pulled down and a second forceps is applied to the main bulk of each hemorrhoid to produce “a triangle of exposure”. Next, the clamped, hemorrhoid is dissected from the sphincter muscle and is dissected proximally as far as the pedicles and then ligated or tied. Unlike the closed procedure, the wound is not sutured closed, but is left open with a light dressing applied to the wound. 
         [0010]    Yet another hemorrhoidectomy procedure involves excising hemorrhoidal tissue above the dentate line and excising and suturing the redundant rectal mucosa to the anoderm. This procedure is particularly used in conjunction with circumferential hemorrhoids. 
         [0011]    In a paper by Dr. G. Allegra entitled “Particular Experience with Mechanical Sutures: Circular Stapler for Hemorrhoidectomy,” presented to the 1.sup.st. National Conference of the Italian Viscerosynthesis Association in May 28-30, 1989, and published in GIORN Chir. Vol. 11-No. 3-pp 95-97, March 1990, Dr. Allegra disclosed a simpler and faster method for performing a hemorrhoidectomy. The paper discloses the use of a conventional circular stapler to perform a hemorrhoidectomy on second and third degree hemorrhoids. According to the procedure detailed by Dr. Allegra, the anus is dilated to place a continuous submucosal circle of sutures at the base of the pectinate or dentate line. Next, the end effector of a conventional circular stapling instrument is opened and placed into the anus of a patient such that the anvil assembly of the stapling end effector is distal of the suture ring and the stapling head assembly (of the stapling end effector) is proximally outside of the patient. This placement enables the surgeon to reach within the anus in order to grasp the loose ends of the suture. The loose ends of the suture are then pulled to draw the circle of suture closed and to draw the hemorrhoidal tissue in around the anvil shaft which connects the anvil to the stapling head assembly of the circular stapling instrument. Next, the surgeon closes the anvil upon the hemorrhoidal mass and the stapler is fired to perform the hemorrhoidal transection. Once fired, the circular stapling instrument is removed from the anus with the transected hemorrhoids captured within. 
         [0012]    One limitation of Dr. Allegra&#39;s procedure is that the stapling head assembly must be placed proximally outside of the patient to enable the surgeon to grasp the loose ends of the suture and to draw the suture out of the anus through a gap between the anus and the stapling head assembly. The gap between the anus and the stapling head assembly is needed to permit withdrawal of the suture from the anus and thus limits the depth that the stapling end effector can be placed into the anus. Using Dr. Allegra&#39;s procedure, if the hemorrhoids are located deeper into the anal canal, as in the case of internal hemorrhoids, the stapling head assembly enters the anus and effectively blocks the surgeon from accessing the loose ends of the suture. 
         [0013]    An additional limitation of Dr. Allegra&#39;s procedure is the amount of hemorrhoidal tissue that can be drawn into the stapling end effector of a conventional circular stapling instrument. Hemorrhoids are drawn into and around an anvil shaft (connecting the open anvil assembly to the stapling head assembly) by tightening a continuous loop of suture placed below the dentate line. This action draws the hemorrhoids around the anvil shaft but does not draw the hemorrhoids into the inner chamber of the stapling head assembly. This limits the amount of hemorrhoidal tissue that can be brought into the stapling end effector and the surgeon may remove only part of a hemorrhoid. 
         [0014]    U.S. Pat. No. 6,083,241, to Longo et al. also discloses a method for removing internal hemorrhoids from a patient using a circular stapler. A suture is placed into or above the internal hemorrhoids of the patient. A needle hook is employed to grasp the suture and withdraw the suture through a passageway in the stapling head assembly and out of the casing of the stapling head assembly. The circular stapling instrument is closed and then fired in order to staple and cut the hemorrhoidal tissue and the stapling instrument is removed from the patient to remove the tissue from the patient. 
         [0015]    A significant drawback of both the Dr. Allegra and the Longo et al. procedures is the complexity of the procedures. Each calls for the hemorrhoidal tissue to be sutured, prior to stapling and cutting. This significantly increases the time of performing the procedure and in turn increases the potential for complications and the potential for trauma to the patient. As described above, each procedure generally requires that a purse string type suture be first sewn into the tissue by using a retractor to expose a portion of the tissue; suturing the exposed portion of the tissue; repositioning the retractor adjacent the sutured portion and repeating these steps around the circumference of the rectal cavity until the entire tissue has been sutured. 
         [0016]    Thus, the need exists for surgical staplers and/or apparatus which are less complex and can more quickly perform a surgical procedure than existing surgical staplers. In addition, the need exists for staplers and/or apparatus which reduce the trauma experienced by the patient during the surgical procedures described above. Further, the need exists for methods of performing the above described surgical procedures which are less complex and less time consuming than existing methods of performing the same. 
       SUMMARY 
       [0017]    In accordance with the present disclosure, a circular surgical stapling apparatus is provided in combination with a vacuum device. The vacuum device may be formed integrally with or incorporated into the surgical stapling apparatus. Alternately, the vacuum device may be removably or fixedly secured to the surgical stapling device. 
         [0018]    In one preferred embodiment of the present disclosure, a vacuum device is secured to the shell assembly of a surgical stapling apparatus. The vacuum device may be secured to the shell assembly of a surgical stapling apparatus by a resilient collar or band such that a source of vacuum is communicated with the vent holes in the shell assembly. It is also contemplated that the vacuum device may be secured directly to one or more of the vent holes of the shell assembly or that the vacuum device may include a vacuum chamber positioned about the shell assembly of the surgical stapling apparatus. In another preferred embodiment, one or more vacuum tubes are provided in the vacuum chamber. Each vacuum tube has a first end positioned with the vacuum chamber and a second end positioned within the inner chamber of the shell assembly. Preferably, the first end of each vacuum tube is supported on a slidable manifold which is connected to a remotely located finger actuator. The finger actuator is actuable to reposition the second end of each vacuum tube from a location within the inner chamber of the shell assembly to a position external of the shell assembly. 
         [0019]    In yet another preferred embodiment of the present disclosure, means for drawing a vacuum is incorporated into the surgical stapling apparatus. In one preferred embodiment, a vacuum channel is provided through the elongated body and shell assembly of the surgical stapling apparatus. One end of the vacuum channel communicates with vacuum openings formed in the anvil shaft of the surgical stapling apparatus and the other end of the vacuum channel communicates with a source of vacuum may be an external source or a self-contained unit positioned within the surgical stapling apparatus. The vacuum openings in the anvil shaft may have any desired configuration. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]    The present disclosure will be further described with reference to the accompanying drawings, wherein like reference numerals refer to like parts in the several views, and wherein: 
           [0021]      FIG. 1  is a side perspective view of a conventional circular surgical stapling apparatus; 
           [0022]      FIG. 2  is a side cross-sectional cutaway view of the distal end of the circular surgical stapling apparatus shown in  FIG. 1  with one preferred embodiment of the presently disclosed vacuum device or collar positioned about a portion of shell assembly; 
           [0023]      FIG. 2A  is a side perspective view of the vacuum collar shown in  FIG. 2  with a portion of the vacuum conduit cutaway; 
           [0024]      FIG. 3  is a side cross-sectional cutaway view of the distal end of the circular surgical stapling apparatus shown in  FIG. 1  with another preferred embodiment of the presently disclosed vacuum device secured to the shell assembly thereof; 
           [0025]      FIG. 4  illustrates a side cross-sectional cutaway view of the distal end of a circular surgical stapling apparatus positioned within the anus including a preferred means for drawing a vacuum within the shell assembly; 
           [0026]      FIG. 5  illustrates a side cross-sectional cutaway view of the distal end of a circular surgical stapling apparatus positioned within the anus including another preferred means for drawing a vacuum with in the shell assembly; 
           [0027]      FIG. 6  illustrates a side cross-sectional cutaway view of the distal end of a circular surgical stapling apparatus positioned within the anus including another preferred means for drawing a vacuum within the shell assembly; 
           [0028]      FIG. 7  is a side cross-sectional cutaway view of a circular surgical stapling apparatus shown in  FIG. 1  positioned within the anus with another preferred embodiment of the presently disclosed vacuum device secured to the shell assembly of the surgical stapling apparatus; 
           [0029]      FIG. 8  is a side cross-sectional cutaway view of the circular surgical stapling apparatus shown in  FIG. 1  with yet another preferred embodiment of the presently disclosed vacuum device, in a non-deployed position, secured to the shell assembly of the surgical stapling apparatus; 
           [0030]      FIG. 9  is a top view of the surgical stapling apparatus shown in  FIG. 8  with the anvil assembly removed; 
           [0031]      FIG. 10  is a side cross-sectional cutaway view of the surgical stapling apparatus shown in  FIG. 8  with the vacuum device in the deployed position; and 
           [0032]      FIG. 11  is a side cross-sectional view of the circular stapling apparatus shown in  FIG. 1  with another preferred embodiment of the presently disclosed vacuum device, in a deployed position, secured to the shell assembly of the surgical stapling device. 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0033]    Preferred embodiments of the presently disclosed surgical apparatus will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. In the drawings and in the description which follows, the term “proximal”, as is traditional will refer to the end of the surgical apparatus which is closest to the operator, while the term “distal” will refer to the end of the device which is furthest from the operator. While the following description of the surgical apparatus and method will relate mainly to the removal of rectal mucosal tissue from a patient, it is envisioned that the apparatus according to the present disclosure is not limited to the removal of the rectal mucosal tissue and can be used to perform additional or other surgical procedures. 
         [0034]    In the present disclosure, the term “rectal mucosectomy” is understood to include rectal-cuff-mucosectomy, circular stapler anopexy, hemorrhoidectomy, anastomosis, colonectomy and any other surgical procedure involving the mucosal wall of a lumen of the body. The term “staple” or “fastener” as used in the present disclosure, includes single or multi-part, e.g., two-part, surgical fasteners, surgical staples, and the like. 
         [0035]    It is also noted that a variety of circular surgical stapling apparatus are well known. Although the present disclosure illustrates one preferred circular stapling apparatus, it is envisioned that the teachings provided herein may be applied to any of the variety of known stapling apparatus. 
         [0036]    Referring initially to  FIG. 1 , a surgical stapling apparatus in accordance with the present disclosure is generally designated as  100 . Surgical stapling apparatus  100  is of a generally conventional structure and includes a yoke  102 , an elongated body  104  extending from yoke  102 , a shell assembly  107  configured and adapted to carry a cartridge assembly  106  ( FIG. 2 ) and defining an internal chamber  150  at a distal end thereof, and an anvil assembly  108  at a distal end of the apparatus  100 . Apparatus  100  has an approximation mechanism (not shown) extending proximally from anvil assembly  108  through elongated body  104  to a wing nut  110  at a proximal end of apparatus  100 , for moving anvil assembly  108  in relation to cartridge assembly  106 . In addition, a pair of handles  112  are mounted to apparatus  100 , to be manually grasped by the surgeon and moved towards each other as indicated by arrows “A” in  FIG. 1 , in order to fire staples from cartridge assembly  106  towards anvil assembly  108  and to actuate an annular blade  130  movably positioned within shell assembly  107 . A safety lock  114  is also mounted on the proximal end of yoke  102 . Safety lock  114  prevents inadvertent movement of handles  112  towards each other to prevent premature firing of the staples or actuation of the annular blade. As is known in the art, one or more suitable venting holes  116  are provided in conical section  118  of shell assembly  107  for venting the interior of cartridge assembly  106 . In accordance with one embodiment of the present disclosure, these and/or other vent holes or apertures can be employed or provided for providing a vacuum to the interior or inner chamber  150  ( FIG. 2 ) of shell assembly  107 . Other known surgical stapling apparatus are described in commonly assigned U.S. Pat. No. 5,915,616 to Viola et al. and PCT International application No. PCT/US02/10792, filed Apr. 3, 2002, the entire disclosure of each of which is incorporated herein by reference. Copending application entitled “Surgical Stapler Apparatus And Method” filed under Express Mail Mailing Label No. EV149022962US filed on an even date herewith is also incorporated herein by reference in its entirety. 
         [0037]    Referring to  FIG. 2 , generally, circular surgical stapling apparatus include an anvil retainer  120  for securing an anvil shaft  122  of the anvil assembly  108  ( FIG. 1 ) to an approximation mechanism of surgical stapling apparatus  100 . The approximation mechanism is actuable, e.g., via wing nut  110 , to reciprocate anvil retainer  120  within elongated body  104  and, thus, reciprocate anvil shaft  122  within elongated body  104  and shell assembly  107 . Reciprocation of anvil shaft  122  within elongated body  104  effects movement of anvil assembly  108  in relation to shell assembly  107  between spaced and approximated positions. A pusher assembly is also provided which includes a pusher back  124  and a staple driver  126 . Pusher back  124  is moved within elongated body  104 , e.g., via operation of handles  112 , to advance staple driver  126  and annular knife blade  130  through cartridge assembly  106  to eject staplers or fasteners  128  from cartridge assembly  106  and cut tissue. 
         [0038]    Referring now to  FIGS. 2 and 2A , in one preferred embodiment of the presently disclosed circular stapling apparatus  100 , a vacuum device including a resilient or elastic collar or band  140  is provided which includes an annular resilient band body  142  and a flexible vacuum conduit  144 . Vacuum conduit  144  has a first end which communicates with a port  146  formed in band body  142 . A second end (not shown) of conduit  144  is adapted to communicate with a source of vacuum. Vacuum conduit  144  can be integrally formed with band body  142  or in the alternative secured to band body with a suitable connector, e.g., threads, interlocking structure, etc. Resilient band  142  is preferably formed of an elastomer neoprene or a natural or synthetic rubber, although other resilient and non-resilient materials may be used. Band  142  is dimensioned to be received preferably tightly about conical section  118  of shell assembly  107  such that port  146  of band body  142  communicates with preferably one or more a venting holes  116  and/or other aperture(s) or clearance(s) in shell assembly  107 . Remaining venting holes  116  are fluidly sealed by band body  142 . 
         [0039]    In use, when the distal end of apparatus  100  is positioned within a lumen, e.g., the anus, and a vacuum is drawn through vacuum conduit  114  and port  146  in band body  142 , a low pressure region or vacuum is created within inner chamber  150  defined in shell assembly  107 . This vacuum or low pressure region causes tissue, e.g., the mucosal wall of the lumen, to be sucked or drawn into inner chamber  150  of shell assembly  107  about anvil shaft  122 . Thus, when apparatus  100  is approximated, i.e., anvil shaft  122  is retracted into elongated body  104 , tissue is trapped between anvil assembly  108  and cartridge assembly  106 . Thereafter, apparatus  100  can be fired in the manner set forth above to staple and sever tissue. 
         [0040]    Referring to  FIG. 3 , it is also contemplated that vacuum conduit  144  can be attached to a venting hole and or other apertures or clearances  116  using means other than a resilient band. For example, a connection, e.g., a screw fitting  152 , a quick disconnect fitting, a friction fitting, etc., on either or both members to be directly or indirectly connected may be used to attach vacuum conduit  144  to, or communicate with, one or more holes  116  (one shown). The remaining holes  116  can be sealed using any known technique or, in the alternative, apparatus  100  may be provided with only a single hole  116 . 
         [0041]      FIGS. 4-11  illustrate various alternative embodiments of the presently disclosed circular stapling apparatus, each including a different means for applying or drawing a vacuum in the inner chamber of the shell assembly. Although many of the embodiments illustrated herein include an external vacuum source, it is envisioned that each apparatus described above can be configured and adapted to include a self-contained vacuum unit, e.g., a vacuum unit may be contained within the handle assembly or elongated body of the circular stapling apparatus. Each of the disclosed circular stapling apparatus may also be adapted to be incorporated into a robotically controlled, remotely actuated system. Thus, the vacuum source can be operated remotely or located in a remote unit or control box, as in a robotic system. 
         [0042]    Referring to the embodiment of the circular stapling apparatus shown in  FIG. 4 , a vacuum channel  160  is provided through pusher back  124 , anvil retainer  120  and anvil shaft  122 . Depending on the particular stapler, these components may be hollow or solid. If the components are solid, channel  160  must be formed, i.e., molded or drilled, in the particular component. One or more vacuum openings  162  are provided in anvil shaft  122 . Where only a single opening  162  is provided in anvil shaft  122 , the opening should preferably be located in or near inner chamber  150 . Openings  162  maybe circular, oval, elongated channels  162   a  ( FIG. 5 ), or any other configuration which permits air flow. A vacuum source (not shown) is fluidly connected to vacuum channel  160 . As discussed above, the vacuum source may be external or a self-contained vacuum unit (not shown) supported in the handle assembly or elongated body of the apparatus. If an external vacuum source is provided, an inlet port (not shown) may be provided in the apparatus at any location proximal of anvil retainer  120  which communicates with vacuum channel  160 . As discussed above with respect to  FIG. 2 , when a vacuum is drawn through vacuum channel  160 , a low pressure region  166  is created in the inner chamber  150  of shell assembly  107  and in the area between shell assembly  107  and anvil assembly  108 . This low pressure region functions to draw tissue from the inner walls  170  of the lumen about anvil shaft  122  of anvil assembly  108  and into inner chamber  150  of shell assembly  107 . Tissue can then be severed and fastened in the manner discussed above. 
         [0043]    The circular stapling apparatus shown in  FIG. 6  is similar to the apparatus shown in  FIGS. 4 and 5  in that vacuum channel  160  is provided through pusher back  124 , anvil retainer  120  and anvil shaft  122 . However, vacuum channel  160  also includes an annular series of radial ports  160   a  formed through anvil shaft  122 , which ports preferably are positioned within inner chamber  150  of shell assembly  107  when anvil assembly  108  and cartridge assembly  106  are in spaced relation. The apparatus operates in a manner similar to that described above. In this and other embodiments herein, ports can be fed by radial passageways extending from a main vacuum channel extending through anvil shaft  122 . 
         [0044]    Referring to  FIG. 7 , the vacuum device may include a hollow sleeve  180  which is positioned about the distal end of elongated body  104 . The sleeve  180  defines a vacuum chamber  182  and includes an outlet port  184  which communicates with a vacuum tube  186 . A distal end  180   a  of hollow sleeve  180  is positioned over conical portion  118  of shell assembly  107 ′ such that holes and/or other apertures or clearances  116  of shell assembly  107 ′ or shaft  104  are positioned within vacuum chamber  182 . As such, when a vacuum is drawn through vacuum tube  186 , a low pressure region is created in vacuum chamber  182  and within inner chamber  150  of shell assembly  107 ′ as well as in the space defined between shell assembly  107 ′ and anvil assembly  108 . The low pressure region, as discussed above, draws mucosal tissue from the lumen walls  170  towards anvil shaft  122  and into inner chamber  150  of shell assembly  107 . 
         [0045]    Shell assembly  107 ′ is substantially identical to shell assembly  107  shown in  FIGS. 2-6  except that the diameter of annular knife blade  130 ′ has been increased to define a larger unobstructed area within inner chamber  150 . Spaces between other surrounding elements of the cartridge assembly radially exterior or outward of the annular knife blade  130 ′ are preferably also compressed. As illustrated, the outer diameter of annular knife  130 ′ is substantially equal to the inner diameter of cartridge  106 . As such, a greater amount of tissue can be severed and retained within shell assembly  107 ′ during use. 
         [0046]    Referring to  FIGS. 8-11 , in addition to hollow sleeve  180 , the vacuum device may include one or more vacuum tubes  200  which extend from within vacuum chamber  182  through holes  116  of shell assembly  107 ′ into inner chamber  150  of shell assembly  107 ′. In one preferred embodiment, a plurality of vacuum tubes  200  are provided. Each vacuum tube includes a first end  200   a  secured to a slidable ring or manifold  202 . Manifold  202  is slidably supported within vacuum chamber  182  and is fastened to a finger actuator  204  by a link  206 . Link  206  may be integrally formed with manifold  202  and finger actuator  204 . Alternately, these elements may be individually formed and secured together using known fastening techniques. Finger actuator  204  is slidable along an outer surface of elongated body  104  to move manifold  202  and vacuum tubes  200  between a retracted (non-deployed) position ( FIG. 8 ) and an advanced (deployed) position ( FIG. 10 ). Although finger actuator  204  is shown positioned on the elongated body  104 , an appropriate linkage may be provided to position the finger actuator adjacent handles  112  ( FIG. 1 ). Guide structure  210  may be provided within shell assembly  107 ′ to direct vacuum tubes  200  through shell assembly  107 ′. 
         [0047]    Vacuum tubes  200  are preferably formed from a flexible material, e.g., plastic, rubber, metals, metal or plastic shape memory materials, etc. A second end of each vacuum tube  200  extends through a respective hole  116  in shell assembly  107 ′ and is positioned within inner chamber  150  of shell assembly  107 ′. The location of the second end  200   b  of vacuum tube  200  can be repositioned by moving finger actuator  204  in relation to elongated body  104  from a position within inner chamber  150  to a position external of shell assembly  107 ′. It is envisioned that the length of vacuum tubes  200  may be selected to facilitate positioning of end  200   b  of vacuum tubes  200  at any location from within inner chamber  150  of shell assembly  107 ′ to anvil assembly  108 . Vacuum tubes  200  may also be of a length to engage tissue positioned radially outwardly of shell assembly  107 ′. In one preferred embodiment illustrated in  FIG. 11 , vacuum tubes  200 ′ are formed of a resilient or shape-memory material which naturally curves radially outwardly of shell assembly  107 ′ when vacuum tubes  200 ′ are moved towards the deployed position. Tubes  200  are preferably of a length to engage tissue, e.g., mucosal tissue, defining the inner wall of a lumen, e.g., the anus. Tubes  200  may be deployed to engage tissue and, then, returned to the non-deployed position to pull tissue into the shell assembly. 
         [0048]    It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the vacuum devices disclosed herein may be incorporated into a circular surgical stapling apparatus not having vent holes in the shell assembly by providing a vacuum channel though the shell assembly of the circular stapling apparatus. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.