Patent Publication Number: US-7713278-B2

Title: Method and instrument for effecting anastomosis of respective tissues defining two body lumens

Description:
RELATED APPLICATIONS 
   This application claims the benefit of the filing date(s) of one or more of U.S. provisional applications: METHODS AND DEVICE FOR ANASTOMOSIS, Ser. No. 60/569,195, filed May 7, 2004; METHODS AND DEVICE FOR ANASTOMOSIS, Ser. No. 60/582,302, filed Jun. 23, 2004, and METHOD AND INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. 60/639,836, filed Dec. 28, 2004. 
   This application relates to and incorporates by reference in their entirety, for any and all purposes, the following non-provisional applications, filed substantially contemporaneously herewith and having one or more inventors in common with the instant application: 
   INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   METHOD AND INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   METHOD AND INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   ANCHORS FOR USE IN ATTACHMENT OF BLADDER TISSUES TO PELVIC FLOOR TISSUES FOLLOWING A PROSTATECTOMY, Ser. No. (to be issued), filed Mar. 30, 2005; 
   INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   INSTRUMENT FOR EFFECTING ANASTOMOSIS OF RESPECTIVE TISSUES DEFINING TWO BODY LUMENS, Ser. No. (to be issued), filed Mar. 30, 2005; 
   DEVICE FOR ALTERNATELY HOLDING, OR EFFECTING RELATIVE LONGITUDINAL MOVEMENT, OF MEMBERS OF A MEDICAL INSTRUMENT, Ser. No. (to be issued), filed Mar. 30, 2005; and 

   FIELD OF THE INVENTION 
   The present invention relates generally to the anastomosis of two hollow organs, a hollow organ and a vessel or two vessels, and is particularly directed to a method and embodiments of a device that accomplish the same in a minimally invasive manner. More particularly, the present invention also relates to an anastomosis instrument and method that may be used for the anastomosis of the bladder and urethra, especially after a patient&#39;s prostate has been removed in a prostatectomy. 
   BACKGROUND OF THE INVENTION 
   Prostate cancer is the second most common malignancy in males after cutaneous malignancies and is the second most common cause of cancer death among men in the United States. Prostate cancer is predominantly a disease of elderly men, and the absolute number of cases is expected to increase as worldwide life expectancy increases. 
   The retropubic approach to prostatectomy as a treatment for prostate cancer was introduced by Millin in 1947. The operation had distinct advantages over perineal prostatectomy in that urologists were more familiar with retropubic anatomy. The retropubic approach to radical prostatectomy also offers the advantage of the ability to perform an extraperitoneal pelvic lymph node dissection for staging purposes. During the past decade, modification in the technique of radical retropubic prostatectomy and the introduction of the anatomic nerve-sparing method resulted in a dramatic decrease in the two morbidities associated with the operation that cause the most concern—incontinence and impotence. 
   In a radical retropubic prostatectomy, the surgeon removes all or most of the patient&#39;s prostate. Because the urethra travels through the prostate, the upper part of the urethra is removed in the surgery. In order to restore proper urinary functions, the bladder and the urethra must be reconnected. 
   Providing this connection is particularly difficult due to the limited working space and the small size of the urethra. The size of the urethra makes it difficult to accurately place the suture thread through the wall of the urethra. Heretofore, surgeons would execute painstaking suturing operations with tiny, fine needles to reconnect the bladder to the urethra. It has been found that the use of sutures for this purpose has caused certain problems in recovery. These problems include necrosis of the sutured tissues, stricture of the urethra that impedes the flow of fluid through it, and a urethra-bladder connection that is not fluid-tight. In addition, when suturing the urethra to the bladder the surgeon can possibly inadvertently pierce the nearby neurovascular bundle, which can cause incontinence or impotence. The suturing process itself has also been found to be cumbersome, requiring the surgeon to grasp and stretch the bladder and urethra together before making the fine sutures. Sutures may also tear the urethra, resulting in further complications. 
   With radical retropubic prostatectomies becoming more common, faster and simpler ways to reconnect the bladder and urethra are in demand. It would be further advantageous to provide a means for the anastomosis of the urethra and bladder that does not require the use of potentially damaging sutures. 
   Additionally, there are other surgical procedures requiring the connection of vessels, hollow organs and tissues defining other body lumens. While some of these structures are large, and more easily manipulated by the surgeon, tissue structures defining other body lumens are smaller and more difficult to manipulate and hold in position while joining ends thereof after, for example, a transectional operation. Accordingly, a faster and simpler way to connect vessels, hollow organs and other tissues defining body lumens would be advantageous. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention, and together with the description serve to explain the principles of the invention. In the drawings: 
       FIG. 1  is a partial, vertical sectional schematic depiction of the positional relationships of the human male bladder, prostate and urethra, and surrounding pelvic floor, prior to a prostatectomy; 
       FIG. 2  is a partial, vertical sectional schematic depiction of the positional relationships of the human male bladder and urethra, and surrounding pelvic floor, following a prostatectomy; 
       FIG. 3  is a perspective view of an anastomotic instrument having an actuator handle, a driver assembly and a positioner assembly in accordance with one embodiment of the present invention; 
       FIG. 4  is a longitudinal cross-sectional view of the actuator handle of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 5  is an expanded longitudinal cross-sectional view of the proximal end of the actuator handle of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 6  is an expanded longitudinal cross-sectional view of the distal end of the actuator handle of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 7  is a longitudinal cross-sectional view of the tube assembly, positioner assembly and driver assembly of the instrument shown in  FIG. 3 ; 
       FIG. 8  is an expanded longitudinal cross-sectional view of the bridge assembly portion of the tube assembly shown in  FIG. 7 ; 
       FIG. 9  is an expanded transverse cross-sectional view of the bridge assembly shown in  FIG. 8 ; 
       FIG. 10  is an expanded longitudinal cross-sectional view of the bridge assembly shown in  FIG. 8 ; 
       FIG. 11  is an expanded longitudinal cross-sectional view of a positioner assembly part of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 12  is a longitudinal cross-sectional view of the driver assembly part of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 13  is a perspective illustration of embodiments of the positioner and driver assemblies of the anastomotic instrument shown in  FIG. 3 ; 
       FIG. 14  is a perspective illustration of embodiments of the positioner and driver assemblies of the anastomotic instrument shown in  FIG. 3  with the positioner and driver assemblies shown in open positions; 
       FIG. 15  is a cross-sectional overhead view of the positioner and driver assemblies of the anastomotic instrument shown in  FIG. 14  showing the driver arms and positioner arms in open positions; 
       FIG. 16  is an expanded perspective view of the driver assembly of the anastomotic instrument shown in  FIG. 14 , showing driver arms, driver pins and anchors; 
       FIG. 17  is a longitudinal cross-sectional view of another embodiment of an anastomotic instrument in accordance with the present invention; 
       FIG. 18  is a transverse cross-sectional view of a driver assembly part of the anastomotic instrument shown in  FIG. 17 ; 
       FIG. 19  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 17 , with driver and positioner petal assemblies shown in opened positions; 
       FIG. 20  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 17 , showing positioner petals in contact with tissue and anchor driver pins and anchors partially deployed into tissues; 
       FIG. 21  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 17 , showing positioner petals in contact with tissues and anchor driver pins and anchors driven into tissues; 
       FIG. 22  is a longitudinal cross-sectional view of another alternate embodiment of an anastomotic instrument of the present invention; 
       FIG. 23  is a cross-sectional view of the driver assembly part of the anastomotic instrument shown in  FIG. 22 ; 
       FIG. 24  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 22 , with positioner petals shown in opened positions; 
       FIG. 25  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 22 , with positioner petals and a driver assembly shown in opened positions; 
       FIG. 26  is a longitudinal cross-sectional view of the anastomotic instrument shown in  FIG. 22 , showing positioner petals in contact with tissue and anchor driver pins and anchors driven into tissues; 
       FIG. 27  is an overhead view of the positioner assembly of the anastomotic instrument shown in  FIG. 24  with the driver assembly removed for purposes of illustration, showing the positioner petals in opened positions; 
       FIG. 28  is a perspective illustration of the alternate anastomotic instrument shown in  FIG. 17 , shown in a closed position; 
       FIG. 29  is a perspective illustration of the alternate anastomotic instrument shown in  FIG. 17 , shown in an opened position; 
       FIG. 30  is a perspective illustration of the alternate anastomotic instrument shown in  FIG. 22 , shown in an opened position; 
       FIG. 31  is an illustration of an anastomotic instrument fully inserted through a patient&#39;s urethra and into the bladder, following a prostatectomy; 
       FIG. 32  is an illustration showing an anastomotic instrument fully inserted through a patient&#39;s urethra and into the bladder following a prostatectomy, with driver and positioner assemblies opened; 
       FIG. 33  is an illustration showing an anastomotic instrument fully inserted through a patient&#39;s urethra and into the bladder following a prostatectomy, with a positioner assembly urging the bladder wall into contact with the pelvic floor with the openings in the bladder and urethra aligned; 
       FIG. 34  is an illustration showing an anastomotic instrument fully inserted through a patient&#39;s urethra and into the bladder following a prostatectomy, and with a driver assembly actuated and anchors driven through the bladder wall and into the pelvic floor; 
       FIG. 35  is an illustration showing an anastomotic instrument inserted through the urethra and into the bladder, with a driver assembly and driver pins retracted and withdrawn from anchors, which are left installed through the bladder wall and into the pelvic floor; 
       FIG. 36  is an illustration showing an anastomotic instrument fully inserted through a patient&#39;s urethra and into the bladder following a prostatectomy, with driver and positioner assemblies returned to initial retracted positions following installation of anchors; 
       FIG. 37  is an illustration showing the bladder and urethra after installation of anchors and removal of an anastomotic instrument used to effect such installation, and showing a guide wire left in place for guiding a catheter into the bladder through the urethra; 
       FIG. 38  is a schematic illustration showing the bladder and urethra after installation of anchors and removal of an anastomotic instrument used to effect such installation, and showing a balloon catheter system inserted into the bladder through the urethra and leading to a urine collection bag; 
       FIG. 39  is a perspective illustration of an embodiment of an anchor; 
       FIG. 40  is a perspective illustration of an alternate embodiment of an anchor; 
       FIG. 41  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 42  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 43  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 44  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 45  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 46  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 47  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 48  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 49  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 50  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 51  is a perspective illustration of an alternate embodiment of an anchor shaft and tip; 
       FIG. 52  is a schematic illustration of a driving button assembly shown in a cocked position; 
       FIG. 53  is a schematic illustration of a driving button assembly shown in a released position; 
       FIG. 54  is a schematic illustration of a driving button assembly shown in a forward seating position; 
       FIG. 55  is a perspective view of an embodiment of an antegrade vesico urethral anastomosis instrument in accordance with the present invention; 
       FIG. 56  is a partial view of the instrument shown in  FIG. 55 , including a curved tube assembly and anastomosis end effector, inserted into the bladder of a patient as used in accordance with the present invention; 
       FIG. 57  is a partial view of the instrument shown in  FIG. 55 , including an opened positioner assembly as used in accordance with the present invention; 
       FIG. 58  is a partial view of the instrument shown in  FIG. 55 , including an opened anchor assembly as used in accordance with the present invention; 
       FIG. 59  is a partial view of the instrument shown in  FIG. 55 , showing positioner arms urging the bladder wall into contact with the pelvic floor in accordance with the present invention; 
       FIG. 60  is a partial view of the instrument shown in  FIG. 55 , after anchors have been driven through the bladder wall into the pelvic floor in accordance with the present invention; 
       FIG. 61  is a partial view of the instrument shown in  FIG. 55 , following withdrawal of anchor driver pins from installed anchors in accordance with the present invention; 
       FIG. 62  is a partial view of the instrument shown in  FIG. 55 , after partial retraction of the instrument to unfold a harness in accordance with the present invention; 
       FIG. 63  is a partial view of the instrument shown in  FIG. 55 , following closing of an anchor assembly and positioner assembly in preparation for their withdrawal, to leave a balloon assembly and catheter behind in accordance with the present invention; 
       FIG. 64  is a partial view of the instrument shown in  FIG. 55 , after removal of a positioner assembly and anchor assembly, used in accordance with the present invention, has commenced; 
       FIG. 65  is a partial view of the instrument shown in  FIG. 55 , after removal of a positioner assembly and anchor assembly, and after inflation of a balloon secured with an anchored harness, used in accordance with the present invention; 
       FIG. 66  is a perspective view of a harness portion of the instrument shown in  FIG. 55 , as it may be secured to anchors via harness anchoring loops; 
       FIG. 67  is a longitudinal cross-sectional view of an embodiment of a balloon assembly that may be adapted for use in accordance with the present invention; 
       FIG. 68  is a transverse cross-sectional view of a catheter that may be used in accordance with the present invention; 
       FIG. 69  is a longitudinal cross-sectional view of one embodiment of a catheter cap and a urine collection bag that may be used in accordance with the present invention; 
       FIG. 70  is an exploded view of an embodiment of an end effector assembly of the instrument shown in  FIG. 55 ; 
       FIG. 71  is a longitudinal and perspective sectional, partial view of an embodiment of an end effector assembly of the instrument shown in  FIG. 55 , showing an open anchor assembly and partially open positioner assembly; 
       FIG. 72  is a longitudinal and perspective sectional view of a transitional tube portion of an anastomosis instrument such as shown in  FIG. 55 , showing exemplary linkages for actuator tubes; 
       FIG. 73  is a longitudinal cross-sectional view of a closing tube latching collar portion of the instrument shown in  FIG. 55 , in a closed position; 
       FIG. 74  is a longitudinal cross-sectional view of a closing tube latching collar portion of the instrument shown in  FIG. 55 , in an open position; 
       FIG. 75  is a side cross-sectional view of an embodiment of a handle assembly of the instrument shown in  FIG. 55 ; 
       FIG. 76  is an exploded perspective view of the handle assembly shown in  FIG. 75 ; 
       FIG. 77  is a sectional view of a positioner assembly and connected portions of the handle assembly shown in  FIG. 55 , showing the components involved in the operation of the positioner assembly; 
       FIG. 78  is a perspective view of a positioner assembly of the instrument shown in  FIG. 55 , shown partially open; 
       FIG. 79  is a sectional view of an anchor assembly and connected portions of the handle assembly shown in  FIG. 55 , showing the components involved in opening and closing the anchor assembly; 
       FIG. 80  is an exploded perspective view of a closing tube latching collar, and associated components, of the instrument shown in  FIG. 55 ; 
       FIG. 81  is a sectional view of an anchor assembly and connected portions of the handle assembly shown in  FIG. 55 , showing the components involved in driving anchors; 
       FIG. 82  is a sectional view of a curved spine tube and connected portions of the handle assembly shown in  FIG. 55 , showing a fixed, skeletal structure of the instrument; 
       FIG. 83  is a perspective view of the distal and proximal ends of another embodiment of an anastomotic instrument of the present invention, shown in a retracted, pre-deployment position, with the intermediate section removed for ease of depiction in the drawing; 
       FIG. 84  is a longitudinal cross section of the distal end of the instrument shown in  FIG. 83 , shown in a retracted, pre-deployment position; 
       FIG. 85  is a longitudinal cross section of an embodiment of a handle assembly adapted for use at the proximal end of an anastomotic instrument of the present invention; 
       FIG. 86  is a partial transverse cross section of the instrument shown in  FIG. 84 , indicated at  86 - 86  of  FIG. 84 , showing sectional views of an outer driver assembly tube, anchor driver pin, inner driver assembly tube, positioner tube, and anchor, loaded into the instrument in a pre-deployment position; 
       FIG. 87  is a side view of a forward member of an anchor that may be used with the instrument shown in  FIG. 83 , shown in a pre-deployment position as in contact with an anchor driver pin; 
       FIG. 88  is a longitudinal cross section of the instrument shown in  FIG. 83 , shown in a retracted, pre-deployment position after insertion into and through a patient&#39;s urethra and into the bladder, following a prostatectomy; 
       FIG. 89  is a longitudinal cross section of the instrument shown in  FIG. 83 , shown after insertion into and through a patient&#39;s urethra and into the bladder, and after a positioner has been moved to a deployed position; 
       FIG. 90  is a longitudinal cross section of an embodiment of the instrument shown in  FIG. 83 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, and after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned; 
       FIG. 91  is a longitudinal cross section of the instrument shown in  FIG. 83 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, and after actuation of an anchor driver assembly to drive anchors into the tissues of the pelvic floor and bladder wall, surrounding the aligned urethra opening and bladder opening; 
       FIG. 92  is a longitudinal cross section of the instrument shown in  FIG. 83 , shown after insertion into and through the urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after anchors have been installed, and after retraction of an anchor driver assembly has commenced, to leave a positioner and positioner tube behind to enable draining of urine from the bladder during recovery and healing; 
       FIG. 93  is a longitudinal cross section of another alternative embodiment of an anastomotic instrument of the present invention, shown after a positioner has been moved to a deployed position, comprising an alternative configuration of driver pins and an outer driver assembly tube; 
       FIG. 94  is a longitudinal cross section of another alternative embodiment of an anastomotic instrument of the present invention, shown after a positioner has been moved to a deployed position, comprising an alternative configuration of driver pins and an outer driver assembly tube, and showing an alternative pre-deployment orientation of rearward members and connecting members of anchors; 
       FIG. 95  is a perspective view of the distal and proximal ends of another embodiment of an anastomotic instrument in accordance with the present invention, shown in a retracted, pre-deployment position, with the intermediate section removed for ease of depiction in the drawing; 
       FIG. 96  is a longitudinal cross section of the distal end of the instrument shown in  FIG. 95 , shown in a retracted, pre-deployment position; 
       FIG. 97  is a partial transverse cross section of the instrument shown in  FIG. 96 , indicated at  97 - 97  of  FIG. 96 , showing sectional views of a second anchor guide collar, first anchor guide collar, positioner tube, and a first anchor and trailing suture, loaded into the instrument in pre-deployment positions; 
       FIG. 98  is a partial transverse cross section of the instrument shown in  FIG. 96 , indicated at  98 - 98  of  FIG. 96 , showing sectional views of an outer driver assembly tube, anchor guide collar, anchor driver pin, inner driver assembly tube, positioner tube, and second anchor and an end of a trailing suture, loaded into the instrument in pre-deployment positions; 
       FIG. 99  is an enlarged perspective view of an embodiment of a first anchor that may be used in the instrument shown in  FIG. 95 , shown in a deployed shape; 
       FIG. 100  is an enlarged frontal view of an embodiment of a second anchor that may be used in the instrument shown in  FIG. 95 , shown in a deployed shape; 
       FIG. 101  is an enlarged side view of the second anchor shown in  FIG. 100 ; 
       FIG. 102  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown in a retracted, pre-deployment position after insertion into and through a patient&#39;s urethra and into the bladder, following a prostatectomy; 
       FIG. 103  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, and after a positioner has been moved to a deployed position; 
       FIG. 104  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, and after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned; 
       FIG. 105  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, and after a first actuation of an anchor driver assembly to drive first anchors into the tissues of the bladder wall surrounding the bladder opening; 
       FIG. 106  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after a first actuation of an anchor driver assembly to drive first anchors into the tissues of the bladder wall surrounding the bladder opening, and after repositioning of anchor driver pins in preparation to drive second anchors; 
       FIG. 107  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after the positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after a first actuation of an anchor driver assembly to drive first anchors into the tissues of the bladder wall surrounding the bladder opening, and after a second actuation of an anchor assembly to drive second anchors into the tissues surrounding the urethra opening; 
       FIG. 108  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after anchor pairs and connecting sutures have been installed, and after retraction of an anchor driver assembly has commenced, to leave the positioner and a positioner tube behind to enable draining of urine and other fluids from the bladder during recovery and healing; 
       FIG. 109  is a longitudinal cross section of the instrument shown in  FIG. 95 , shown after retraction of an anchor driver assembly and after the anastomosis procedure has been completed, with a positioner in a retracted position ready for withdrawal of the remaining parts of the instrument from the bladder, down through the urethra and out of the patient&#39;s body; 
       FIG. 110  is a perspective view of another embodiment of the distal and proximal ends of an anastomotic instrument of the present invention, with the intermediate section removed for ease of depiction in the drawing; 
       FIG. 111  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown in a retracted and pre-deployment position after insertion into and through a patient&#39;s urethra and into the bladder, following a prostatectomy; 
       FIG. 112  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, and after a positioner has been moved to a deployed position; 
       FIG. 113  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through the urethra and into the bladder, after a positioner has been moved to a deployed position, and after an expander collar has been drawn into a fastener driver assembly to expand a fastener set; 
       FIG. 114  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after an expander collar has been drawn into a fastener driver assembly to expand a fastener set, and after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned; 
       FIG. 115  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, and after actuation of a fastener driver assembly has begun; 
       FIG. 116  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, and after a fastener driver assembly has been fully actuated to install a fastener set; 
       FIG. 117  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after a fastener driver assembly has been fully actuated to install a fastener set, and after an expander collar has been moved out of the fastener driver assembly to allow the fastener driver assembly to assume a smaller diameter which will allow it to be retracted through the installed fastener set; 
       FIG. 118  is a longitudinal cross section of the instrument shown in  FIG. 110 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, after a fastener set has been installed, and after a fastener driver assembly has been withdrawn from the patient to leave the positioner and a positioner tube behind to enable draining of urine and other fluids from the bladder during recovery and healing; 
       FIG. 119  is an enlarged perspective view of a fastener set that may be used with the instrument shown in  FIG. 110 , shown in the shape it may have prior to expansion and installation; 
       FIG. 120  is an enlarged perspective view of a fastener set that may be used with the instrument shown in  FIG. 110 , shown in the shape may have after expansion and installation; 
       FIG. 121  is an enlarged perspective view of an end cap of an actuator rod that may be used with the instrument shown in  FIG. 110 ; 
       FIG. 122  is a longitudinal cross section of another embodiment of an anastomotic instrument of the present invention, in a pre-deployment, retracted position; 
       FIG. 123  is a longitudinal cross section of the instrument shown in  FIG. 122 , shown after insertion into and through a patient&#39;s urethra and into the bladder, following a prostatectomy; 
       FIG. 124  is a longitudinal cross section of the instrument shown in  FIG. 122 , shown after insertion into and through a patient&#39;s urethra and into the bladder, and after a positioner has been moved to a deployed position; 
       FIG. 125  is a longitudinal cross section of the instrument shown in  FIG. 122 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, and after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned; 
       FIG. 126  is a longitudinal cross section of the instrument shown in  FIG. 122 , shown after insertion into and through a patient&#39;s urethra and into the bladder, after a positioner has been moved to a deployed position, after the bladder wall has been urged into contact with the pelvic floor with the openings in the bladder and urethra aligned, and after a lodging member has been moved to a deployed position; 
       FIG. 127  is an enlarged perspective view of an end cap of a positioner actuating rod, that may be used with the instrument shown in  FIG. 122 ; 
       FIG. 128  is a schematic view of the instrument shown in  FIG. 122 , shown inserted into a patient with a positioner in a deployed position, with the instrument connected at its proximal end to a urine collection bag; 
       FIG. 129  is a longitudinal cross section of another embodiment of the instrument of the present invention, configured for an antegrade anastomosis procedure, shown in a deployed position; 
       FIG. 130  is a longitudinal cross section of another embodiment of the instrument of the present invention, configured for an antegrade anastomosis procedure, shown in a deployed position; 
       FIG. 131  is a perspective view of an embodiment of a lodging member having perforations and projections; 
       FIG. 132  is a longitudinal cross section of the lodging member shown in  FIG. 131 ; 
       FIG. 133  is a longitudinal cross section of another embodiment of a lodging member having perforations and projections; 
       FIG. 134  is a perspective view of an anastomotic instrument having an actuator handle, a tube assembly and an end effector assembly in accordance with one embodiment of the present invention; 
       FIG. 135  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder opening; 
       FIG. 136  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, with a positioner assembly and an anchor driver assembly opened, and with the positioner assembly urging the bladder wall into contact with the pelvic floor; 
       FIG. 137  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, with a positioner assembly opened, and after a driver assembly has driven anchors through the bladder wall and into the pelvic floor; 
       FIG. 138  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, with a positioner assembly opened, after a driver assembly has driven anchors through the bladder wall and into the pelvic floor, and after driver pins have been withdrawn from the anchors; 
       FIG. 139  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, with a positioner assembly opened, after a driver assembly has driven anchors through the bladder wall and into the pelvic floor, after driver pins have been withdrawn from anchors driven into the pelvic floor, and after the driver assembly has been closed; 
       FIG. 140  is a longitudinal cross-sectional view of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, with a positioner assembly opened, after a driver assembly has driven anchors through the bladder wall and into the pelvic floor, after driver pins have been withdrawn from anchors driven into the pelvic floor, and after the driver assembly and positioner assembly have been closed; 
       FIG. 141  is a longitudinal cross-sectional view of components of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, after installation of anchors, and after positioner and anchor driver assemblies have been withdrawn to leave behind an end cap assembly, anchors installed through the bladder wall and into the pelvic floor, and a balloon harness attached therebetween; 
       FIG. 142  is a longitudinal cross-sectional view of components of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, after installation of anchors, after positioner and anchor driver assemblies have been withdrawn to leave behind an end cap assembly, anchors installed through the bladder wall and into the pelvic floor, and a balloon harness attached therebetween, and after insertion of a balloon catheter assembly; 
       FIG. 143  is a longitudinal cross-sectional view of components of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, after installation of anchors, after positioner and anchor driver assemblies have been withdrawn to leave behind an end cap assembly, anchors installed through the bladder wall and into the pelvic floor, and a balloon harness attached therebetween, after insertion of a balloon catheter assembly, and after inflation of a balloon; 
       FIG. 144  is a longitudinal cross-sectional view of components of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown inserted into and through a patient&#39;s urethra and into the bladder lumen, after installation of anchors, after positioner and anchor driver assemblies have been withdrawn to leave behind an end cap assembly, anchors installed through the bladder wall and into the pelvic floor, and a balloon harness attached therebetween, after insertion of a balloon catheter assembly, and after inflation of a balloon, shown one possible alternative embodiment; 
       FIG. 145  is a longitudinal cross-sectional view of components of an end effector assembly of an anastomotic instrument in accordance with one embodiment of the present invention, shown after the anastomosis procedure has been substantially completed, after withdrawal of a balloon catheter assembly, and in successive positions during withdrawal of an end cap assembly and balloon harness; 
       FIG. 146  is a perspective, exploded view of exemplary embodiments of an end cap assembly, balloon harness, and catheter end plug portion of a balloon catheter assembly; and 
       FIG. 147  is a transverse (horizontal), superior (top) partial planar view of the human male pelvis and pelvic floor architecture, depicting preferred locations for installation of anchors. 
   

   Reference will now be made in detail to various alternative embodiments of the method and instrument of the invention, and various alternative components thereof, illustrated in the accompanying drawings. 
   DETAILED DESCRIPTION OF THE INVENTION 
   Before the present method and embodiments of an instrument are disclosed and described, it is to be understood that this invention is not limited to the particular process steps and materials disclosed herein as such process steps and materials may vary somewhat. It is also to be understood that the terminology used herein is used for the purpose of describing particular embodiments only and is not intended to be limiting since the scope of the present invention will be limited only by the appended claims. 
   Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. Although any method, instrument and materials similar or equivalent to those described herein may be used in the practice or testing of the invention, particular embodiments of a method, instrument and materials are now described. 
   It must be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the content clearly dictates otherwise. 
   In describing and claiming the present invention, the following terminology will be used in accordance with the definitions set out below. 
   As used herein, the term “anastomosis” means the surgical joining of respective tissues defining body lumens and other hollow body structures, especially the joining of hollow vessels, passageways or organs to create an intercommunication between them. 
   The term “patient,” used herein, refers to any human or animal on which an anastomosis may be performed. 
   As used herein, the term “biocompatible” includes any material that is compatible with the living tissues and system(s) of a patient by not being substantially toxic or injurious and not causing immunological rejection. “Biocompatibility” includes the tendency of a material to be biocompatible. 
   As used herein, the term “bioabsorbable” includes the ability of a material to be dissolved and/or degraded, and absorbed, by the body. 
   As used herein, the term “shape memory” includes the tendency of a material, such as but not limited to a suitably prepared nickel-titanium alloy (“nitinol”), to return to a preformed shape, following deformation from such shape. 
   As used herein, the term “integral” means that two or more parts so described are affixed, fastened or joined together so as to move or function together as a substantially unitary part. “Integral” includes, but is not limited to, parts that are continuous in the sense that they are formed from the same continuous material, but also includes discontinuous parts that are joined, fastened or affixed together by any means so as become substantially immovably affixed to, and substantially unitary with, each other. 
   As used herein, the term “proximal” (or any form thereof), with respect to a component of an instrument, means that portion of the component that is generally nearest the surgeon, or nearest to the end of the instrument handled by the surgeon, when in use; and with respect to a direction of travel of a component of an instrument, means toward the end of the instrument generally nearest the surgeon, or handled by the surgeon, when in use. 
   As used herein, the term “distal” (or any form thereof), with respect to a component of an instrument, means that portion of the component that is generally farthest from the surgeon, or farthest from the end of the instrument handled by the surgeon, when in use; and with respect to a direction of travel of a component of an instrument, means away from the end of the instrument generally nearest the surgeon, or handled by the surgeon, when in use. 
   As used herein, the term “transverse” (or any form thereof), with respect to an axis, means extending in a line, plane or direction that is across such axis, i.e., not collinear or parallel therewith. “Transverse” as used herein is not to be limited to “perpendicular”. 
   As used herein, the term “longitudinal axis”, with respect to an instrument, means the exact or approximate central axis defined by said instrument along its greater dimension, i.e., along its length, from its distal end to its proximal end, and vice versa, and is not intended to be limited to imply a straight line, wherein, for example, an instrument includes a bend angle as described herein, it is intended that “longitudinal axis” as used herein follows such bend angle. Where used in association with an end effector, the term “longitudinal axis” means the exact or approximate central axis defined by said end effector extending along its greater dimension, i.e., along its length, from its distal end to its proximal end, and vice versa. 
   The method and instrument of the present invention utilizes a simple, effective mechanical arrangement for performing anastomosis of respective tissues defining two body lumens, for example, connecting the bladder to the urethra following a prostatectomy. By eliminating more painstaking, cumbersome suturing techniques, anastomosis techniques are improved. For use in the disclosed procedure, there are provided various embodiments of an improved instrument for bringing bladder wall tissues into contact with the pelvic floor tissues, with the openings in the bladder and urethra aligned, and for securing them in position so that they may knit and heal together. 
   By utilizing the disclosed techniques and an instrument of the present invention, the number of steps in the anastomosis procedure may be decreased, decreasing cost and reducing the required time for the procedure. The present invention may also eliminate complications associated with other anastomosis techniques that require hand suturing. 
   The present invention provides for a system that allows for, for example, connecting the bladder to the urethra using an instrument inserted through the urethra and into the bladder (in retrograde direction) without the need for access inside the bladder for manipulation and actuation of the instrument. Alternatively, the system and instrument may be configured such that it may be inserted into the bladder and then the urethra in an antegrade direction, through small incisions in the patient&#39;s abdomen and an upper surface of the bladder. Again, manipulation and actuation of the instrument may be performed by the surgeon from outside the patient&#39;s body. 
   Referring now to the drawings in detail, wherein like numerals indicate the same elements throughout the views,  FIG. 1  schematically illustrates in vertical cross section the positioning of a human male bladder  1 , bladder wall  2 , prostate  3 , pelvic floor  7  and urethra  5 , prior to a prostatectomy. In a radical prostatectomy, the prostate  3 , a lower portion of the bladder wall  2 , and an upper portion of the urethra  5  are excised, removing the fluid connection between the bladder lumen  8  and the remaining portion of the urethra. The substantially horizontal broken lines in  FIG. 1  schematically illustrate the lines along which the prostate and adjacent bladder and urethra tissues are excised. 
     FIG. 2  depicts an anatomical cross-section of the abdominal cavity following a radical prostatectomy wherein the excision of a portion of the bladder wall  2  results in a bladder opening  4  and the excision of the prostate results in a urethra opening  6  in urethra  5 . Following this surgery, bladder opening  4  is typically reduced in size by means known in the art, such as a “tennis racket” suture technique. 
   Rotationally-Opened Embodiment 
     FIGS. 3-16  show an embodiment of an instrument  10  which may be used to perform an anastomosis procedure, for example, a procedure to effect anastomosis of a patient&#39;s bladder and urethra following a prostatectomy. 
   As shown configured for use in a retrograde manner in  FIG. 3 , one embodiment of the anastomotic applier instrument  10  in accordance with the invention may comprise an elongated tube assembly  500 , a driver assembly  300  secured onto the distal end of the tube assembly  500 , an optional positioner assembly  400  which may be used to bring the bladder wall and the pelvic floor tissues into close proximity or contact, and an actuator handle  100  for effecting opening of the positioner and driver assemblies and the driving and seating of anchors. In general, the instrument may be used for performing a vesico-urethral anastomosis after the prostate has been removed in a radical retropubic prostatectomy (see  FIGS. 1 and 2 ). This connection is necessary to restore the patient&#39;s urinary functions after the prostatectomy. 
     FIG. 4  shows an embodiment of an actuator handle  100  of the anastomotic instrument shown in  FIG. 3 . Handle  100  is operatively connected to the proximal end of the elongated tube assembly  500 , which transmits manipulating and actuating forces from the handle  100  to the positioner assembly  400  and driver assembly  300  at the distal end of the tube assembly  500 . Two tubes, outer tube  510  and medial actuator tube  280 , exit handle  100  at its distal end. Outer tube  510  is affixed by any suitable means to and is substantially integral with handle housing  112 , and housing  112  and outer tube  510  are substantially stationary and skeletal with respect to the other, moving, parts of the handle  100  and tube assembly  500 . Medial actuator tube  280  both rotates and moves longitudinally with respect to outer tube  510 , in response to input from the surgeon as will be hereinafter described, and thereby transmits rotational and longitudinal actuating forces and movement through tube assembly  500 . 
   In the embodiment shown in  FIGS. 4-6 , the handle  100  may comprise a housing  112  having actuating mechanisms disposed therein as will be hereinafter described. The housing  112  may include two or more parts, having alignment pins  105  and mating holes to facilitate assembly and make the parts integral after assembly. 
   Housing  112  contains actuating mechanisms to effect rotational and longitudinal actuating forces and movement in medial actuator tube  280 . Referring to  FIG. 5 , knob  110  may be an actuating member for manipulation by a surgeon, and may be adapted to be pushed distally by the surgeon, and urged back proximally by knob return spring  150 , with respect to housing  112 . Knob  110  may also be adapted to be rotated by the surgeon with respect to housing  112  by the surgeon. Thus, knob  110  may be rotatable and movable longitudinally within housing  112 , within the limits of longitudinal travel defined by knob track  116  in housing  112 , as the ends thereof stop longitudinal movement of knob  110  by contact with knob rim  111 . Knob  110  may also be hollow, having guidewire passage  114  therethrough. Within guidewire passage  114  of knob  110  may be one or more longitudinal spline grooves  115 . Spline grooves  115  can slidably mate with one or more splines  185  of proximal rotation tube  180 . Thus, it can be appreciated that knob  110  and proximal rotation tube  180  may be coupled with respect to rotational movement, but not coupled with respect to longitudinal movement and therefore, be longitudinally slidable with respect to one another. Thus configured, rotation of knob  110  can effect corresponding rotation of proximal rotation tube  180 . In turn, proximal rotation tube  180  may be fixedly coupled to medial actuator tube  280 . Thus, rotation of knob  110  can effect corresponding rotation of medial actuator tube  280 , while longitudinal movement of knob  110  will not effect longitudinal movement of medial actuator tube  280 . 
   Prior to the firing of the handle assembly as will be described below, knob  110  may be turned to effect corresponding rotational movement in medial actuator tube  280 , so as to open driver assembly  300  and positioner assembly  400  as will be described below. 
     FIGS. 5 and 6 , depict handle  100  in an uncocked, pre-deployment position. As will be hereinafter described, one embodiment of an anchor driver assembly of the present invention (such as that shown in  FIG. 3  at  300 ) requires longitudinal force and movement of a member in a proximal direction in order to drive anchors. This force and movement in a proximal direction may be effected by handle  100  via medial actuator tube  280 . Medial actuator tube  280  may be drawn in a longitudinally proximal direction, i.e., rearwardly, into handle  100 , through a mechanism that will now be described. 
   A driving spring  160  may be contained within housing  112 , in compression, as shown in  FIGS. 5 and 6 . The proximal end of driving spring  160  contacts and acts against the distal end of a proximal linking tube  140 , urging linking tube  140  to move in a proximal direction with respect to housing  112 . The proximal end of linking tube  140  rotatably and slidably fits around an interior spindle  117  of knob  110  and rests against spindle shoulder  118 . 
   In the position shown in  FIGS. 5 and 6 , driving tube  120  is in a forward, distal position inside housing  112 . Driving tube  120  is connected at its distal end to proximal rotation tube  180  via lip  123 , such that proximal rotation tube  180  is free to rotate within driving tube  120 , but by the arrangement shown, driving tube  120  and proximal rotation tube  180  are configured to be linked and move as a unit in a longitudinal direction. Driving tube  120  may be prevented from rotating so as not to interfere with actuation of driving button pawl  205 , by one or more pins  128  affixed in housing  112 , engaged in driving tube pin slot  129 . At the top of  FIG. 6 , it can be seen that driving button  202  may be integral with driving button pawl  205 , and driving button  202  and correspondingly driving button pawl  205  are biased in a counterclockwise direction by spring  235 , such that pawl  205  is biased downward into driving tube firing slot  210 . 
   In order the ready the handle depicted in  FIGS. 5 and 6  to effect a longitudinal proximal movement of medial actuator tube  280  (which movement may be used to drive anchors as will be hereinafter described), a surgeon may depress knob  110  in a longitudinal, distal direction within housing  112  (to the right with respect to  FIG. 5 ). As a result of contact between shoulder  118  and the proximal end of linking tube  140 , this movement of knob  112  can move linking tube  140  a corresponding direction and distance, and also correspondingly, longitudinally compress and thereby charge driving spring  160 . Linking tube  140  has affixed at its proximal end one or more driving tube engagers  170 , which may be spring-biased inwardly and have latching ends  171  that protrude inwardly through slots in linking tube  140  as shown. Upon longitudinal movement of linking tube  140  in a distal direction as a result of depressing knob  110 , latching ends  171  can moveably engage and latch upon latching shoulder  126  of driving tube  120 , latching driving tube  120  to linking tube  140  such that the two will move as a unit in a rearward, proximal longitudinal direction, in response to force exerted on linking tube  140  by driving spring  160 , once driving tube  120  is released as will be described below. Thus, when a surgeon depresses knob  110  in a distal longitudinal direction (to the right with respect to  FIG. 5 , driving spring  160  is charged and the handle is thereby cocked for driving anchors as will be hereinafter described. After cocking, knob  110  is urged to return to its proximal (rearward) position by knob return spring  150 . Knob return spring  150  and driving spring  160  may be coaxially aligned and separated by a spring divider  130 . 
   Driving tube  120  is released and permitted to be driven in a longitudinal proximal (rearward) direction with respect to housing  112  when the surgeon engages and urges driving button  202  forwardly (with respect to  FIG. 6 ). This rotates driving button  202  and correspondingly, pawl  205  clockwise about pin  230 , and lifts pawl  205  out of driving tube firing slot  210 . Driving tube  120  is thereby released to be driven rearwardly (to the left with respect to  FIGS. 5 and 6 ) under the force exerted by driving spring  160 , acting on linking tube  140 , linked to driving tube  120  via driving tube engagers  170 . As driving tube  120  is driven rearwardly, it correspondingly pulls medial actuator tube  280  rearwardly a corresponding distance, via lip  123 . This actuation constitutes “firing” the handle  100  to pull medial actuator tube  280  in a longitudinal proximal (rearward) direction into handle  100 , which may be used to drive anchors as will be described below. 
   After “firing” of handle  100 , it may be desirable to effect additional longitudinal movement of medial actuator tube  280  so as to cause further seating of anchors, and afterward, to effect withdrawal of anchor driver pins from anchors as will be described below. Referring to  FIG. 6 , after firing, driving tube retraction slot  225  in driving tube  120  is moved to a position beneath driving button pawl  205 , and pawl  205 , at the urging of torsion spring  235  and/or pressure by the surgeon, moves into retraction slot  225 . The surgeon may then exert proximal and downward pressure (with respect to  FIG. 6 ) on driving button  202 , which will both maintain pawl  205  in retraction slot  225 , and also urge pin  230  down and out of rocker detent  238  in driving button slot  240 , enabling the surgeon to urge driving tube  120  further proximally and thus further drive anchors a distance allowed by seating extension  220  in driving button slot  240 , and/or further seat anchors into tissues, as will be described below. This arrangement may also transfer to the surgeon touch-perceptible feedback through driving button  202  as to how much pressure is being exerted to drive and seat anchors. 
   After driving and seating of anchors, the surgeon may then effect the withdrawal of anchor driver pins from anchors (as will be described below) by effecting a return of medial actuator tube to its original position as will now be described. The surgeon exerts downward and distally-directed pressure on driving button  202 . Such downward pressure maintains pawl  205  in retraction slot  225  and keeps pin  230  out of rocker detent  238 , while urging driving tube  120  distally (to the right with respect to  FIG. 6 ). As driving tube  120  is urged distally, medial actuator tube  280  is urged distally a corresponding distance via driving tube lip  123  acting on proximal actuator tube  180 , which is affixed to medial actuator tube  280 . This returning motion is limited by the distal extent of driving button slot  240 . When pin  230  reaches this extent, the surgeon&#39;s release of pressure on driving button  202  will permit pin  230  to be urged upwardly (with respect to  FIG. 6 ) under the force exerted by torsion spring  235  into extension detent  245 . 
   Following installation of anchors, knob  110  may be turned to effect corresponding rotational movement in medial actuator tube  280  so as to retract or close driver assembly  300  and positioner assembly  400  as will be described below. 
   It is contemplated that various pieces of the handle assembly may be an integral structure formed from several components, or these features may be an integrally molded from a material such as plastic so as to form a single integral structure. The handle assembly may be constructed from conventional materials for surgical instruments, for example a metal such as stainless steel or plastic. The instrument may be constructed primarily from conventional metal or plastic materials so that it is inexpensive to manufacture and can be disposable. The instrument may also be sold in a package that is presterilized for surgical use. 
   Housing  112 , driving button  202 , spring divider  130  and knob  110  may be formed of plastic or any suitable material having necessary properties of strength, stiffness and formability. It may be desirable for spline grooves  115  to be a suitable metal for improved hardness and wear resistance, such that spline grooves  115  would be part of a metal insert around which knob  110  is formed. Proximal actuator tube  180 , linking tube  140  and driving tube engagers  170 , driving tube  120 , medial actuator tube  280  and outer tube  510  may be formed of stainless steel, plastic or any other suitable material having necessary properties of strength, hardness and stiffness. Springs  150 ,  160  and  235  may be formed of spring steel or any suitable material that would have suitable formability, shape memory, stiffness (spring constant) and strength properties. While proximal actuator tube  180 , linking tube  140 , driving tube  120 , medial actuator tube  280  and outer tube  510  are depicted as having tube shapes, they may also have any shape suitable for transmitting longitudinal and rotational forces and movement to a distal end as required for an instrument of the present invention. 
   It will be apparent to persons skilled in the art that a variety of mechanisms might be configured and adapted to transmit longitudinal (advancement and retraction) and rotational forces and movement move from a proximal handle assembly to a distal end in order to effect the forces and movement necessary to actuate an instrument of the present invention. It will be apparent to persons skilled in the art that the mechanism that supplies the driving force supplied by driving spring  160  may also be other biasing or driving devices including but not limited to levers, gears, pressurized gases/fluids and any other mechanisms for selectively deploying linear driving forces known in the art. 
   An alternative embodiment for the driving button assembly shown in  FIG. 6  will now be described. Referring to  FIGS. 52-54 , driving button  202  is linked to the mechanism by driving button pin  230 , captured by driving button pin boss  206 . Driving button  202  includes driving button pawl  205 , driving pin boss  206 , driving trigger  204  and retraction member  207 . Driving button  202  is angularly movable about driving button pin  230  which is captured by driving pin boss  206 , and driving button pin  230  may slidably ride in a longitudinal direction with respect to the length of the instrument, in driving button groove  240 , which includes rocker detent  238 . One or more springs  235  are provided which act upon driving button  202  in two ways: First, to urge driving button  202  upward such that driving button pin  230  is urged upward, in orientation with respect to  FIGS. 52-54 , and such that driving pin  230  is urged into rocker detent  238 , when driving trigger  204  is not being depressed; second, to urge driving button  202  in a counterclockwise direction, such that driving trigger  204  and driving button pawl  205  are urged in a counterclockwise direction, about driving button pin  230 , with respect to  FIGS. 52-54 , thus maintaining driving button pawl  205  engaged with driving tube retention slot  210 . It will be appreciated that a single torsion spring configured and acting upon driving button  202  in a manner such as shown in  FIG. 6  (torsion spring  235 ) may be used to accomplish the desired result, but also, that other suitable spring or biasing mechanisms or configurations are possible. Driving button pawl  205  is adapted to engage, alternatively, driving tube retention slot  210 , and driving tube retraction slot  225 , of driving tube  120 , in a manner similar to that shown for the driving button pawl  205  in  FIG. 6 . 
   Operation of the embodiment of driving button assembly shown in  FIGS. 52-54  will now be described. When an instrument such as driver assembly  300  ( FIG. 3 ) has been loaded with anchors and is in the retracted position ready for insertion and subsequent use, driving button assembly  200  will be in the position shown in  FIG. 52 . Driving button  202  is biased upwardly and in a counterclockwise direction about driving button pin  230  by one or more springs  235  so that driving button pin  230  is maintained engaged in rocker detent  238 , and driving button pawl  205  is maintained engaged in driving tube retention slot  210 , restraining driving tube  120  against spring bias acting upon driving tube  120  as more fully described above. 
   Once the applier has been inserted and opened to the position shown in  FIG. 14 , the driving tube  120  is released and driven by depressing driving trigger  204 .  FIG. 53  depicts a “snapshot” of the positioning of driving button  202  relative to driving tube  120 , after driving trigger  204  is depressed to release driving tube  120  by disengaging driving button pawl from driving tube retention slot. With respect to  FIG. 53 , it can be seen that downward pressure on driving trigger  204  causes clockwise rotation of driving button  202  about driving button pin  230 , causing driving button pawl  205  to move upwardly and disengage from driving tube retention slot  210 . Disengagement of driving button pawl  205  from driving tube retention slot  210  releases driving tube  120 , permitting it to move to the left (with respect to  FIGS. 52-54 ) under urging of a spring as more fully described above. This drives driver pins and anchors as more fully described below. 
     FIG. 54  illustrates the positioning of driving button  202  relative to driving tube  120 , when the mechanism is ready for retraction of the driver pins from the installed anchors. It will be appreciated from  FIGS. 53 and 54  that continuing downward pressure exerted by the surgeon on driving trigger  204  urges driving button pawl  205  downward into driving tube retraction slot  225 . At the same time, driving button pin boss  206  is urged downward, and correspondingly, driving button pin  230  is urged downward and out of rocker detent  238 . When driving button  202  is in this position, shown in  FIG. 54 , the surgeon may then engage retraction member  207  to move driving button  202  to the right (with respect to  FIG. 54 ), which correspondingly pulls driving tube  120  to the right by engagement of driving button pawl  205  with driving tube retraction slot  225 . In this manner, the driver pins may be withdrawn from the now-installed anchors as more fully described below. 
   Referring back to FIGS.  3  and  7 - 9 , it may be desirable that tube assembly  500  be curved and flexible to facilitate insertion into the patient. Accordingly, it may be desirable to manufacture certain components of tube assembly  500 , including outer tube  510 , medial actuator tube  280 , distal rotation tube  580  and central tube  590 , of materials that have suitable combined properties of biocompatibility, strength, stiffness, flexibility, elasticity and shape memory so as to provide a suitable balance of flexibility to facilitate insertion, with strength, rigidity and shape memory to facilitate manipulation to transfer longitudinal and rotational forces from the handle assembly  100  to the positioner assembly  400  and driver assembly  300 . The inventors have found that suitably treated nitinol, known in the art for having such properties and used for endoscopic surgical instruments with similar requirements, is a suitable material. However, other materials such as styrene or other polymers may be satisfactory for some components. 
     FIGS. 7-10  are views of the portion of tube assembly including a bridge assembly  600 . The tube assembly and bridge assembly provide for isolation and transmission of rotational and longitudinal advancement and retraction force and movement from medial actuator tube  280  to a positioner assembly  400  and driver assembly  300 . In one embodiment, medial actuator tube  280  may rotate, and longitudinally advance and retract within and with respect to outer tube  510 , and is operatively connected to a positioner assembly  400  and a driver assembly  300 , via a bridge assembly  600 . The bridge assembly  600  provides an operative connection of the medial actuator tube  280  so as to limit rotational movement, and transmit both limited rotational movement and longitudinal movement to distal rotation tube  580 , and is adapted to allow an effective amount of rotational and longitudinal travel. The bridge assembly  600  also provides an operative connection of the medial actuator tube  280  to central tube  590  so as to translate longitudinal movement to central tube  590 . 
   Referring to  FIGS. 9 and 10 , medial actuator tube  280  has therein one or more bridge slots  640 , and terminates within bridge assembly  600 . Bridge  610  has a hub  650  located within medial actuator tube  280 , and one or more vanes  620 , which protrude through bridge slots  640  in medial actuator tube  280 , and longitudinally ride within one or more longitudinal bridge tracks  670  cut or formed within a bridge guide  660 . Bridge guide  660  is affixed within, and therefore integral with, outer tube  510 . Thus, vanes  620  and therefore bridge  610  may slide longitudinally within bridge guide  660  and outer tube  510 , but are prevented from rotating. 
   It can be appreciated from  FIGS. 9 and 10  that the range of rotation of medial actuator tube  280  with respect to outer tube  510  is limited by the circumferential dimension of bridge slots  640  in medial actuator tube  280 , and contact between the edges of bridge slots  640  and vanes  620 . The circumferential dimension of bridge slots  640  in actuator tube  280  may be varied according to the range of rotation that may be required to actuate the instrument. Longitudinal bridge tracks  670  may be long enough to allow vanes  620  to slide longitudinally to the full range of longitudinal motion of medial rotation tube  280  that may be required to actuate the instrument. 
   Central tube  590  is affixed within bridge hub  650  and is integral therewith. Thus, longitudinal motion is translated from medial actuator tube  280  to bridge vanes  620  and correspondingly bridge hub  650  via interaction between bridge slots  640  and bridge vanes  620 . Correspondingly, longitudinal motion of bridge hub  650  is translated to central tube  590  because bridge hub  650  and central tube  590  are integral. Thus, longitudinal motion of medial actuator tube  280  is translated to corresponding longitudinal motion of central tube  590 . 
   At the same time, rotational motion of medial actuator tube  280  is not translated to central tube  590 . As noted, central tube  590  is integral with bridge hub  650 , and bridge hub  650  is prevented from rotating by the situation of bridge vanes  620  in bridge tracks  670 , which are, in turn, integral with outer tube  510 . 
   Referring to  FIG. 10 , distal rotation tube  580  is affixed and integral with rotation spacer  288 , which, in turn, is affixed and integral with the distal end of medial actuator tube  280 . Thus, both longitudinal movement and rotation of medial actuator tube  280  are translated directly to corresponding longitudinal movement and rotation of distal rotation tube  580 . As previously noted, however, the range of rotational movement of medial actuator tube  280  is limited by the circumferential dimension of bridge slots  640 , and thus, the range of rotational movement of distal rotation tube  580  is correspondingly limited. 
   Central tube  590  and distal rotation tube  580  are not affixed to one another and therefore distal rotation tube  580  may rotate with respect to central tube  590 . 
   A funnel guide  606  may be affixed to the proximal end  608  of central tube  590 , thereby providing for ease of feeding a guide wire upward through medial actuator tube  280  and into central tube  590 . Funnel guide  606  would not be affixed to medial actuator tube  280 , and would be longitudinally and rotationally movable therein. 
   Distal rotation tube  580  and central tube  590  may be located within and supported through a bend in the tube assembly by rotation tube stabilizer  530 , a proximal end of which appears at the right of  FIGS. 8 and 10 , and the entirety of which appears in  FIG. 7 . 
   Referring now to  FIG. 11-16 , the tube assembly is operably coupled with positioner assembly  400 . A proximal positioner mount  410  is affixed and integral with outer tube  510 . Distal positioner mount  440  is affixed and made integral with proximal positioner mount  410  by positioner mount connector members  412 . Thus, proximal positioner mount  410  and distal positioner mount  440 , as made integral with outer tube  510 , provide a stationary reference and mounting point for moving parts which will now be described. 
   Referring to  FIGS. 11 and 12 , as noted and described above, central tube  590  may move longitudinally, but may not rotate, with respect to outer tube  510 , and thus, may move longitudinally, but may not rotate, with respect to proximal positioner mount  410  and distal positioner mount  440 . Central tube  590  is affixed and integral at its distal end with distal end cap  390 . Distal driver mount  340  is affixed and integral with tabs  392  of distal end cap  390 . Proximal driver mount  310  is affixed and made integral with distal driver mount  340  via driver mount connector members  314 . Thus, distal end cap  390 , distal positioner mount  340 , driver mount connector members  314  and proximal driver mount  310  and central tube  590  are integral and move longitudinally as a unit with respect to outer tube  510 , but may not rotate with respect to outer tube  510 . 
   It can be seen from  FIGS. 3-14  that guidewire passage  114  leads through the center of handle assembly  1100 , through tube assembly  500  (and within medial actuator tube  280 ), through central tube  590 , through positioner assembly  400  and driver assembly  300  and out distal end cap  390 . 
   As noted and described above, distal rotation tube  580  may rotate about central tube  590 , in direct correspondence with rotation of medial actuator tube  280 , within a range limited by the circumferential dimension of bridge slots  640  in medial actuator tube  280  (see  FIGS. 9 and 10 ). Within driver assembly  300 , distal rotation tube  580  terminates and is integrally affixed to distal rotation tube collar  394  and gear tube  380 . Thus, rotation of distal rotation tube  580  causes directly corresponding rotation of gear tube  380 . In  FIGS. 11 and 12 , it can be seen that gear tube  380  resides directly outside distal rotation tube  580  and extends proximally from distal driver mount  340  to proximal positioner mount  410 . In  FIG. 11 , it can be seen that clearance within rotation tube stabilizer  530  is present to permit proximal longitudinal movement of gear tube  380  thereinto. 
   Referring again to  FIG. 12 , and also  FIG. 14 , it can be seen that distal driver gear  360  and proximal driver gear  320  reside within driver assembly  300 . Distal driver gear  360  and proximal driver gear  320  are coaxial and integrally affixed to gear tube  380 . Arcuate slots  361  in distal driver gear  360  and arcuate slots  321  in proximal driver gear  320  accommodate passage of driver mount connector members  314  therethrough and also permit distal driver gear  360  and proximal driver gear  320  to rotate within a limit about the axis of gear tube  380  without interference from driver mount connector members  314 . 
   Referring to  FIG. 11 , distal positioner gear  460  and proximal positioner gear  420  reside within positioner assembly  400 . Distal positioner gear  460  and proximal positioner gear  420  are coaxial with, and longitudinally splined with, gear tube  380 , such that distal positioner gear  460  and proximal positioner gear  420  are coupled with gear tube  380  with respect to rotation, but uncoupled with respect to relative longitudinal motion. Thus, gear tube  380  may move longitudinally within positioner assembly  400 , without effecting corresponding longitudinal movement of positioner assembly  400  or any parts thereof. Arcuate slots  461  in distal driver gear  460  and arcuate slots  421  in proximal driver gear  420  accommodate passage of driver mount connector members  412  therethrough and also permit distal positioner gear  460  and proximal positioner gear  420  to rotate within a limit about the axis of gear tube  380  without interference from positioner mount connector members  412 . 
   Thus, it can be appreciated from the description above that rotating medial actuator tube  280  correspondingly rotates distal rotation tube  580  and gear tube  380 , and finally, distal driver gear  360 , proximal driver gear  320 , distal positioner gear  460  and proximal positioner gear  420 . It also may be seen that longitudinal movement of central tube  590  with respect to outer tube  510  causes corresponding longitudinal movement of driver assembly  300  with respect to outer tube  510 , but not longitudinal movement of positioner assembly  400  with respect to outer tube  510 . 
   Referring now to  FIGS. 11 ,  13  and  14 , distal positioner pinions  462  are integral with and may rotate about pinion shafts (not shown) which are rotatably supported in distal positioner mount  440 . Distal positioner pinions  462  mesh with distal positioner gear  460 , and may be driven thereby. Distal positioner pinions  462  are also integral with distal positioner arms  470 . Similarly, proximal positioner pinions  422  are integral with and may rotate about pinion shafts (not shown) which are rotatably supported in proximal positioner mount  410 . Proximal positioner pinions  422  mesh with proximal positioner gear  420 , and may be driven thereby. Proximal positioner pinions  422  are also integral with proximal positioner arms  430 . 
   Thus, referring to  FIGS. 11 ,  13  and  14 , it can be seen that rotation of distal rotation tube  580  correspondingly rotates gear tube  380 , and thus, distal and proximal positioner gears  460  and  420 , which, in turn, drive distal and proximal positioner pinions  462  and  422 , causing positioner arms  470  and  430  to either swing outwardly (toward a position shown in  FIG. 14 ) or inwardly (toward a position shown in  FIG. 13 ). It will be appreciated that the position shown in  FIG. 13  is the position in which positioner assembly  400  would be placed during insertion into and retraction from a patient. It will be further appreciated that the position shown in  FIG. 14  is the position in which positioner assembly  400  is ready for use for bringing the bladder wall surrounding the bladder opening into contact with the pelvic floor, as will be further described below. Finally, it will be appreciated from the description set forth above (and referring also to  FIGS. 8-10 ), that the limits of the rotational motion of gear tube  380  required, alternately, to extend or retract arms  470  and  430  of positioner assembly  400 , are defined by the circumferential dimension of bridge slots  640  in medial rotation tube  280  and their interaction with bridge vanes  620 . 
   Referring now to  FIGS. 12-16 , distal driver pinions  362  are integral with pinion shafts  316 , which are rotatably supported in distal driver mount  340 . Distal driver pinions  362  mesh with distal driver gear  360 , and may be driven thereby. Distal driver pinions  362  are also integral with distal driver arms  370 , which, in turn, are integral with driver pins  376 . Similarly, proximal driver pinions  322  are integral with pinion shafts  316 , which are rotatably supported in proximal driver mount  310 . Proximal driver pinions  322  mesh with proximal driver gear  320 , and may be driven thereby. Proximal driver pinions  322  are also integral with proximal driver arms  330 , which, in turn, are integral with additional driver pins  376 . 
   Thus, referring to  FIGS. 12-16 , it can be seen that rotation of distal rotation tube  580  correspondingly rotates gear tube  380 , and thus, distal and proximal driver gears  360  and  320 , which, in turn, drive distal and proximal driver pinions  362  and  322 , causing driver arms  370  and  330  to either swing outwardly (toward a position shown in  FIG. 14 ) or inwardly (toward a position shown in  FIG. 13 ). It will be appreciated that the position shown in  FIG. 13  is the position in which driver assembly  300  would be placed during insertion into and retraction from a patient. It will be further appreciated that the position shown in  FIG. 14  is the position in which driver assembly  300  is ready for driving anchors, as will be further described below. Finally, from the description set forth above (and referring also to  FIGS. 8-10 ), it will be appreciated that the limits of the rotational motion of gear tube  380  required, alternately, to extend or to retract arms  370  and  330  of driver assembly  300 , are defined by the circumferential dimension of bridge slots  640  in medial rotation tube  280  and their interaction with bridge vanes  620 . 
   Referring to  FIG. 14 , one or more driver pins  376  are affixed to driver arms  330  and  370 . Each of the one or more driver pins  376  are adapted to retain anchors  700  having anchor heads  710 , for example, by friction fit or other suitable means. Anchors  700  may have hollow bores within, opening at their heads  710 , and extending substantially within their lengths, and driver pins  376  may extend within such bores substantially the entire lengths thereof, so that the distal ends of driver pins  376  drive anchors  700  at their forward ends, so as to prevent anchors  700  from buckling or veering off-direction as they might otherwise do if driven at their rearward ends proximate to heads  710 . 
   Still referring to  FIGS. 10-14 , longitudinal force and movement may be translated to the driver arms  370  to, alternately, drive anchors  700  into tissues, and withdraw driver pins  376  from anchors  700  after they are installed into tissues, as follows. As previously noted and described, longitudinal force and movement is translated directly from medial actuator tube  280  to central tube  590  via bridge assembly  600 . As noted, central tube  590  is integral with distal end cap  390 , distal driver mount  340 , driver mount connector member  314  and proximal driver mount  310 . Because driver arms  330  and  370  are operably mounted within driver mounts  310  and  340 , longitudinal force and movement exerted via medial actuator tube  280 , translated to central tube  590 , is also translated directly to longitudinal force and movement of driver arms  330  and  370  (and entire driver assembly  300 ), and thus to driver pins  376  and anchors  700 . As can be appreciated from the description above, gear tube  380  will be moved longitudinally in correspondence with longitudinal movement of central tube  590  and driver assembly  300 . As noted, gear tube  380  is permitted to longitudinally move relative to and through positioner assembly  400  by means of longitudinal splines coupling gear tube  380  with proximal and distal positioner gears  420  and  460 , without effecting corresponding longitudinal movement thereto. 
   It will be appreciated that sufficient proximal longitudinal movement should be provided and translated to driver arms  330  and  370  and driver pins  376  by the mechanism described above so as to carry and drive anchors  700  past positioner assembly  400  and into the target tissues. The advancement/retraction longitudinal travel distance of the driver assembly  300  can be generally greater than the length of the anchors  700  in order to move the anchors past the positioner and fully seat the anchors into the target tissues. In the embodiment shown and described thus far, the position of the anchors when installed in the tissues may be substantially parallel with the longitudinal axis of the driver assembly  300 , but the position of the anchors may also be at an angle therewith. Additionally, in the embodiment shown and described thus far, the anchors may enter the target tissues substantially perpendicular with them, as they are held by positioner assembly  400 . 
   It is also contemplated that various integral components of the positioner and driver assemblies described above may be formed, molded or machined as a unitary, continuous structure. For example, driver arms  330  and  370  may be unitary and continuous with driver pins  376 , rather than be assembled pieces. 
   Referring now to FIGS.  3  and  31 - 38 , a surgeon may use the embodiment just described in a retrograde direction in the following manner. The driver assembly  300  may be loaded with one or more anchors  700 , as may be required, prior to use. The instrument may then be inserted into the urethra and advanced in a retrograde direction until the distal end of the instrument  10  is through the urethra  5  ( FIG. 31 ), through the bladder opening  4 , and the driver assembly  300  and positioner assembly  400  are inside the bladder lumen  8 . 
   After insertion into the bladder  1 , instrument  10  may be initially actuated by rotating knob  110  to open the positioner and driver assemblies to the initial deployment position as shown in  FIG. 32  (see also  FIG. 14 ). The entire instrument may then be retracted by pulling handle  100  in a proximal direction downwardly through the urethra  5 , bringing the opened positioner assembly into contact with the bladder wall  2  surrounding the bladder opening  4 , and urging bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6 , with the respective openings  4  and  6  aligned, as shown in  FIG. 33 . Once in position, the instrument may then be prepared for further actuation by cocking the handle mechanism by depressing knob  110  as described above. Next, it may be further actuated to drive anchors  700  by depressing driving button  202 , which will actuate the mechanism in handle assembly  100  previously described so as to pull driver assembly  300  in a proximal direction with respect to positioner assembly  400 , driving anchors  700  into and through the bladder wall  2  and into the underlying pelvic floor  7 , in positions surrounding the aligned openings  4  and  6 , to positions shown in  FIG. 34 . As noted above, using driving button  202 , the surgeon may then desire to further actuate the handle assembly  100  to further seat anchors  700  into the tissues. Next, still using driving button  202  as described above, the surgeon may push driver assembly  300  in a distal direction, withdrawing driver pins  376  from the installed anchors  700 , to the position shown in  FIG. 35 . Finally, knob  110  may be rotated again to re-close driver assembly  300  and positioner assembly  400  to the position shown in  FIG. 36 . In the closed position, the instrument  10  can then be withdrawn back out of the urethra  5 . Optionally, prior to withdrawal of the instrument from the urethra, a guide wire  80  may be inserted through the instrument (via a guide wire passage) and into the bladder lumen, and left behind for use described below after withdrawal of the instrument, see  FIGS. 36 and 37 . 
   Referring to  FIG. 38 , guide wire  80  may then be used to guide a balloon catheter system  90  into the bladder lumen  8 . As shown in  FIG. 38 , one embodiment provides for a balloon catheter system  90  wherein a balloon  94  is expanded to hold the catheter in place. Drainage holes  92  allow urine to drain from the bladder  1  through a catheter tube  96  into a urine collection bag  98 . 
   In another embodiment of the present invention, referring to  FIGS. 3 and 4 , the actuator knob  110  is depressed first to cock the actuator. Then the actuator knob is rotated causing a concurrent rotation of the distal rotation tube, which thereby opens the positioner and driver arms, and the anchors, to a distance of approximately 2-8 mm out and parallel with the longitudinal axis of the driver assembly. 
   It can be appreciated by one skilled in the art that the positioner and driver assemblies may have alternate configurations providing an instrument adapted to for use in a retrograde manner as described above, or in an antegrade manner. 
   It can be appreciated by one skilled in the art that the positioner assembly may have a variety of alternative configurations including but not limited to embodiments described herein (and thus including, without limitation, shuttlecock assembly  800  with positioner petals  830  ( FIGS. 17-21 ), umbrella assembly  900  with reverse positioner petals  930  ( FIGS. 22-27 ), positioner assembly  1440  with positioner arms  1441  ( FIGS. 56-64 ;  70 ,  71 ,  77 ,  78 ), or positioner  2017  ( FIGS. 122-126 ),  2090  ( FIGS. 110-118 ),  2122  ( FIGS. 95 ,  96 ,  103 - 109 ) and  2168  ( FIGS. 83 ,  84 ,  89 - 94 ) (all of which are described below)), providing an alternately retractable and transversely extendible device useful for, referring to  FIG. 2 , insertion in a retracted position in a retrograde direction through the urethra  5  and into bladder opening  4 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned; or alternatively, insertion in a retracted position in an antegrade direction through an incision in the abdomen and an upper surface of the bladder  1 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned. Generally, the positioner assembly may comprise and make use of any number of alternately extendable and retractable projections, petals, arms, claws, or other grasping or catching members for catching and gaining control of bladder wall  2  surrounding bladder opening  4 . The positioner assembly may have at least one member operably connected to a longitudinal member of the instrument and alternately transversely extendable from and retractable toward the longitudinal axis thereof in response to input by a surgeon at a proximal end of the instrument. 
   Alternatively, it can be appreciated by one skilled in the art that when an anchor driver assembly is included with the instrument that is functional to open and subsequently drive anchors through the bladder wall and into the pelvic floor as described herein, the positioner assembly or positioner as shown may be dispensed with in some circumstances. For example, referring to  FIGS. 32 and 33 , it can be appreciated that driver assembly  300 , when opened and drawn downwardly until the distal ends of anchors  700  contact and possibly puncture bladder wall  2  surrounding bladder opening  4 , can be sufficient for use in capturing bladder wall  2  and drawing it downward into contact with, and securing it to, pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, without the need for positioner assembly  400  as shown, in some circumstances. Thus, driver assembly  300  with anchors  700  may serve a dual function as a positioner and as an anchor driver assembly. 
   “Shuttlecock” Embodiment 
     FIGS. 17-21  illustrate another embodiment of a method and apparatus of the invention. As shown in  FIGS. 17-19 , a “shuttlecock” assembly  800  is provided. (As used herein, the term “shuttlecock” is only used for convenient reference to the present embodiment described, because as depicted in the drawings it bears some resemblances to a shuttlecock. The term is not, however, intended to connote any limitations, concerning appearance or otherwise. Those skilled in the art will appreciate that an instrument incorporating the features and functions described may or may not bear resemblances to a shuttlecock.) Affixed at the distal end of central tube  590  is distal end cap  390 . Central tube  590  may be located within positioner petal retainer actuator tube  810 , and positioner petal retainer actuator tube  810  may be located within driver pin actuator tube  820 , and it can be appreciated from  FIGS. 17 and 18  that the three tubes  590 ,  810  and  820  may be substantially coaxial. Tubes  590 ,  810  and  820  can also be longitudinally movable with respect to each other. 
   Driver pins  376  may be affixed at one end to the distal end of driver pin actuator tube  820 . Driver pins  376  may be made of spring wire or other suitable material having shape memory, and may include shorter lengths affixed to the distal end of driver pin actuator tube  820 , bends  377 , and greater lengths which receive detachable hollow anchors  700 . Prior to use of the instrument, anchors  700  may be loaded onto driver pins  376 , and may be releasably held thereon by friction fit or any other suitable means. When assembly  800  is in the retracted position shown in  FIG. 17 , the greater lengths of driver pins  376  may be held in a retracted position lying substantially along tube  820  as shown. When assembly  800  is in the opened position shown in  FIG. 19 , the spring bias in bends  377  of driver pins  376  can cause the greater lengths and free ends of driver pins  376 , and correspondingly, anchors  700  on driver pins  376 , to move outwardly to the opened position shown. Anchors  700  may have hollow bores within, opening at their heads  710 , and extending substantially within their lengths, and driver pins  376  may extend within such bores substantially the entire lengths thereof, so that the distal ends of driver pins  376  may apply driving force proximate to the forward ends of anchors  700 , so as to prevent anchors  700  from buckling or veering off-direction as they might otherwise do if driven at their rearward ends proximate to heads  710 . 
   Each of positioner petals  830  may be affixed at one end to distal end cap  390 . Positioner petals  830  may be made of a spring metal or other suitable material having shape memory, biased so as to spring outwardly to the opened position shown in  FIG. 19  when unrestrained, or may simply ride passively on top of driver pins  376  and anchors  700 , being flexibly affixed or hinged to distal end cap  390 . When assembly  800  is in the retracted position shown in  FIG. 17 , positioner petals  830  lie in a retracted position as shown, to the outside of driver pins  376  and anchors  700 . When assembly  800  is in the opened position shown in  FIG. 19 , the tips  835  of positioner petals  830  have been moved outwardly to an opened position shown, wherein the angle formed by the lengths of positioner petals  830  and the axis of tubes  590 ,  810  and  820  may be approximately 15 degrees. 
   When assembly  800  is in the retracted position shown in  FIG. 17 , positioner petals  830 , and driver pins  376  and anchors  700 , may be retained against the urging of the spring bias in driver pins  376 , by positioner petal retainer  860 . As shown in  FIG. 18 , positioner petal retainer  860  is connected to and made integral with positioner petal retainer actuator tube  810  by positioner petal retainer braces  862 . As noted above, positioner petal retainer actuator tube  810  is longitudinally movable with respect to central tube  590  and driver pin actuator tube  820 . 
   As shown in  FIG. 19 , driver pins  376  and positioner petals  830  are allowed to move to their opened positions when positioner petal retainer  860  is moved upwardly toward distal end cap  390  (see also  FIG. 29 ). Because positioner petal retainer  860  is integral with positioner petal retainer actuator tube  810  via positioner petal retainer braces  862 , pushing positioner petal retainer actuator tube  810  toward distal end cap  390 , while holding central tube  590  and driver pin actuator tube  820  stationary, moves positioner petal retainer  860  toward distal end cap  390 , releasing and allowing positioner petals  830  and driver pins  376  and anchors  700  to open to the position shown in  FIG. 19  (see also  FIGS. 28 ,  29 ). It can be understood from  FIG. 18  that the positioning of positioner petal retainer braces  862  between the separate positioner petals  830  permits this relative motion. 
   As may be seen in  FIG. 17 , the entire shuttlecock assembly  800 , including the central tube  590 , positioner petal retainer actuator tube  810  and driver pin actuator tube  820 , are carried by the outer tube  510  and centered therein by the outer tube end collar  805 . It will be understood by those skilled in the art that tubes  590 ,  810 ,  820  and  510  may be held stationary and/or selectively longitudinally moved with respect to each other by any suitable proximal actuating mechanism. 
   Use and operation of this embodiment to perform anastomosis in a retrograde manner to join a patient&#39;s bladder and urethra following radical prostatectomy will now be described. Referring to  FIG. 2  for anatomical reference, shuttlecock assembly  800  (in a retracted position such as shown in  FIG. 17 ) is inserted into the patient&#39;s urethra, and guided up through the urethra  5 , through bladder opening  4 , and into the bladder lumen  8 , to a fully inserted position whereby shuttlecock assembly  800  may be opened within the bladder as will be hereinafter described. 
   Once assembly  800  is in the fully inserted position, referring back to  FIGS. 17 and 19 , positioner petals  830  and driver pins  376  with anchors  700  are opened by pushing positioner petal retainer actuator tube  810  toward distal end cap  390  while holding central tube  590  and driver pin actuator tube  820  stationary. Positioner petal retainer  860 , being integral with positioner petal retainer actuator tube  810  via positioner petal retainer braces  862 , is thus moved toward distal end cap  390 , which in turn allows positioner petals  830  and driver pins  376  with anchors  700  to spring outwardly into the opened position as shown in  FIG. 19 . 
   Again referring to  FIG. 2  for anatomical reference, the entire assembly  800 , now in the opened position within the patient&#39;s bladder, is then pulled toward the urethra opening  6  by withdrawing tubes  590 ,  810 ,  820  and  510 , together, back down through the urethra. This brings positioner petal tips  835  into contact with the inside of the bladder wall  2  at positions about bladder opening  4 , and urges bladder wall  2  surrounding bladder opening  4  toward pelvic floor  7  surrounding urethra opening  6 , bringing these tissues into contact with openings  4  and  6  aligned. 
   Once the bladder wall  2  and pelvic floor  7  are brought into contact, the next step is to drive anchors  700 , by retracting driver pin actuator tube  820  while holding the remaining tubes  590  and  810  stationary. Retracting driver pin actuator tube  820  causes affixed driver pins  376  to drive anchors  700  into and through bladder wall  2 , as shown in  FIG. 20 , and then into pelvic floor  7 , as shown in  FIG. 21 . It will be appreciated that barbs  730  on anchors  700  cause anchors  700  to lodge in pelvic floor  7 , and that heads  710  on anchors  700  act to retain bladder wall  2  in a position in, contact with pelvic floor  7 , such that bladder opening  4  is held in communication with urethra opening  6 . 
   As with the first embodiment described herein, optionally, prior to withdrawal of the instrument from the urethra, a guide wire may be inserted through the instrument (via a guide wire passage) and into the bladder lumen, and left behind for use described above after withdrawal of the instrument, see  FIGS. 37 and 38 . 
   The sequence of steps described above is then reversed to enable withdrawal of the shuttlecock instrument  800  from the patient. Driver pin actuator tube  820  is pushed while holding remaining tubes  590  and  810  stationary, causing driver pins  376  to withdraw from anchors  700 , which are now lodged in pelvic floor  7  through bladder wall  2 . The entire assembly  800 , still in the opened position inside bladder lumen  8 , is then pushed slightly further into the bladder lumen and away from the urethra by pushing tubes  590 ,  810 ,  820  and  510 , together, back upwardly. The instrument  800  is then brought into a closed position by retracting positioner petal retainer actuator tube  810  while holding central tube  590  and driver pin actuator tube  820  stationary. Positioner petal retainer  860 , being integral with positioner petal retainer actuator tube  810  via positioner petal retainer braces  862 , is thus moved in a proximal direction to a position away from distal end cap  390 , which in turn urges positioner petals  830  and driver pins  376  inwardly into the retracted position (but now without anchors  700 ) as shown in  FIG. 17 . In a retracted position, the entire assembly  800  may then be withdrawn downwardly through the urethra and out of the patient. 
   It can be appreciated by one skilled in the art that the shuttlecock assembly described above may be in alternate configurations providing an instrument adapted for use in a retrograde manner as described above, or an antegrade manner. 
   It can be appreciated by one skilled in the art that the mechanism comprising the positioner petals and performing the bladder positioning function thereof may have a variety of alternative configurations including but not limited to embodiments described herein (and thus including, without limitation, the positioner assembly  400  described above ( FIGS. 11 ,  13 - 14 ), umbrella assembly  900  with reverse positioner petals  930  ( FIGS. 22-27 ), positioner assembly  1440  with positioner arms  1441  ( FIGS. 56-64 ;  70 ,  71 ,  77 ,  78 ), or positioner  2017  ( FIGS. 122-126 ),  2090  ( FIGS. 110-118 ),  2122  ( FIGS. 95 ,  96 ,  103 - 109 ) and  2168  ( FIGS. 83 ,  84 ,  89 - 94 ) (all of which are described below), providing a transversely retractable and extendible device useful for, referring to  FIG. 2 , insertion in a retracted position in a retrograde direction through the urethra  5  and into bladder opening  4 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned; or alternatively, insertion in a retracted position in an antegrade direction through an incision in the abdomen and an upper surface of the bladder  1 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned. Generally, the positioner assembly may comprise and make use of any number of alternately extendable and retractable projections, petals, arms, claws, or other grasping or catching members for catching and gaining control of bladder wall  2  surrounding bladder opening  4 . The positioner assembly may have at least one member operably connected to a longitudinal member of the instrument and alternately transversely extendable from and retractable toward the longitudinal axis thereof in response to input by a surgeon at a proximal end of the instrument. 
   Alternatively, it can be appreciated by one skilled in the art that when an anchor driver assembly is included with the instrument, that is functional to open and subsequently drive anchors through the bladder wall and into the pelvic floor as described herein, the positioner assembly or positioner petals as shown may be dispensed with in some circumstances. For example, referring to  FIGS. 20 and 21 , it can be appreciated that anchor driver pins  376  and anchors  700 , when opened within the bladder lumen and drawn downwardly until the distal ends of anchors  700  contact and possibly puncture bladder wall  2  surrounding bladder opening  4 , can be sufficient for use in capturing bladder wall  2  and drawing it downward into contact with, and securing it to, pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, without the need for positioner petals  830  as shown, in some circumstances. Thus, driver pins  376  with anchors  700  may serve a dual function as a positioner and as an anchor driver assembly. 
   “Umbrella” Embodiment 
     FIGS. 22-27  illustrate another embodiment of the method and apparatus of the invention. As shown in  FIGS. 22-25 , an “umbrella” assembly  900  is provided. (As used herein, the term “umbrella” is only used for convenient reference to the present embodiment described, because as depicted in the drawings it bears some resemblances to an umbrella. The term “umbrella” is not, however, intended to connote any limitations, concerning appearance or otherwise. Those skilled in the art will appreciate that an instrument incorporating the features and functions described may or may not bear resemblances to an umbrella.) Affixed at the distal end of central tube  590  is distal end cap  390 , and central tube  590  and distal end cap  390  are integral. Central tube  590  may be located within driver pin spreader tube  893 , and driver pin spreader tube  893  is located within reverse positioner petal tube  935 , and it can be appreciated from  FIG. 22  that the three tubes  590 ,  893  and  935  may be substantially coaxial. Tubes  590 ,  893  and  935  can be also longitudinally movable with respect to each other. 
   Driver pins  376  having bases  395  are affixed to end cap  390 . Driver pins  376  may be made of spring wire or other suitable material having shape memory, and include lengths and free ends that receive detachable hollow anchors  700 . Prior to use of the instrument, hollow anchors  700  may be loaded onto driver pins  376 , and releasably held thereon by friction fit or any other suitable means. When assembly  900  is in the retracted position shown in  FIG. 22 , the greater lengths of driver pins  376  may be held in a retracted position substantially parallel with the axis of tubes  590 ,  893  and  935 , by spring bias or shape memory in driver pins  376 . When assembly  900  is in the fully opened position shown in  FIG. 25 , the lengths and free ends of driver pins  376  have been urged outwardly to an opened position as shown. Anchors  700  may have hollow bores within, opening at their heads  710 , and extending substantially within their lengths, and driver pins  376  may extend within such bores substantially the entire lengths thereof, so that the distal ends of driver pins  376  may apply driving force proximate to the forward ends of anchors  700 , so as to prevent anchors  700  from buckling or veering off-direction as they might otherwise do if driven at their rearward ends proximate to heads  710 . 
   As may be appreciated by comparing  FIGS. 24 and 25 , driver pins  376  with anchors  700  are moved from the retracted position to the opened position by movement of driver pin spreader  890  toward distal end cap  390 . Driver pin spreader is hollow and integral with driver pin spreader tube  893 , and may move longitudinally with respect to central tube  590  and reverse positioner petal tube  935 . Thus, as driver pin spreader tube  893  is moved toward distal end cap  390 , angled upper spreader face  891  of driver pin spreader  890  urges anchors  700  and correspondingly, driver pins  376 , radially outwardly to the opened position shown in  FIG. 25 . 
   As may be seen in  FIGS. 23 and 24 , reverse positioner petals  930  are integral with reverse positioner petal tube  935 . Reverse positioner petals  930  are made of spring metal or other suitable material having shape memory, and are biased to assume the opened position shown in  FIG. 24 . Thus, pushing reverse positioner petal tube  935  toward distal end cap  390  while holding the other tubes  590 ,  893  and  510  stationary pushes positioner petals  930  out of outer tube  510  through outer tube end collar  805  and allows them to open to their biased positions shown in  FIGS. 24 and 25 . 
   As may be seen in  FIG. 22 , the entire umbrella assembly  900 , including the central tube  590 , driver pin spreader tube  893  and reverse positioner petal tube  935 , are carried by the outer tube  510  and centered therein by the outer tube end collar  805 . It will be understood by those skilled in the mechanical design arts that tubes  590 ,  893 ,  935  and  510  may be held stationary or selectively longitudinally moved with respect to each other by any suitable proximal actuating mechanism. 
   Use and operation of this embodiment to perform anastomosis to join a patient&#39;s bladder and urethra following radical retropubic prostatectomy will now be described. Referring to  FIG. 2  for anatomical reference, umbrella assembly  900  (in retracted position as shown in  FIG. 22 ) is inserted into the patient&#39;s urethra, and guided up through the urethra  5 , and into bladder lumen  8  through bladder opening  4 , to a fully inserted position whereby umbrella assembly  900  may be opened within the bladder lumen as will be hereinafter described. 
   Once assembly  900  is in the fully inserted position, referring back to  FIGS. 22 and 24 , reverse positioner petals  930  are extended and opened by pushing reverse positioner petal tube  935  toward distal end cap  390  while holding central tube  590  and driver pin spreader tube  893  stationary. Next, referring to  FIGS. 24 and 25 , driver pins  376  with anchors  700  are opened by pushing driver pin spreader tube  893  toward distal end cap  390  while holding central tube  590  and reverse positioner petal tube  935  stationary. Thus assembly  900  is brought into the fully opened position shown in  FIG. 25 . 
   Again referring to  FIG. 2  for anatomical reference, the entire assembly  900 , now in the fully opened position within bladder lumen  8 , is then pulled toward urethra opening  6  by withdrawing all tubes  590 ,  893 ,  935  and  510 , together, back down through the urethra. This brings reverse positioner petals  930  into contact with bladder wall  2  at positions about bladder opening  4 , and urges bladder wall  2  toward and into contact with pelvic floor  7  about urethra opening  6 , with the respective openings  4  and  6  aligned. 
   Once the bladder wall and pelvic floor are brought into contact, the next step is to drive anchors  700 , by pulling central tube  590  while holding the remaining tubes  893  and  935  stationary. Pulling central tube  590  causes driver pins  376  to drive anchors  700  into and through bladder wall  20 , and then into pelvic floor  7 , as shown in  FIG. 26 . It will be appreciated that barbs  730  on anchors  700  cause anchors  700  to lodge in pelvic floor  7 , and that heads  710  on anchors  700  act to retain bladder wall  20  in a position in contact with pelvic floor  7 , such that bladder opening  4  is held in communication with urethra opening  6 . 
   As with the first embodiment described herein, optionally, prior to withdrawal of the instrument from the urethra, a guide wire may be inserted through the instrument (via a guide wire passage) and into the bladder lumen, and left behind for use described above after withdrawal of the instrument, see  FIGS. 37 and 38 . 
   The sequence of steps described above is then reversed to enable withdrawal of the umbrella instrument  900  from the patient. Central tube  590  is pushed while holding the remaining tubes  893  and  935  stationary, causing driver pins  376  to withdraw from anchors  700 , which are now lodged in pelvic floor  7  through bladder wall  2 . The entire assembly  900 , still in the opened position inside the patient&#39;s bladder, is then pushed slightly further into the bladder and away from the urethra by pushing tubes  590 ,  893 ,  935  and  510 , together, back into the urethra. The instrument  900  is then brought into the retracted position as follows: Pulling driver pin spreader tube  893  while holding central tube  590  and reverse positioner petal tube  935  stationary moves driver pin spreader  890  from the position shown in  FIG. 25  to the position shown in  FIG. 24 , allowing driver pins  376  to return to their normally biased, retracted positions shown in  FIG. 24  (but now without anchors  700 ). Next, pulling reverse petal tube  935  while holding central tube  590  and driver pin spreader tube  893  stationary withdraws reverse positioner petals  930  from their normally biased, opened positions shown in  FIG. 24 , to their retracted positions inside outer tube  510 , shown in  FIG. 22 . In the retracted position shown in  FIG. 22 , the assembly  900  may then be withdrawn downwardly through the urethra and out of the patient. 
   It can be appreciated by one skilled in the art that the positioner assembly may be in alternate configurations providing an applier adapted to for use in a retrograde manner as describe above, or an antegrade manner. 
   It can be appreciated by one skilled in the art that the mechanism comprising the positioner petals and performing the bladder positioning function thereof may have a variety of alternative configurations including but not limited to embodiments described herein (and thus including, without limitation, the positioner assembly  400  ( FIGS. 11 ,  13 ,  14 ) or shuttlecock assembly  800  with positioner petals  830  ( FIGS. 17-21 ) described above, positioner assembly  1440  with positioner arms  1441  ( FIGS. 56-64 ;  70 ,  71 ,  77 ,  78 ), or positioner  2017  ( FIGS. 122-126 ),  2090  ( FIGS. 110-118 ),  2122  ( FIGS. 95 ,  96 ,  103  - 109 ) and  2168  ( FIGS. 83 ,  84 ,  89 - 94 ) (all of which are described below)), providing a transversely retractable and extendible device useful for, referring to  FIG. 2 , insertion in a retracted position in a retrograde direction through the urethra  5  and into bladder opening  4 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned; or alternatively, insertion in a retracted position in an antegrade direction through an incision in the abdomen and an upper surface of the bladder  1 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned. Generally, the positioner assembly may comprise and make use of any number of alternately extendable and retractable projections, petals, arms, claws, or other grasping or catching members for catching and gaining control of bladder wall  2  surrounding bladder opening  4 . The positioner assembly may have at least one member operably connected to a longitudinal member of the instrument and alternately transversely extendable from and retractable toward the longitudinal axis thereof in response to input by a surgeon at a proximal end of the instrument. 
   Alternatively, it can be appreciated by one skilled in the art that when an anchor driver assembly is included with the instrument, that is functional to open and subsequently drive anchors through the bladder wall and into the pelvic floor as described herein, the positioner assembly or positioner petals as shown may be dispensed with in some circumstances. For example, referring to  FIGS. 25 and 26 , it can be appreciated that anchor driver pins  376  and anchors  700 , when opened within the bladder lumen and drawn downwardly until the distal ends of anchors  700  contact and possibly puncture bladder wall  2  surrounding bladder opening  4 , can be sufficient for use in capturing bladder wall  2  and drawing it downward into contact with, and securing it to, pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, without the need for reverse positioner petals  930  as shown, in some circumstances. Thus, driver pins  376  with anchors  700  may serve a dual function as a positioner and as an anchor driver assembly. 
   Balloon/Harness Embodiment 
     FIGS. 55-64  depict another embodiment of a method and instrument in accordance with the present invention (shown in an antegrade configuration), the instrument having a handle assembly  1100 , a straight tube assembly  1200 , a curved tube assembly  1300 , and an end effector assembly  1400 . In one embodiment of the present invention, instrument  1000  may be endo-scopically inserted into the abdominal cavity of a patient to effect an anastomosis between the urethra and bladder of a patient, thereby re-establishing the fluid connection between bladder  1  and the urethra  5 . 
     FIG. 56  depicts curved tube assembly  1300  and end effector assembly  1400  after insertion into the bladder lumen  8  of a patient through an opening in the abdomen and upper surface of the bladder (not shown). The openings may be made, and abdominal insertion of the instrument may be accomplished by, for example, inserting a cannula with a trocar (not shown) into the abdomen and guiding it to and through an upper surface of the bladder in a generally antegrade direction, withdrawing the trocar, and inserting the instrument through the cannula and into the bladder lumen. Curved tube assembly  1300  may be flexible and may be provided with a bias at a bend angle (from about approximately 55 degrees to about approximately 90 degrees may be suitable) to provide curvature that may be desirable for inserting end effector assembly  1400  into the urethra  5  and actuating the instrument in an antegrade procedure. The bend angle of curved tube assembly  1300  may vary depending upon the particular needs of the procedure or surgeon utility. 
     FIG. 57  depicts end effector assembly  1400  with opened positioner arms  1441  inside the bladder lumen  8 . Following the insertion of balloon assembly  1410  into bladder opening  4 , distal positioner tube  1445  has been moved downwardly and distally, causing positioner arms  1441  to open to positions transverse to the longitudinal axis of end effector assembly  1400 . Positioner arms  1441  are adapted to be effective for use in catching and urging bladder wall  2  surrounding bladder opening  4  toward pelvic floor  7  surrounding urethra opening  6 . 
     FIG. 58  depicts the end effector assembly with anchor driver assembly  1460  opened inside the bladder lumen. During the insertion of end effector assembly  1400  into the bladder to the position shown in  FIG. 56 , the anchor pivot arms  1461  of anchor driver assembly  1460  are sheathed by anchor closing collar  1330  and are restrained in a closed position lying along distal positioner tube  1445 , as may be seen by comparing  FIGS. 57 and 58 . When anchor closing collar  1330  is moved upwardly with respect to distal anchor driver tube  1450 , the anchor pivot arms  1461  are unsheathed, allowing them to swing outwardly, under spring bias, to the position shown in  FIG. 58 , bringing anchors  700  into a position reading for driving. 
     FIG. 58  further illustrates positioning of the distal balloon assembly  1410  in the urethra opening  6 . Locating the urethra opening  6  with end  1413  and inserting end  1413  into the urethra opening  6  ensures that when the positioner arms  1441  contact and urge the bladder wall  2  toward the pelvic floor  7 , the urethra opening  6  and the bladder opening  4  will be substantially aligned. 
     FIG. 59  illustrates the positioning of end effector assembly  1400 , bladder wall  2 , and pelvic floor  7  after instrument  1000  has been urged downward, thus causing positioner arms  1441  to urge bladder wall  2  downward into contact with pelvic floor  7 , which may be accomplished by pushing the entire instrument toward the pelvic floor. As bladder wall  2  surrounding bladder opening  4  is urged into contact with pelvic floor  7  surrounding urethra opening  6 , balloon assembly  1410  is urged into urethra opening  6   
     FIG. 60  illustrates the instrument after anchors  700  of anchor driver assembly  1460  have been driven through the bladder wall  2  into the pelvic floor  7  to secure bladder wall  2  surrounding bladder opening  4  in contact with pelvic floor  7  surrounding urethra opening  6 , with bladder opening  4  and urethra opening  6  substantially aligned. Once in the opened and ready position, as shown in  FIG. 58 , the anchors  700  may be driven through the bladder wall into the pelvic floor by moving distal anchor driver tube  1450  in a distal direction (toward the distal end of the instrument), which correspondingly moves the anchor pivot arms  1461 , anchor driver pin bases  1462 , anchor driver pins (concealed within anchors  700  as shown), and thus anchors  700 . Driving anchors  700  through bladder wall  2  and into pelvic floor  7  positions the distal portion of balloon assembly  1410  within the urethra  5  to insure that anchors  700  are installed such that the bladder opening  4  and the urethra opening  6  remain substantially aligned. 
     FIG. 61  illustrates the instrument after withdrawal of anchor driver pins  1463  from the installed anchors  700  that are now lodged in the pelvic floor  7  to secure the bladder wall  2  to the pelvic floor  7 . Anchors  700  may be provided with barbs or other suitable structures adapted to lodge anchors  700  in tissues. As such, when anchor driver assembly  1460  is withdrawn by remotely pulling distal anchor driver tube  1450  while holding distal positioner tube  1445  substantially stationary, anchors  700  remain lodged in the tissue. Prior to use of the instrument, anchors  700  have been pre-loaded and may be releaseably held on the anchor driver pins  1463  by a friction fit or any other suitable means which will allow release when anchors  700  are lodged in tissues and anchor driver pins  1463  are withdrawn therefrom. 
     FIG. 62  illustrates the end effector assembly  1400  after it has been partially retracted so as to situate the proximal portion of the balloon assembly  1410  within the bladder lumen  8 . As the end effector assembly  1400  is retracted, harness  1430  is unfolded and exposed. Harness  1430  may be integral with harness collar  1433  and may be affixed to anchors  700  at the anchor heads  710  with an anchoring loop, that may consist of suture material, running through both the anchor head  710  and the harness  1430 . As the end effector assembly  1400  is retracted, harness  1430  becomes unfolded as the harness collar  1433  is moved upward. End effector assembly  1400  may be retracted until harness  1430  resists retraction as a result of the attachment of harness  1430  to the anchor heads  710 . 
     FIG. 63  illustrates the instrument after the positioner arms  1441  of the positioner assembly  1440  have been closed by retracting the positioner tube  1445  away from the pelvic floor  7 , and after the anchor pivot arms  1461  have been closed by moving anchor closing collar  1330  towards the pelvic floor while holding catheter tube  1420  and distal anchor driver tube  1450  substantially stationary. As will be apparent to a person of ordinary skill in the art, the steps of closing the positioner arms  1441  and closing the anchor pivot arms  1461  may be accomplished at any suitable time or sequence during the procedure. 
     FIG. 64  illustrates the anchor driver assembly  1460  and the positioner assembly  1440  after their withdrawal from the bladder  1  has been commenced. Removing anchor driver assembly  1460  and positioner assembly  1440  leaves behind catheter tube  1420 , in communication with balloon assembly  1410 , also left behind. Catheter tube  1420  may be a catheter that is left in place until anastomosis is complete, to enable drainage of urine during recovery and healing. 
     FIG. 65  illustrates balloon  1411  of balloon assembly  1410  after it has been inflated by pumping gas or fluid through an inflation lumen  1423  in catheter tube  1420  (see  FIGS. 67 ,  68 ). Balloon  1411  may be inflated until it is restrained by harness straps  1432 , which then press balloon  1411  against the tissue surrounding bladder opening  4  so as to apply sufficient pressure to maintain contact between bladder wall  2  surrounding bladder opening  4  and pelvic floor  7  surrounding urethra opening  6 , to effect knitting of the respective tissues and thus effect anastomosis. 
   During recovery and healing, urine from the patient&#39;s bladder may be drained through drainage holes  1421  that are in communication with a urine drainage lumen  1422  in catheter tube  1420  (see  FIGS. 67 ,  68 ). Drainage holes  1421  may be positioned, for example, distally on the catheter tube  1420 , or in any other suitable location. Suitable gas or fluid pressure within balloon  1411  may be maintained until the anastomosis is complete, by monitoring and adjusting the pressure within balloon  1411  through inflation lumen  1423 . The possibility of pressure necrosis in the tissues beneath the balloon may be reduced by including, for example, ribs  1415 , or other bumps, nodules, projections, or other features on the underside of balloon  1411 , which may be effective to reduce the loss of blood flow to tissue in contact with balloon  1411 . These features may be solid or of uniform wall thickness. 
   Additionally, balloon  1411  may be designed with features that effect the shape that it assumes upon inflation, and thus, effect the shape and area of the lower surface of balloon  1411  that contacts the bladder wall  2  upon inflation. For example, balloon  1411  may be designed and manufactured so as to have walls that are thicker on an upper portion and thinner on a lower portion, so that the lower portion of balloon  1411  is predisposed to expand downwardly and outwardly between the harness straps, and thereby present a larger surface area to contact the bladder wall  2 . Alternatively, balloon  1411  may be designed with features that cause it to assume a specific advantageous shape upon inflation. 
   Balloon assembly  1410 , harness  1430 , and catheter tube  1420  may removed from the patient by removing the harness anchoring loop  1435  attachment from the anchor heads  710  and harness straps  1432 . As shown in  FIG. 66 , harness straps  1432  may be affixed to the anchor heads  710  by one or more harness anchoring loops  1435  that pass through holes located in both the harness straps  1432  and the anchor heads  710 . As may be appreciated from  FIGS. 66-69 , free ends of harness anchoring loops  1435  may extend through catheter tube  1420  to its proximal end. Thus, the balloon assembly  1410  may be removed by pulling harness loop plug  1485  attached to one free end of each of harness anchoring loops  1435  and pulling the harness loop plug  1485  until the harness anchoring loops  1435  are completely removed from the instrument. Removing the harness anchoring loops  1435  from anchor heads  710  and harness straps  1432  disassociates the anchors  700  from the harness  1430  allowing the balloon assembly  1410  to be retracted.  FIG. 67  illustrates anchoring loop passages  1436  where, in one embodiment of the present invention, harness anchoring loops  1435  may pass through the anchoring loop passage  1436  into the anchoring loop lumens  1424  of catheter tube  1420  ( FIG. 68 ). Harness anchoring loops  1435  may comprise suture material. 
     FIGS. 67 and 68  illustrate an embodiment of a method and configuration of an instrument adapted to enable inflation of balloon  1411  of balloon assembly  1410  in accordance with the present invention. Catheter tube  1420  may include an inflation lumen  1423  that extends distally through the balloon assembly body  1412 . An inflation port  1414  provides a passageway between inflation lumen  1423  and the balloon cavity to enable inflation, deflation and balloon pressure regulation. Gas or fluid pressure, provided and regulated through inflation lumen  1423  may pass through inflation port  1414  to adjust and regulate the pressure within the balloon  1411  as may be desired to affect the pressure the balloon exerts on the tissues. In one embodiment of the present invention, balloon  1411  may be expanded until restricted by harness straps  1432  of harness  1430 . Balloon  1411  may be constructed from an elastomeric material that fully encircles the balloon assembly body  1412 . The proximal and distal portions of balloon  1411  may be glued or otherwise adhered to the balloon assembly body  1512  by any suitable means. 
     FIG. 68  illustrates an embodiment of a catheter tube  1420  in accordance with the present invention having a urine drainage lumen  1422 , at least one anchoring loop lumen  1424 , and an inflation lumen  1423 . It will be apparent to one of ordinary skill in the art that various types of lumens are within the scope of the present invention and that the lumens or catheter cross sections described may be maintained within a single catheter or housed separately depending on the needs of the user. Catheter tube  1420  may be any suitable diameter. 
     FIG. 69  illustrates an embodiment of the proximal end of a catheter tube  1420  as may be connected to a urine collection bag  1500 . Gas or fluid may be delivered through backflow stop valve  1483  located in the collection bag (as shown) and/or in the catheter. This may be accomplished by, for example, applying sufficient positive pressure to open backflow stop valve  1490 , or by inserting a needle through the valve to apply pressure. 
   Still referring to  FIGS. 68 and 69 , a catheter cap  1480  is provided, connected to urine collection bag  1500  via urine tube  1482 . Urine tube  1482  may be provided with a urine backflow stop valve  1483  to prevent urine backflow. Catheter cap  1480  may be removably attached to catheter tube  1420  by, for example, threads  1481 . 
     FIGS. 66-69  illustrate a way in which one or more harness anchoring loops  1435  may be routed and contained within an instrument, and within a tube such as, for example, catheter tube  1420 . Those skilled in the art will appreciate that other configurations are possible, as are other ways of attaching and detaching anchor heads  710  with a harness strap  1432 . Catheter tube  1420  may be constructed from any material that is substantially biocompatible or suitable for use within the human body such as, for example, latex, other suitable polymers, nitinol, or combinations thereof. 
   Referring to  FIGS. 58 ,  59 ,  64  and  70 , catheter tube  1420  may be located within distal positioner tube  1445  and positioner assembly  1440 . The distal end of positioner assembly  1440  may abut harness collar  1433  of harness  1430 . Positioner arms  1441  of the positioner assembly  1440  are opened when the distal positioner tube  1445  is driven in a distal direction with respect to catheter tube  1420 , compressing positioner assembly  1440  longitudinally against harness collar  1433 . Distal positioner tube  1445  may be coupled with the positioner assembly  1440  by, for example, a pin or other suitable attachment mechanism. 
   Referring to  FIGS. 58 ,  59 ,  63 ,  64  and  70 , distal positioner tube  1445  may be located within distal anchor driver tube  1450 . When the anchor pivot arms  1461  are opened (as shown in  FIGS. 58 and 59 ), the distal anchor driver tube  1450  may be moved to drive the anchor driver assembly  1460  distally (and thus, in use, downward towards the pelvic floor), so as to drive the anchors  700  through the bladder wall  2  and into the pelvic floor  7 . Distal anchor driver tube  1450  is coupled with anchor pivot arm yoke  1467  of anchor driver assembly  1460 . Anchor pivot arm yoke  1467  may be coupled with the anchor pivot arms  1461  by, for example, pins, or any other suitable means, and biased to swing outwardly by anchor pivot arm springs  1466  or other suitable biasing means. The anchor pivot arms  1461  may be hingeably coupled with an anchor driver pin base  1462  with an affixed anchor driver pin  1463 . Pins, or any other suitable attachment means permitting swinging movement, may be used to couple the anchor driver pin base  1462  to the anchor pivot arm  1461 , and anchor pivot arm  1461  and driver pin base  1462  may have suitable cooperating shapes that limit the range of relative swinging movement between them to a suitable angle as may be appreciated from  FIG. 59 . Anchor pivot arm springs  1466  may be included to bias anchor pivot arms  1461  toward an open position shown in  FIG. 59 . Anchor driver assembly  1460  may be brought to a closed position (shown in  FIG. 63 ), with anchor pivot arms  1461  lying substantially alongside distal positioner tube  1445 , by moving anchor closing tube  1220  distally, which correspondingly pushes ribbed flex tube  1325  and anchor closing collar  1330  distally, with respect to distal anchor driver tube  1450 , causing anchor closing collar  1330  to contact anchor pivot arms  1461 , urge them to a closed position, and then sheath and restrain them. This motion is reversed in order to permit anchor pivot arms  1461  to open. 
   Distal anchor driver tube  1450  may be substantially coaxially located within curved spine tube  1305 . Curved spine tube  1305  functions as a portion of a skeleton, on, in or about which the other components reside and move. It may be desirable for purposes of manipulability and use of the instrument that curved spine tube  1305  be substantially rigid, or somewhat flexible, and it may be formed of nitinol, or any other material having the desired properties. 
   Still referring to  FIGS. 59 ,  63 ,  64  and  70 , curved spine tube  1305  may be located within flex tube  1325 . Flex tube  1325  may be constructed from any suitable material such as, for example, a substantially biocompatible polymer having sufficient flexibility to permit the longitudinal movement of flex tube  1325  over and with respect to curved spine tube  1305 . Flex tube  1325  may be provided with ribs, as shown, or other suitable features that impart or increase flexibility. Flex tube  1325  may be affixed at its proximal end to anchor closing tube  1220  via flex tube coupling  1225 , and affixed at its distal end to anchor closing collar  1330 , by a pin or other suitable attachment means. Anchor closing collar  1330  may be adapted to contact, urge closing of, and sheath and restrain anchor pivot arms  1461 . Thus, anchor pivot arms  1461  and thus anchor driver assembly  1460  may be placed in a closed position by moving anchor closing tube  1220  distally, and placed in an open position by moving anchor closing tube  1220  proximally, with respect to distal anchor driver tube  1450 . 
     FIG. 71  is a partial cross-sectional view, taken through the central axis of the distal end of the instrument shown in  FIG. 55 , illustrating particular exemplary components of the anchor and positioner assemblies of the instrument and the manner in which they may be connected to actuating tubes. Distal positioner tube  1445  is the innermost tube shown in  FIG. 71 , and terminates at positioner proximal collar  1442 , with which it may be made integral by suitable means. Positioner arms  1441  are hingeably affixed to positioner proximal collar  1442  at their proximal ends, and to positioner distal collar  1443  at their distal ends. It will be understood from examination of  FIGS. 64 and 70  that catheter tube  1420 , not shown in  FIG. 71 , may be located inside distal positioner tube  1445 , positioner distal collar  1442 , and positioner proximal collar  1443 , when the instrument is completely assembled. It will also be understood from  FIGS. 64 and 70  that harness collar  1433  is located on catheter tube  1420  adjacent to positioner distal collar  1443 , when the instrument is completely assembled. Referring again to  FIG. 71 , it can be understood that distal longitudinal movement of distal positioner tube  1445 , with respect to and toward harness collar  1433 , causes longitudinal compression of positioner assembly  1440  against harness collar  1433 , which in turn causes positioner arms  1441  to open outwardly from and transversely to the longitudinal axis of the assembly as shown partially in  FIG. 71 , toward fully opened positions that may be seen in  FIGS. 58-62 . The construction of positioner assembly  1440  in this embodiment may be seen in more detail in  FIG. 78 . It can be seen that longitudinal compression of positioner assembly  1440  causes positioner arms  1441  to extend outwardly as enabled by their shapes and hinges  1444  between proximal and distal segments of positioner arms  1441 . As shown, positioner assembly  1440  may include positioner proximal collar  1442 , positioner arms  1441 , and positioner distal collar  1443 , may be a single unitary part formed of a substantially biocompatible and flexible polymeric material suitable to allow integral hinges  1444  to flex as shown when opening of bladder assembly  1440  is required, and to return to an unflexed position when closing of the positioner assembly  1440  is required. 
   Referring to  FIGS. 58 and 59 , in an open position, positioner assembly  1440  is adapted to be useful for catching at bladder opening  4  and urging bladder wall  2  thereabout downwardly into contact with pelvic floor  7 . Positioner assembly  1440  may comprise the embodiment shown or any other suitable mechanism that transversely extends one or more members that will catch in bladder opening  4  and be useful for urging the bladder wall downwardly into contact with the pelvic floor, in response to force and movement translated from input from the surgeon at the proximal portion of the instrument, and then retracts or closes such members in response to force and movement translated from input from the surgeon, when it is desired that the mechanism be withdrawn. 
   Referring again to  FIG. 71 , distal anchor driver tube  1450  may be affixed to, and integral with, anchor pivot arm yoke  1467 . Anchor pivot arms  1461  may be attached to pivot arm yoke  1467  by pins as shown or other suitable means, and biased to swing outwardly by springs  1466 . The angle through which anchor pivot arms  1461  may swing outwardly may be restricted by suitably cooperating shapes of pivot arm yoke  1467  and anchor pivot arms  1461 . Anchor driver pin bases  1462  may be pivotably attached to anchor pivot arms  1461  by pins as shown or other suitable means. The angle through which anchor driver pin bases  1462  may move with respect to anchor pivot arms  1461  may be restricted by suitably cooperating shapes of anchor pivot arms  1461  and pin bases  1462 . Anchor driver pins  1463  are affixed to pin bases  1462  and may be integral therewith. 
   Anchors  700  may be hollow so as to fit onto anchor driver pins  1463  and be releasably held thereon by friction fit or any other suitable releasable means. Anchors  700  may have hollow bores within, opening at their heads, and extending substantially within their lengths, and driver pins  1463  may extend within such bores substantially the entire lengths thereof, so that the distal ends of driver pins  1463  may apply driving force proximate to the forward ends of anchors  700 , so as to prevent anchors  700  from buckling or veering off-direction as they might otherwise do if driven at their rearward ends. When anchors  700  are inserted into tissues, barbs thereon, or any other suitable lodging structures, cause anchors  700  to lodge in the tissues. Following insertion of anchors  700  in tissues, anchor driver pins  1463  may then be retracted from anchors  700  by retracting distal anchor driver tube  1450 . It will be appreciated that it may be desirable that distal anchor driver tube  1450  be flexible. Distal anchor driver tube  1450  may be formed from any suitable material such as, for example, nitinol. The anchor pivot arm springs may be for example, leaf springs, or any other suitable biasing device for biasing anchor driver assembly  1460  in an open position when unsheathed by anchor closing collar  1330 . 
   Still referring to  FIG. 71 , anchor closing collar  1330  may be integrally affixed to the distal end of flex tube  1325 . Referring to  FIG. 70 , the proximal end of flex tube  1325  may be integrally affixed to anchor closing tube  1220  via flex tube coupling  1225 . Referring again to  FIG. 71 , flex tube  1325  and integral anchor closing collar  1330  are not affixed to, and longitudinally movable with respect to, anchor pivot arm yoke  1467  and curved spine tube  1305 . Thus, it can be appreciated that distal longitudinal movement of anchor closing tube  1220 , with distal anchor driver tube  1450  held stationary, can cause corresponding distal longitudinal movement of anchor closing collar  1330 , causing it to contact anchor pivot arms  1461 , urge them to a closed position lying substantially alongside distal positioner tube  1445 , and sheath and restrain them, in positions that may be seen, for example, in  FIGS. 57 and 63 . Conversely, moving anchor closing tube  1220  in a proximal direction, with distal anchor driver tube  1450  held stationary, pulls anchor closing collar  1330  up and off anchor pivot arms  1461 , allowing them to spring to an opened position shown, for example, in  FIGS. 58 and 71 . 
   Distal positioner tube  1445  and distal anchor driver tube  1450  are not affixed to one another, and therefore, may be longitudinally moved with respect to each other. This enables, for example, distal anchor driver tube  1450  to be moved distally while distal positioner tube is stationary, as would occur when anchors  700  are being driven through a bladder wall held stationary and in contact with a pelvic floor, by positioner assembly  1440 . 
     FIG. 72  illustrates an exemplary configuration of a transition assembly that can be effective for translating relative force and movement of/between actuating members of a handle assembly  1100  to actuating members of an end effector assembly  1400 , such as shown in  FIG. 55 . Distal positioner tube  1445  is integral with positioner tube coupling  1206 , which is in turn integral with straight positioner tube  1209 , which is operatively connected with handle assembly  1100  as may be seen in  FIGS. 55 ,  72  and  77 . Thus, longitudinal force and movement in straight positioner tube  1209  effected by the handle assembly is directly translated to distal positioner tube  1445  via positioner tube coupling  1206 . Referring again to  FIG. 72 , distal anchor driver tube  1450  is integral with anchor driver tube coupling  1207 , which is in turn integral with straight anchor driver tube  1208 , which is operatively connected to handle assembly  1100  as may be seen in  FIGS. 55 ,  72  and  81 . Thus longitudinal force and movement in straight anchor driver tube coupling  1207  effected by the handle assembly is directly translated to distal anchor driver tube  1450  via anchor driver tube coupling  1207 . Referring to  FIGS. 72 and 82 , curved spine tube  1305  is integral with spine  1201 , which is in turn integral with handle housing  1101 , and thus curved spine tube  1305 , spine  1201  and handle housing  1101  form the instrument&#39;s relative stationary skeleton about which the actuating components move. As may be seen in  FIGS. 73 and 74 , spine tube  1201  may be integrally fitted and affixed to the handle housing by a spine retainer structure  1190  or other suitable structure integral with the handle housing. Finally, still referring to  FIG. 72 , and also  FIGS. 55 and 79 , flex tube  1325  is integral with flex tube coupling  1225  and anchor closing tube  1220 , which is operatively connected to handle assembly  1100 . Thus, longitudinal force and movement in anchor closing tube  1220  effected by the handle assembly is directly translated to flex tube  1325  and thus anchor closing collar  1330 . It will be apparent to a person of ordinary skill in the art that the configuration of components illustrated in  FIG. 72  is only an example by which force and movement in components effected by a handle assembly may be translated to components in an end effector, and that this translation may be accomplished in a variety of ways in accordance with the present invention. 
     FIG. 82  depicts an exemplary structure that may be incorporated into the instrument to provide a skeletal (“ground”) structure about which other components move and are actuated, and which can provide a structure to support manipulation of the entire instrument as a unit. As previously noted, curved spine tube  1305  is integral with spine  1201 . Spine  1201  is integral with handle housing  1101 . These three components are, thus, substantially integral. Housing  1101  may be molded or formed of a suitable rigid polymeric material. It may be desirable that spine  1201  and curved spine tube  1305  be substantially rigid, and have suitable stiffness and strength to support exertion of manipulative forces by the surgeon upon the instrument necessary to insert the instrument into a patient&#39;s abdomen, locate the bladder opening, urge the bladder into contact with the pelvic floor, and hold the bladder in contact with the pelvic floor during actuation of the instrument to drive anchors. Spine  1201  and curved spine tube  1305  may be formed of stainless steel, nitinol or any other suitable material. Curved spine tube  1305  may be affixed or joined to spine  1201  by any suitable means including but not limited to pins, welding, press fitting, cooperating threads, adhesives, etc. Spine  1201  may be affixed or joined to housing  1101  by any suitable means. 
     FIGS. 73 ,  74 ,  79  and  80  illustrate an exemplary mechanism that may be incorporated into a handle assembly, by which an anchor closing tube  1220  may be alternately, selectively, longitudinally moved in proximal or distal directions and held so as to alternatively, selectively, open or close an anchor assembly to alternate positions shown, for example, in  FIGS. 57 and 58 . Anchor closing tube  1220  may be coupled with closing tube latching collar  1180  by pins as shown in  FIG. 80  or any other suitable means so that the two components move together longitudinally as a unit. Closing tube latch base  1179  may be integral with handle housing  1101 , and thus may be part of the instrument&#39;s skeleton. Closing tube latching collar  1180  freely rides upon closing tube spindle  1183 , which assures suitable alignment of closing tube latching collar with latch base  1179 , and supports a proximal end of closing tube spring  1181 . Closing tube latching collar  1180  includes latch members  1182  adapted to interact with cooperating features of closing tube latch base  1179  so as to alternately, selectively, be pushable proximally and rotatable to latch and be longitudinally restrained within latch base  1179  in the position shown in  FIG. 74 , or rotatable to unlatch and be released from latch base  1179  to assume the position shown in  FIG. 75 . When in a position released from latch base  1179 , closing tube latching collar  1180  is biased toward a distal position by closing tube spring  1181 . Closing tube latching collar  1180  may be restrained from disassociating distally from closing tube spindle  1183  by cooperating rims or lips or any other suitable means (not shown). Thus, it can be appreciated that by the exemplary configuration of components shown, anchor closing tube  1220  is biased in a distal position (thus, biasing anchor closing collar  1330  in a distal position holding anchor driver assembly  1460  in a closed position through exemplary mechanisms described above) by closing tube spring  1181 . When the surgeon wishes to open the anchor assembly, he or she may push closing tube latching collar  1180  proximally with respect to the handle housing until closing tube latching members  1182  engage with cooperating features of closing tube latch base  1179 , and then turn closing tube latching collar  1180  to latch into closing tube latch base  1179 . This pulls anchor closing tube  1220  proximally, pulling anchor closing collar  1330  proximally to release the anchor pivot arms into an opened position. 
     FIGS. 75-77  illustrate an exemplary mechanism that may be incorporated into the instrument to effect and translate force and movement to open and hold open a positioner assembly in accordance with the present invention. Positioner lever  1110  is pivotably mounted on, and may pivot about, axle  1113  which is integral with housing  1101 . Positioner lever  1110  has a longer portion and a shorter portion; the shorter portion has thereon positioner lever teeth  1111 . Positioner tube actuator rack  1160  rides longitudinally between guides or a track integral with housing  1101 , and is longitudinally movable proximally and distally. Positioner tube actuator rack  1160  has teeth  1159  thereon. Positioner lever  1110  and positioner tube actuator rack  1160  are situated such that positioner tube actuator rack teeth  1159  and positioner lever teeth  1111  are enmeshed. Thus, with respect to  FIGS. 75-77 , it can be appreciated that counterclockwise angular movement of positioner lever  1110  about axle  1113  is translated to distal linear movement of positioner tube actuator rack  1160 , and vice versa. The distal end of positioner tube actuator rack  1160  may be coupled with straight positioner tube  1209  by cooperating rims or lips forming an annular collar or other suitable means, such that the two parts move longitudinally together as a unit, and straight positioner tube  1209  may be made integral with distal positioner tube  1445  via positioner tube coupling  1206  as previously described. Thus, it can be appreciated that when a surgeon holding handle assembly  1100  pulls or squeezes positioner lever  1110 , distal positioner tube  1445  is urged distally. Referring to  FIG. 77 , it can be appreciated that when the entire instrument is assembled and positioner distal collar  1443  is restrained distally by a balloon assembly (see, e.g.,  FIGS. 56 ,  57 ), distal longitudinal movement of distal positioner tube  1445  causes longitudinal compression of positioner assembly  1440 , which causes positioner arms  1441  to open outwardly of the longitudinal axis, and vice versa. Positioner tube spring  1161 , in compression, biases positioner tube actuator rack  1160  toward a proximal position. Thus, it can be appreciated from  FIG. 77  that as a result, distal positioner tube  1445  is biased in a proximal position, allowing positioner arms  1441  and positioner assembly  1440  to assume a closed position. Driver/positioner locking lever  1170  is pivotably mounted on and pivots about pin  1176 , which may be integral with housing  1101 , and is biased by spring  1171 , in compression, in a counterclockwise direction (with respect to  FIG. 75 ). Driver/positioner locking lever  1170  comprises a driver/positioner locking latch  1178 . When the handle assembly is assembled and ready for use, a lower surface of driver/positioner locking latch  1178  rests upon and is urged against an upper surface of the proximal end  1177  of positioner tube actuator rack  1160 . As positioner lever  1110  is pulled or squeezed in counterclockwise direction (with respect to  FIG. 75 ), moving positioner tube actuator rack  1160  distally as previously described, a notch  1174  at the proximal end  1177  of positioner tube actuator rack  1160  moves beneath locking latch  1178  of driver/positioner locking lever  1170 , and locking latch  1178  moves into notch  1174  by urging of spring  1171 . This locks actuator rack  1160  into a distal position. As a result, as may be appreciated from  FIG. 77 , positioner arms  1441  and positioner assembly  1440  may be locked into an opened position. In order to then close positioner assembly  1440 , the surgeon may depress driver/positioner locking lever  1170 , which lifts locking latch  1178  out of notch  1174 , permitting positioner tube actuator rack  1160  to return to a proximal position under urging of spring  1161 . 
     FIGS. 75 ,  76  and  81  illustrate an exemplary mechanism that may be incorporated into the instrument to effect and translate force and movement to drive an anchor assembly in accordance with the present invention. Anchor driver lever  1120  is pivotably mounted on, and may pivot about, axle  1113  which is integral with housing  1101 . Anchor driver lever  1120  has a longer portion and a shorter portion; the shorter portion has thereon anchor driver lever teeth  1121 . Anchor driver intermediate rack  1122  rides longitudinally between guides or a track integral with housing  1101 , and is longitudinally movable proximally and distally. Anchor driver intermediate rack  1122  has proximal teeth  1127  and distal teeth  1128  thereon. Anchor driver lever  1120  and anchor driver intermediate rack  1122  are situated such that anchor driver intermediate rack proximal teeth  1127  will engage anchor driver lever teeth  1121  when anchor driver lever  1120  is moved counterclockwise through a suitable angle (with respect to  FIG. 75 ). Small anchor driver pinion  1123  and large anchor driver pinion  1124  are integral, and rotate about a pin supported by bosses in housing  1101 . Small anchor driver pinion  1123  and anchor driver intermediate rack are situated such that small anchor driver pinion  1123  is enmeshed with anchor driver intermediate rack distal teeth  1128 . Anchor driver rack  1125  rides longitudinally between guides or a track integral with positioner tube actuator rack  1160 , and a length and a distal end of anchor driver rack  1125  may extend into and be supported within spine  1201  as may be seen in  FIG. 75 . Anchor driver rack  1125  has anchor driver teeth  1129  thereon. Anchor driver rack  1125  and anchor driver lever  1120  are situated such that anchor driver teeth  1129  are enmeshed with large anchor driver pinion  1124 . The distal end of anchor driver rack  1125  is affixed by any suitable means to straight anchor driver tube  1208 . Thus, it may be appreciated from the foregoing, and examination of  FIGS. 75 ,  76  and  81 , that moving anchor driver lever  1120  so as to cause it to rotate counterclockwise (with respect to  FIGS. 75 and 81 ) to the point where driver lever teeth  1121  mesh with proximal teeth  1127  on intermediate driver rack  1122 , will drive intermediate driver rack  1122  distally, which in turn, will cause small anchor driver pinion and large anchor driver pinion  1123  and  1124  to rotate counterclockwise, which, in turn, will drive anchor driver rack  1125 , straight anchor driver tube  1208 , anchor driver tube coupling  1207 , distal anchor driver tube  1450 , and thus, anchor driver assembly  1460 , distally. As may be appreciated from, for example,  FIGS. 59 and 60 , when the instrument is fully assembled and being used, this distal movement of anchor driver assembly  1460  drives anchors  700  into the tissues. 
   Positioner lever  1110  and anchor driver lever  1120  abut one another in side-by-side relationship, and both are mounted upon and pivot about axle  1113 . Positioner lever  1110  and anchor driver lever  1120  are formed so as to have cooperating features where they abut, such that counterclockwise movement of positioner lever  1110  effects corresponding counterclockwise movement of anchor driver lever  1120  (with respect to  FIG. 75 ). Driver lever spring  1126 , in tension, is connected between a hook or other suitable attachment point in housing  1101  and an attachment point on the shorter portion of anchor driver lever  1120  as shown. Thus, anchor driver lever  1120  is biased in a clockwise direction (with respect to  FIG. 75 ). 
   Additionally, anchor driver lever  1120  is prevented from being depressed prior to activation of anchor positioner lever  1110 . Driver lever locking hook  1172  is pivotably mounted on and may rotate about a pin supported in housing  1101  as shown, and is biased in a counterclockwise direction by spring  1171  in compression, such that it hooks over a pin  1169  transversely protruding from the shorter portion of anchor driver lever  1120  at the position shown, preventing driver lever  1120  from moving counterclockwise (the pin is not directly shown; it protrudes from the back side of the component with respect to  FIG. 75 ). However, when positioner lever  1110  is depressed, locking hook release member  1112  thereon engages locking hook  1172  and urges it in a clockwise direction (with respect to  FIG. 75 ), which causes it to disengage from pin  1169 , thereby releasing anchor driver lever  1120  so that it may move in a counterclockwise direction. 
   Additionally, when the instrument is ready for use, but prior to deployment, anchor driver rack  1125  (and thus, anchor driver assembly  1460 ) is locked in a proximal position, by engagement of locking latch  1178  of driver/positioner locking lever  1170 , with driver rack notch  1173 . When actuation of the instrument is begun by pulling and thereby rotating positioner lever  1110  counterclockwise, moving positioner tube actuator rack  1160  distally as previously described, a notch  1174  at the proximal end  1177  of positioner tube actuator rack  1160  moves beneath locking latch  1178  of driver/positioner locking lever  1170 , and locking latch  1178  moves into notch  1174  by urging of spring  1171 . As locking latch  1178  moves into notch  1174 , it moves out of driver rack notch  1173 , releasing driver rack  1125  so that it may be driven by pulling anchor driver lever  1120  as previously described. 
   Thus, it may be appreciated from the above description and from  FIGS. 73-82 , that when the instrument is assembled and made ready for use, positioner assembly  1440  is in a closed position, and anchor driver assembly  1460  is held closed by anchor closing collar  1330  and locked in a proximal position with respect to positioner assembly  1440 , placing the instrument in position to facilitate insertion into the patient. After insertion of the instrument into proper position within the patient with the end effector assembly within a lumen, actuation may be commenced by pulling positioner lever  1110  to the position in which it opens positioner assembly  1440  and is locked in such position by driver/positioner locking lever  1170  under urging of spring  1171 . When driver/positioner locking lever  1170  locks positioner lever  1110 , it simultaneously unlocks anchor driver rack  1125  by disengaging driver positioner locking latch  1178  from driver rack notch  1173 , freeing anchor driver rack  1125  to be driven in a distal direction. Anchor driver assembly  1460  may then be opened by pulling closing tube latching collar  1180  distally until it engages latch base  1179 , and rotating latching collar  1180  to latch into latch base  1179 . Anchor driver rack may then be driven in a distal direction (to drive anchors) by pulling anchor driver lever  1120 . After anchors are driven, spring  1126  in tension urges anchor driver lever  1120  to return, thus causing anchor driver rack  1125  and correspondingly anchor driver assembly  1460  to return to their original proximal positions (and pulling anchor driver pins out of anchors installed into tissues). Anchor driver assembly  1460  may then be returned a closed position by rotating and disengaging closing tube latching collar  1180  from latch base  1179 , which allows latching collar  1180  to return to its distal position urged by spring  1181 , moving closing collar  1330  distally and causing it to close anchor driver assembly  1460 . Finally, positioner assembly  1440  may be closed by depressing driver/positioner locking lever  1170 , which lifts driver/positioner locking latch  1178  from notch  1174  in the proximal end  1177  of positioner tube actuator rack  1160 , allowing positioner tube actuator rack  1160  to return to a proximal position under urging of positioner tube spring  1161 , closing positioner assembly  1440 . Thus, the instrument is returned to a closed position ready for withdrawal from the patient. 
   Referring to  FIGS. 55 ,  64 ,  65  and  75 , it may be appreciated that catheter tube  1420  may be routed through handle assembly  1100 , and through the entire instrument, to balloon assembly  1410 , where it may be affixed to harness collar  1433 . In one embodiment the catheter tube  1420  may extend proximally through the handle housing  1101  and out of the rear of the instrument  1000  as shown in  FIG. 75 . Anchor driver rack  1125  may be hollow, or may have a channel and “U”-shaped cross-section, and driver/positioner locking lever  1170  and handle housing  1101  may have suitable holes or other features, to accommodate passage of catheter tube  1420  therethrough. When the instrument is readied for use to install anchors, catheter tube  1420  may be releasably gripped at or within handle assembly  1110  by any suitable means so as to be held stationary with respect to handle housing  1101 , placing it in tension with respect to positioner assembly  1440  when positioner assembly  1440  is longitudinally compressed against harness collar  1433  to cause positioner assembly  1440  to open. After the instrument has been actuated to drive anchors and returned a closed position, catheter tube  1420  may then be released to permit withdrawal of all components except for catheter tube  1420  and balloon assembly  1410 , for use in completing the anastomosis procedure as described above. 
   Levers  1110 ,  1120  and  1170  and positioner tube actuator rack  1160  may be formed of any material having suitable properties of strength, stiffness and formability or moldability, including polymeric materials. 
   Small anchor driver pinion  1123 , large anchor driver pinion  1124 , anchor driver intermediate rack  1122 , anchor driver rack  1125 , positioner tube actuator rack  1160  and driver lever locking hook  1172  may be made of any material having suitable strength for small mechanical components, including steel or high-strength polymers. 
   The above-described embodiment is only one example describing portions of an instrument that may be used for one or more of the bringing and holding of the bladder in contact with the pelvic floor with the openings in the bladder and urethra aligned, driving anchors through the bladder wall and into the pelvic floor and securing a harness within the bladder lumen, inflating a balloon within the harness and thereby applying pressure to the bladder wall to effect knitting of the bladder wall with the pelvic floor, and draining urine from the bladder during the time required for recovery and healing, to effect an anastomosis between the bladder and the urethra following a prostatectomy. 
   It will be appreciated by one skilled in the art that the components described above may have alternative configurations and embodiments useful for effecting the same steps. It will be appreciated by one skilled in the art that the components described above may, alternatively, be designed and configured so as to be useful for effecting the above-described steps in a retrograde direction rather than an antegrade direction as described above. 
   It can be appreciated by one skilled in the art that the mechanism comprising the positioner assembly  1440  and performing the bladder positioning function thereof may have a variety of alternative configurations including but not limited to embodiments described herein (and thus including, without limitation, the positioner assembly  400 , shuttlecock assembly  800  with positioner petals  830  ( FIGS. 17-21 ), umbrella assembly  900  with reverse positioner petals  930  ( FIGS. 22-27 ), described above, or positioner  2017  ( FIGS. 122-126 ),  2090  ( FIGS. 110-118 ),  2122  ( FIGS. 95 ,  96 ,  103 - 109 ) and  2168  ( FIGS. 83 ,  84 ,  89 - 94 ) (all of which are described below)), providing a transversely retractable and extendible device useful for, referring to  FIG. 2 , insertion in a retracted position in a retrograde direction through the urethra  5  and into bladder opening  4 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned; or alternatively, insertion in a retracted position in an antegrade direction through an incision in the abdomen and an upper surface of the bladder  1 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned. Generally, the positioner assembly may comprise and make use of any number of alternately extendable and retractable projections, petals, arms, claws, or other grasping or catching members for catching and gaining control of bladder wall  2  surrounding bladder opening  4 . The positioner assembly may have at least one member operably connected to a longitudinal member of the instrument and alternately extendable transversely from and retractable toward the longitudinal axis thereof in response to input by a surgeon at a proximal end of the instrument. 
   Alternatively, it can be appreciated by one skilled in the art that when an anchor driver assembly is included with the instrument, that is functional to open and subsequently drive anchors through the bladder wall and into the pelvic floor as described herein, the positioner assembly or positioner arms as shown may be dispensed with in some circumstances. For example, referring to  FIGS. 58-61 , it can be appreciated that anchor driver pins  1463  and anchors  700 , when opened within the bladder lumen and pushed downwardly until the distal ends of anchors  700  contact and possibly puncture bladder wall  2  surrounding bladder opening  4 , can be sufficient for use in capturing bladder wall  2  and pushing it downward into contact with, and securing it to, pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, without the need for positioner assembly  1400  as shown, in some circumstances. Thus, anchor driver assembly  1460  with anchors  700  may serve a dual function as a positioner and as an anchor driver assembly. 
   Alternative Balloon/Harness Embodiment 
     FIG. 136  depicts another exemplary embodiment of an instrument  3000  of the present invention, adapted for use in effecting the anastomosis of the bladder and urethra tissues following a radical prostatectomy in accordance with a method of the present invention. The instrument may comprise a handle assembly  3100 , a tube assembly  3200  and an end effector assembly  3400 . End effector assembly  3400  is adapted to facilitate retrograde insertion into and through a patient&#39;s urethra  5  and into the bladder lumen  8  through bladder opening  4 . It will be understood by those skilled in the art that instrument  3000  can, alternatively, be designed and configured in an embodiment to be effective to perform steps substantially similar to those herein described via insertion from an antegrade direction, i.e., through incisions through the abdomen and an upper surface of the bladder (not shown), and downwardly through the bladder opening  4  and into urethra opening  6 . An example of such an embodiment is depicted and described in co-pending U.S. applications Ser. Nos. 60/639,836 and 60/582,302. 
     FIG. 135  is a longitudinal cross-sectional view of end effector assembly  3400  after insertion into and through the patient&#39;s urethra  5  and into the bladder opening  4 . It can be seen that end effector assembly  3400  may comprise distal end cap assembly  3410 , balloon harness  3430 , anchor driver assembly  3460 , and positioner assembly  3440 . End effector assembly  3400  and the assemblies it comprises, just identified, may be operably connected to, and controlled by, handle assembly  3100  (shown in  FIG. 136 ), via tube assembly  3200 , which may comprise spine tube  3210 , central rod or guide wire  3230 , inner positioner tube  3240 , outer positioner tube  3241 , anchor driver closing tube  3260  and anchor driver tube  3261 . These tubes and rod may be assembled so as to be substantially coaxial. Central rod or guide wire  3230  may pass through the length of the instrument within anchor driver closing tube  3260 , and may be affixed and made integral with end cap  3411  by any suitable means. Anchor driver closing tube  3260  may be longitudinally movable with respect to central rod or guide wire  3230 , and may be affixed and made integral with anchor closing collar  3464  by any suitable means. Anchor driver closing tube  3260  may be located within anchor driver tube  3261 , and may be longitudinally movable with respect thereto. Anchor driver tube  3261  may be affixed and made integral with anchor pivot arm yoke  3467  by any suitable means. Anchor driver tube  3261  may be located within inner positioner tube  3240 , and may be longitudinally movable with respect thereto. Inner positioner tube  3240  may be affixed and made integral with positioner distal collar  3443  by any suitable means. Inner positioner tube  3240  may be located within outer positioner tube  3241 , and may be longitudinally movable with respect thereto. Outer positioner tube  3241  may be affixed and made integral with positioner proximal collar  3442  and spine tube  3210  by any suitable means. Tubes  3210 , 3241 , 3240 , 3261  and  3260 , and rod  3230 , may be made of nitinol or any other material having suitable combined properties of strength, stiffness and biocompatibility as may be desirable for purposes of the present embodiment. The instrument also includes balloon harness  3430 , which is attached at a distal end to end cap assembly  3410 , and releasably attached at proximal ends to anchors  700 . Anchors  700  are releasably held by the instrument as will be described below. Use of the present embodiment of an instrument and method, in accordance with the present invention, and remaining components and operation thereof, for effecting anastomosis of a patient&#39;s bladder and urethra following a radical prostatectomy, will now be described. 
   As previously noted, and as shown in  FIG. 135 , end effector assembly  3400  may be inserted into and through the patient&#39;s urethra in a retrograde direction and into the bladder opening  4 , and then into the bladder lumen as may be appreciated from  FIG. 136 .  FIG. 136  depicts the end effector assembly after insertion completely into the bladder lumen  8 , after anchor driver assembly  3460  and positioner assembly  3440  have been opened for use, and after positioner assembly  3440  has been brought into contact with bladder wall  2  and used to urge the bladder wall  2  surrounding the bladder opening into contact with the pelvic floor  7 . To open the positioner assembly  3440 , the surgeon holds spine tube  3210  and outer positioner tube  3241  stationary, and withdraws inner positioner tube  3240  proximally, using handle assembly  3100  (shown in  FIG. 136 ). This draws positioner distal collar  3443  toward positioner proximal collar  3442 . Positioner arms  3441  have upper segments hinged by any suitable means to positioner distal collar  3443  and lower segments hinged by any suitable means to positioner proximal collar  3442 , and also hinged together by any suitable means. Thus, drawing positioner distal collar  3443  toward positioner proximal collar  3442  in the manner described above causes positioner arms  3441  to fold outwardly and transversely with respect to the longitudinal axis of the instrument, as may be appreciated from a comparison of  FIGS. 135 and 136 . 
   Once positioner arms  3441  of positioner assembly  3440  are opened, the surgeon may manipulate the instrument to cause positioner arms  3441  to urge bladder wall  2  downward into contact with pelvic floor  7 , as may be appreciated from  FIG. 136 . It will also be appreciated from  FIG. 136  that the respective openings in the bladder and the urethra are aligned. 
   The surgeon may open the anchor driver assembly  3460  by holding anchor driver closing tube  3260  stationary while withdrawing anchor driver tube  3261  proximally, or, alternatively, by holding anchor driver tube  3261  stationary while advancing anchor driver closing tube  3260  distally, again, via use of handle assembly  3100  (shown in  FIG. 136 ). As noted above, anchor pivot arm yoke  3467  is integral with anchor driver tube  3261 , and anchor closing collar  3464  is integral with anchor driver closing tube  3260 . Anchor pivot arms  3461  are pivotably connected to anchor pivot arm yoke  3467 , and are biased to swing outwardly by anchor pivot arm springs  3466 . As shown in  FIG. 135 , when anchor driver assembly  3460  is in a closed position, anchor closing collar  3464  sheaths and restrains anchor pivot arms  3461  in a retracted position. When anchor pivot arm yoke  3467  is urged proximally down and away from stationary anchor closing collar  3464 , or alternatively, when anchor closing collar  3464  is urged distally up and away from stationary anchor pivot arm yoke  3467 , anchor pivot arms  3461  are released from anchor closing collar  3464  and allowed to swing outwardly under urging of springs  3466 , as may be appreciated from a comparison of  FIGS. 135 and 136 . The angle at which anchor pivot arms  3461  swing outwardly as described above may be limited by, for example, suitable cooperating shapes of pivot arms  3461  and anchor pivot arm yoke  3467 , or, alternatively for example, by cooperating shapes and limiting the relative longitudinal travel between anchor closing collar  3464  and anchor pivot arms  3461 . 
   Referring to  FIG. 136 , it can be seen that anchor driver pin bases  3462  are pivotably connected to anchor pivot arms  3461 , and may be biased to swing inwardly with respect thereto by any suitable means, to assume a substantially downward orientation as shown in  FIG. 136 . Anchor driver pins  3463  may be affixed and made integral with anchor driver pin bases  3462 . Anchors  700  may be loaded onto anchor driver pins  3463  and held thereon by friction fit or any other suitable releasable means. Anchors  700  may include harness hooks  760  (as may be seen in greater detail in  FIG. 141 ). As may be appreciated from a comparison of  FIGS. 135 and 136 , anchors  700  may be moved outwardly and into a position ready for driving by opening anchor driver assembly  3460  as described above. 
   Referring now to  FIGS. 136 and 137 , using handle assembly  3100  (see  FIG. 136 ) the surgeon may drive anchors  700  downwardly through the bladder wall  2  and into tissues of the pelvic floor  7  by withdrawing anchor driver tube  3261 , which pulls anchor pivot arm yoke  3467 , and correspondingly, anchor pivot arms  3461 , anchor driver pin bases  3462 , anchor driver pins  3463 , and anchors  700 , downward. Anchor pivot arms  3461  and anchor driver pin bases  3462  may be situated on the instrument so that when driven downward, anchors  700  do not interfere with, and are driven down between, positioner arms  3441 . Anchors  700  may comprise barbs or other suitable lodging structures (not shown) on their shafts, so as to cause them to be lodged in and resist withdrawal from the tissues of the pelvic floor. 
   Referring now to  FIGS. 137 and 138 , the surgeon may retract the driver pins  3463  from the now-installed anchors  700 , by advancing anchor driver tube  3261  distally, which will move anchor pivot arm yoke  3467 , and correspondingly, anchor pivot arms  3461 , anchor driver pin bases  3462 , and anchor driver pins  3463 , distally upward. If anchors  700  are lodged or otherwise remain in the tissues of the pelvic floor  7 , anchor driver pins  3463  onto which anchors  700  are held by releasable means, will release from anchors  700 , leaving anchors  700  installed and lodged in the tissues as shown in  FIG. 138 . 
   Referring to  FIGS. 138 and 139 , again, using handle assembly  3100  (shown in  FIG. 136 ), the surgeon may close the anchor driver assembly, and return it to its original position to facilitate withdrawal from the patient, by distally advancing anchor driver tube  3261  while holding anchor driver closing tube  3260  stationary. Alternatively, the surgeon may proximally retract anchor driver closing tube  3260  while holding anchor driver tube  3261  stationary. Either sequence will bring anchor pivot arm yoke  3467 , and correspondingly, anchor pivot arms  3461 , within anchor closing collar  3464 , causing anchor pivot arms  3461  to be moved upwardly and inwardly relative to anchor closing collar  3464  and be sheathed and restrained thereby, as depicted in  FIG. 139 . 
   In final preparation for withdrawal of anchor driver and positioner assemblies, referring to  FIGS. 139 and 140 , the surgeon may retract positioner arms  3441  by distally advancing inner positioner tube  3240  while holding outer positioner tube  3241  and spine tube  3210  stationary. This moves positioner distal collar  3443  distally and away from positioner proximal collar  3442 , drawing positioner arms  3441  inwardly to the position shown in  FIG. 140 . 
   With the anchor driver and positioner assemblies retracted to the positions shown in  FIG. 140 , the surgeon may withdraw these assemblies from the patient by withdrawing, together as a group, spine tube  3210 , outer positioner tube  3241 , inner positioner tube  3240 , anchor driver tube  3261  and anchor driver closing tube  3260 , leaving behind end cap assembly  3410 , harness  3430  and anchors  700 , as may be seen by comparing  FIGS. 140 and 141 . Referring to  FIG. 141 , it can be seen that balloon harness  3430  has been attached to bladder walls  2  surrounding bladder opening  4 , which, in turn, may be held in contact with the tissues of pelvic floor  7  surrounding urethra opening  6 , by installed anchors  700 . Tails  3433  of harness  3430  may be held by anchors  700  by way of hooks  760  as shown or by any other suitable means. Central rod  3230  can now serve as a guide wire as will be described below, and may also be used to withdraw the remaining portions of the instrument following completion of the procedure. 
   It will be apparent to persons skilled in the art that a variety of mechanisms might be comprised by handle assembly  3100  and configured and adapted to transmit longitudinal (advancement and retraction) forces and movement to an end effector assembly  3400 , in order to effect and translate the forces and movement therein necessary to actuate the exemplary embodiments as described above. 
     FIG. 146  shows end cap assembly  3410  and balloon harness  3430  in more detail. End cap assembly  3410  may comprise drainage extension  3413  having thereon harness attachment neck  3415  and one or more drainage holes  3414 . End cap assembly  3410  may also include snap-in collar  3412  and end cap  3411 , which may be integrally formed or assembled. End cap  3411  may be connected or affixed to and made integral with central rod or guide wire  3230  by any suitable means. Balloon harness  3430  may include attachment collar  3431 , to fit around harness attachment neck  3415  and be held thereon by their respective cooperating shapes and dimensions. Balloon harness  3430  may also includes tails  3433  having therein anchor hook holes  3432 , through which anchor hooks  760  may pass, thus attaching balloon harness  3430  to anchors  700  (see, again,  FIG. 141 ). Balloon harness  3430  may be made of any suitable biocompatible polymer having properties of flexibility but effectively limited elasticity so as to render it suitable for remaining held in position and serving the balloon restraining function that will be described below. 
   Returning to  FIG. 141 , and also referring to  FIG. 142 , the next step in the exemplary method described herein is for the surgeon to insert balloon catheter assembly  3500  into the patient and into the balloon harness  3430  via central rod  3230 , serving as a guide wire. 
   Central rod  3230 , serving as a guide wire, may be provided with one or more markings along its length (not shown) that enable the surgeon to determine the distance that a balloon catheter assembly is inserted into the patient. By noting the length of the balloon catheter assembly and its position with respect to the one or more markings on central rod or guide wire  3230  after insertion, the surgeon can determine whether the catheter assembly has been inserted to the correct depth within the patient with respect to the harness and distal end cap assembly. 
   Referring to  FIGS. 142 ,  143  and  146 , balloon catheter assembly  3500  may comprise catheter tube  3510 , balloon  3520  attached thereto, and catheter end plug  3530 . Catheter tube  3510  may include inflation lumen  3511  and inflation port  3512 . Balloon  3520  may have proximal and distal portions attached in any substantially gas and/or fluid-tight manner at proximal and distal points on catheter tube  3510 , and may be ring-shaped upon inflation or otherwise have a central passage through which catheter tube  3510  passes, as may be appreciated from  FIG. 143 . Catheter end plug  3530  may comprise snap-in button  3531 , one or more drainage holes  3414 , and catheter tube insert  3534 , with stop collar  3535 . 
   Referring again to  FIG. 142 , upon insertion of balloon catheter assembly  3500 , snap-in button  3531  of catheter end plug  3530  cooperates with and snaps into snap-in collar  3412  of distal end cap assembly  3410 , and is held thereby. Referring to  FIGS. 142 and 143 , balloon  3520  may then be inflated, and have its internal pressure regulated, via inflation lumen  3511  and inflation port  3512  in catheter tube  3510 . Referring to  FIG. 143 , it may be seen that balloon  3520 , upon inflation, may expand outwardly between the straps of harness  3430 , and be used to exert pressure on the bladder walls  2  surrounding the bladder opening in order to, both, press bladder walls  2  into contact with the tissues of pelvic floor  7 , and seal off the bladder opening, pelvic floor and urethra from urine and other materials collecting in the bladder during recovery and healing. During recovery and healing, urine and other materials collecting in the bladder may be drained into catheter tube  3510  via drainage holes  3414  and  3533 , in distal end cap assembly  3410  and catheter end plug  3530 , respectively. During recovery and healing, catheter tube  3510  may be connected at a proximal end to a urine collection bag (not shown). 
   It may be appreciated that the combination of a harness structure anchored to the pelvic floor as depicted and described herein, constraining and holding the inflated balloon of a balloon catheter, has the desirable effect of constraining the catheter from substantial axial or longitudinal movement within the urethra during the period required for anastomosis. 
   Suitable gas or fluid pressure within balloon  3520  may be maintained until anastomosis is complete, by monitoring and adjusting the pressure within balloon  3520  through inflation lumen  3511 . About 1 to 6 p.s.i. pressure within the balloon may be suitable, and about 1.5 to 2.5 p.s.i. is preferred. The possibility of pressure necrosis in the tissues beneath the balloon may be reduced by including, for example, ribs or other bumps, nodules, projections, or other features (not shown) on the underside of balloon  3520 , which may be effective to reduce the loss of blood flow to tissue in contact with balloon  3520 . These features may be solid or of uniform wall thickness. Additionally, balloon  3520  may be designed with features that effect the shape that it assumes upon inflation, and thus, effect the shape and area of the lower surface of balloon  3520  that contacts the bladder wall  2  upon inflation. For example, balloon  3520  may be designed and manufactured so as to have walls that are thicker on an upper portion and thinner on a lower portion, so that the lower portion of balloon  3520  is predisposed to expand downwardly and outwardly between the harness straps, and thereby present a larger surface area to contact the bladder wall  2 . Alternatively, balloon  3520  may be designed and manufactured so as to have walls that are thicker on a lower portion and thinner on an upper portion, so that the upper portion of balloon  3520  is predisposed to inflate first, within the bladder lumen, and thereby draw the remaining portion of the balloon up into the bladder lumen, and substantially out of the pelvic floor region, before the lower portion fully inflates. Alternatively, balloon  3520  may be designed with features that cause it to assume other specific advantageous shapes upon inflation to, for example, fill a large portion of the space defined by the harness straps. 
   In order to facilitate inflation and assist in maintaining suitable gas or fluid pressure within balloon  3520 , a two-way check valve may be installed along the inflation gas or fluid passage including inflation lumen  3511 . For example, a two-way check valve may comprise a “duckbill” type valve or other valve that functions to permit gas or fluid to pass into inflation lumen  3511  but prevents gas or fluid from passing back out, in conjunction with a pressure release valve that functions to permit gas or fluid to pass out of the system if pressure within balloon  3520  and/or the fluid passage exceeds a desired maximum amount. 
     FIG. 144  depicts an alternative manner of attachment of balloon  3520  to the distal end of catheter tube  3510 . In comparison with balloon  3520  as depicted in  FIG. 143 , it can be seen in  FIG. 144  that the sheet-like material forming the upper wall of balloon  3520  has been attached to the distal end of catheter tube  3510  in inverted orientation, which may serve to enhance sealing at the attachment point and improve the balloon&#39;s ability to sustain gas or fluid pressure when inflated. 
   Following substantial completion of the anastomosis procedure, i e., following substantial knitting of the tissues of the bladder walls and the pelvic floor surrounding the respective openings of the bladder and the urethra, the balloon may be deflated and the balloon catheter assembly  3500  withdrawn from the patient. This leaves behind the end cap assembly  3410 , harness  3430  and anchors  700 , as may be seen by comparing  FIGS. 144 and 145 . Following withdrawal of the balloon catheter assembly, end cap assembly  3410  and harness  3430  may be withdrawn from the patient by proximally withdrawing central rod or guide wire  3230  (shown in progress in  FIG. 145 ). It can be seen in  FIG. 145  that the tails  3433  of harness  3430  may be removed from and released by harness hooks  760  of anchors  700  by inversion of the position of harness  3430 , and subsequent proximal tension exerted thereon, effected by withdrawing distal end cap assembly  3230 , causing harness tails  3433  to slide off attachment hooks  760 . Anchors  700  may be left behind in the patient. 
   As noted, central rod or guide wire  3230  may be attached to and made integral with end cap  3411  by any suitable means. When central rod or guide wire  3230  is made integral with end cap  3411 , it is substantially integral with the other components of end cap assembly  3410  as described herein, and thus also with attachment collar  3431  of balloon harness  3430 . As such, central rod or guide wire  3230  may be used for withdrawal of balloon harness  3430  following substantial completion of the anastomosis procedure. 
   The above-described embodiment is only one example describing portions of an instrument that may be used for one or more of the bringing and holding of the bladder in contact with the pelvic floor with the openings in the bladder and urethra aligned, driving anchors through the bladder wall and into the pelvic floor and securing a harness within the bladder lumen, inflating a balloon within the harness and thereby applying pressure to the bladder wall to effect knitting of the bladder wall with the pelvic floor, and draining urine from the bladder during the time required for recovery and healing, to effect an anastomosis between the bladder and the urethra following a prostatectomy. 
   It will be appreciated by one skilled in the art that the components described above may have alternative configurations and embodiments useful for effecting the same steps. It will be appreciated by one skilled in the art that the components described above may, alternatively, be designed and configured so as to be useful for effecting the above-described steps in an antegrade direction rather than a retrograde direction as described above. 
   It can be appreciated by one skilled in the art that the mechanism comprising the positioner assembly  3440  and performing the bladder positioning function thereof may have a variety of alternative configurations including but not limited to embodiments described herein (and thus including, without limitation, the positioner assembly  400 , shuttlecock assembly  800  with positioner petals  830  ( FIGS. 17-21 ), umbrella assembly  900  with reverse positioner petals  930  ( FIGS. 22-27 ), described above, or positioner  2017  ( FIGS. 122-126 ),  2090  ( FIGS. 110-118 ),  2122  ( FIGS. 95 ,  96 ,  103 - 109 ) and  2168  ( FIGS. 83 ,  84 ,  89 - 94 ) (all of which are described below)), providing a transversely retractable and extendible device useful for, referring to  FIG. 2 , insertion in a retracted position in a retrograde direction through the urethra  5  and into bladder opening  4 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned; or alternatively, insertion in a retracted position in an antegrade direction through an incision in the abdomen and an upper surface of the bladder  1 , extending or expanding within bladder lumen  8 , catching in bladder opening  4  and manipulating to urge bladder wall  2  surrounding bladder opening  4  into contact with pelvic floor  7  surrounding urethra opening  6  with the respective openings aligned. Generally, the positioner assembly may comprise and make use of any number of alternately extendable and retractable projections, petals, arms, claws, or other grasping or catching members for catching and gaining control of bladder wall  2  surrounding bladder opening  4 . The positioner assembly may have at least one member operably connected to a longitudinal member of the instrument and alternately extendable transversely from and retractable toward the longitudinal axis thereof in response to input by a surgeon at a proximal end of the instrument. 
   Alternatively, it can be appreciated by one skilled in the art that when an anchor driver assembly is included with the instrument, that is functional to open and subsequently drive anchors through the bladder wall and into the pelvic floor as described herein, the positioner assembly or positioner arms as shown may be dispensed with in some circumstances. For example, referring to  FIGS. 135 and 136 , it can be appreciated that anchor driver pins  3463  and anchors  700 , when opened within the bladder lumen and pushed downwardly until the distal ends of anchors  700  contact and possibly puncture bladder wall  2  surrounding bladder opening  4 , can be sufficient for use in capturing bladder wall  2  and pushing it downward into contact with, and securing it to, pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, without the need for positioner assembly  3440  as shown, in some circumstances. Thus, anchor driver assembly  3460  with anchors  700  may serve a dual function as a positioner and as an anchor driver assembly. 
   “H” Anchor Embodiment 
     FIG. 83  is a perspective view of another embodiment of an anastomotic instrument  2150  of the present invention, in its pre-deployment position, and  FIG. 84  is a longitudinal cross-sectional view of the distal end of the instrument, also shown in its pre-deployment position. The instrument may comprise anchor driver assembly  2151 , which may include outer driver assembly tube  2152 , having distal end  2154 , anchor driver tube  2155  which distally terminates with anchor driver pins  2156 , and inner driver assembly tube  2158  which distally terminates with anchor track collar  2159 . The described embodiment of the instrument may further comprise positioner tube  21 - 67 , positioner  2168  affixed to the distal end of positioner tube  2167 , rod  2170  and rod cap  2171 . When the instrument is assembled and prepared for use, anchor driver assembly  2151  may be loaded with one or more anchors  700 , each of which may comprise a forward member  750 , shaft  720  and rearward member  710 . 
   Referring to  FIG. 84  and as may be seen in more detail in  FIG. 86 , positioner tube  2167 , inner driver assembly tube  2158  distally terminating in anchor track collar  2159 , and outer driver assembly tube  2152 , may be assembled such that they are substantially coaxial. Anchor track collar  2159  and inner driver assembly tube  2158  may have in their outer surfaces one or more longitudinally-oriented anchor tracks  2160  which direct upwardly and radially outwardly, moving longitudinally, proximally to distally. Outer driver assembly tube  2152  may have one or more anchor storage grooves  2153  on its inside surface, situated opposite anchor tracks  2160 . When the instrument is assembled and ready for use, inner driver assembly tube  2158 , with anchor track collar  2159 , and outer driver assembly tube  2152 , are made integral with respect to each other by any suitable means. 
     FIG. 87  is an enlarged view of the forward end of an anchor that may be used in the present embodiment. Anchor  700  has forward member  750  which may have a sharp forward end  751 , and has shaft  720  which connects with a rearward member  710  (not shown in  FIG. 87 ). Anchor  700  may be manufactured so as to be biased with shape memory to assume an “H” shape, with the forward and rearward members forming the vertical legs and the connecting member forming the horizontal connection of the “H”, and may be made of a material having suitable properties of strength, flexibility, shape memory, non-reactivity with body tissues and fluids, and biocompatibility. Anchor  700  may also be made of one or more dissolving bioabsorbable materials. Anchor  700  may, alternatively, be manufactured in a variety of suitable shapes as depicted in  FIGS. 40-51 , and one of the embodiments of the instrument described herein suitably adapted for use with such anchors substantially as hereinafter described. 
     FIGS. 84 and 86  depict anchors  700  loaded into the instrument of the present embodiment, ready for deployment. As can be seen from the drawings, as loaded, anchors  700  reside in the spaces defined by anchor tracks  2160  and anchor storage grooves  2153 . As can be appreciated from the drawings, the spaces defined by the anchor tracks  2160  and anchor storage grooves  2153  restrain the anchors  700  while the anchors are loaded in the instrument, holding them such that forward lodging lodging members  750  and penetration limiting members  710  are positioned lying longitudinally alongside connecting members  720 . 
   As can be seen in  FIGS. 84 and 86 , when the instrument is ready for use, anchor driver pins  2156  also reside in anchor tracks  2160  with their distal ends behind the forward lodging lodging members  750  in a position ready for driving anchors  700  as will be hereinafter described. Anchor driver pins  2156  are integral with a distal end of anchor driver tube  2155  (shown in  FIG. 83 ). Anchor driver tube  2155  is longitudinally movable with respect to outer driver assembly tube  2152  and inner driver assembly tube  2158 . Anchor driver pins  2156  are formed from a suitable flexible, shape memory material such as nitinol, and are biased so as to be substantially straight in their natural positions. 
   As may be seen in  FIG. 87 , the end of anchor driver pin  2156  may have a recess  2157  or any other suitable feature for receiving and holding forward member  750  during the anchor driving step as will be hereinafter described. 
   The instrument may comprise one or more anchors, and the associated tracks, grooves and anchor driver pins described above, situated about the instrument in positions such that upon correct rotational orientation of the instrument, the anchors may be driven upwardly and radially outwardly into tissues in directions selected to avoid nerve and/or circulatory system bundles or other sensitive areas. 
   Referring again to  FIG. 84 , the instrument of the present embodiment also includes positioner tube  2167 . Affixed at the distal end of positioner tube  2167  is positioner  2168 , shown in its pre-deployment shape in  FIGS. 83 and 84 . The pre-deployment shape of positioner  2168 , shown in  FIGS. 83 and 84 , facilitates insertion of the instrument into the patient. Positioner  2168  may be made of a suitable elastic and flexible polymeric material having shape memory, manufactured so as to be biased to assume a normally transversely-oriented shape such as, for example, that shown in  FIG. 89 , upon retraction of rod  2170 . As shown in  FIG. 89 , positioner  2168  may have, about its perimeter, one or more drainage holes  2169  which can permit urine, fluids or clotted material to drain into positioner tube  2167  after the instrument has been deployed. Positioner  2168  is alternately moved to its pre-deployment position shown in  FIGS. 83 and 84 , or allowed to return via shape memory to its normal (deployed) position shown in  FIG. 89 , by longitudinal movement of rod  2170 , and correspondingly, end cap  2171 , which is integrally affixed to rod  2170 . Positioner tube  2167  is longitudinally movable with respect to inner driver assembly tube  2158 , and vice versa. 
   Outer driver assembly tube  2152 , anchor driver tube  2155 , inner driver assembly tube  2158 , positioner tube  2167  and rod  2170  may be made of one or more materials having suitable combined properties of shape memory, flexibility, strength and stiffness that both enable the tubes and rod to flex during insertion into the patient&#39;s body and through the urethra as will be hereinafter described, but also will prevent them from collapsing, kinking, binding, or breaking during use. The selected materials may also be substantially non-reactive with body fluids and tissues, and be substantially biocompatible. The inventors have determined that nitinol, known in the art as suitable for a variety of surgical devices and tubes, is one example of a suitable material. 
   It will be appreciated that a hollow tube may be used in the instrument for positioner tube  2167  when a coaxial arrangement with rod  2170  is desirable, or when positioner tube  2167  is to serve as a catheter, such as will be further described below, but that a rod may be substituted for positioner tube  2167  and be used to provide substantially the same mechanical function, i.e., transmission of forces to actuate the positioner, and thus may be used when a catheter function, or a coaxial arrangement, and thus a tube, is not required. Conversely, a tube can serve the purpose of rod  2170 . Thus, for purposes of claims set forth, unless otherwise specified in a claim, the term “tube” where such element is operably affixed or connected with, or contacts, the positioner, is intended to include and cover a rod, and vice versa. 
   A method for performing anastomosis in a retrograde manner using the above-described instrument, following a prostatectomy, will now be described. Following a prostatectomy, the patient&#39;s bladder  1  and urethra opening  6  are separated by a void formerly occupied by the prostate, as shown in  FIG. 2 . It is necessary to connect the bladder  1  with the urethra  5 , with bladder opening  4  and urethra opening  6  aligned, to restore urinary functions after recovery and healing. 
   As shown in  FIG. 88 , the anastomotic instrument is inserted upwardly into and through the patient&#39;s urethra  5 , through the bladder opening  4 , and into the bladder  1 . The surgeon then retracts rod  2170  and correspondingly, end cap  2171 , which allows positioner  2168  to assume its normal transversely-oriented shape via shape memory, as shown in  FIG. 89 . The now-transverse orientation of positioner  2168  prevents it from being retracted without pulling bladder wall  2  surrounding bladder opening  4  with it. 
   Next, the surgeon retracts the entire instrument downwardly through the urethra, which causes positioner  2168  to pull bladder walls  2  surrounding bladder opening  4  into contact with pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, to the position shown in  FIG. 90 . 
   Next referring to  FIG. 91 , anchor driver tube  2155  is moved longitudinally upwardly and distally, which correspondingly causes anchor driver pins  2156  to move upwardly and distally, inside anchor tracks  2160 , and then upwardly and radially outwardly, driving forward lodging lodging members  750  of anchors  700  upwardly and radially outwardly, first into and through the tissues of the pelvic floor  7  surrounding the urethra opening  6 , and then into and through the tissues of the bladder wall  2  surrounding the bladder opening  4 , and into the bladder, as shown in  FIG. 91 . As may be seen in  FIG. 91 , as forward lodging lodging members  750  are driven into the tissues, connecting members  720  trail behind forward lodging lodging members  750 , into place in the tissues. Anchor driver tube  2155  and correspondingly anchor driver pins  2156  are then retracted back into the instrument, releasing lodging members  750  of anchors  700 . When lodging members  750  of anchors  700  are released by retraction of anchor driver pins  2156 , they are no longer restrained from their normal biased positions, and lodging members  750  move under bias and contact with the bladder wall to a position substantially transverse to the axes of connecting members  720  as may be seen in  FIG. 92 , such that lodging members  750  prevent anchors  700  from retracting back through the holes in the tissues made by lodging members  750  during the driving step, and thus, serve to lodge the anchors in the tissues. Similarly, when penetration limiting members  710  are pulled out of the instrument, they are no longer restrained from their normal biased positions, and penetration limiting members  710  move under bias and contact with the urethra wall to a position substantially transverse to the axes of connecting members  720  as may be seen in  FIG. 92 , such that penetration limiting members  710  may not be pulled through the holes in the tissues made by lodging members  750  during the driving step, and thus serve to limit further penetration of anchors  700  into the tissues. Upon completion of installation of anchors  700 , as can be seen in  FIG. 92 , anchors  700  hold the tissues of bladder wall  2  surrounding bladder opening  4  in contact with the tissues of pelvic floor  7  surrounding urethra opening  6 , with the bladder opening  4  and urethra opening  6  aligned. Thus held in contact, the tissues of the bladder wall  2  and pelvic floor  7  may knit and heal together with the bladder opening and urethra opening aligned. 
   Next, the entire anchor driver assembly, comprising inner driver assembly tube  2158  and anchor track collar  2159 , anchor driver tube  2155 , and outer driver assembly tube  2152 , may be retracted as a unit (as shown in progress in  FIG. 92 ), down the urethra and out of the patient&#39;s body, leaving behind positioner tube  2167 , positioner  2168  and rod  2170 . Remaining positioner  2168  and positioner tube  2167  may now be used to exert supplemental downward pressure on bladder walls  2  surrounding the bladder opening  4  so as to enhance contact and knitting between the tissues of bladder walls  2  surrounding the bladder opening  4 , and the tissues of pelvic floor  7  surrounding the urethra opening  6 . Additionally, or alternatively, positioner  2168 , including drainage holes  2169 , and positioner tube  2167 , may now be used to seal off the junction between the bladder and urethra and drain urine and other fluids from the bladder during recovery and healing. Used for this purpose, positioner tube  2167  would be connected to a urine collection bag (not shown) via intermediate tubing. Following recovery and healing, rod  2170  and correspondingly end cap  2171  are moved longitudinally upwardly and distally with respect to positioner tube  2167 , thus urging positioner  2168  into its pre-deployment position as shown in  FIGS. 83 and 84 , and enabling retraction of these remaining parts of the instrument out of the bladder, down through the urethra, and out of the patient&#39;s body. 
     FIGS. 93 and 94  depict an alternative embodiment and alternative loaded anchor positions for the instrument of the present invention. As can be seen, in this embodiment anchor driver pins  2156  include rear driver steps  2172 , which function to drive penetration limiting members  710  of anchors  700  at the same time the distal ends of anchor driver pins drive forward lodging lodging members  750  of anchors  700 . The geometry of outer driver assembly tube  2152 , anchor storage groove  2153  and/or anchor track  2160  are suitably modified accordingly. With this alternative embodiment, tension in shaft  720  during the driving step may be avoided and driving and ejection of the anchor from the instrument may be eased. Additionally, as depicted in  FIG. 94 , in this alternative embodiment anchors  700  may be loaded with forward lodging lodging members  750  and penetration limiting members  710  oriented in opposite directions as shown, which may serve to improve the positioning of rearward member  710  in the urethra after actuation of the anchor driver assembly and driving of the anchors. 
   Those skilled in the art will appreciate that a variety of simple mechanical devices may be configured or adapted to operate and manipulate and outer driver assembly tube  2152  and inner driver assembly tube  2158 , anchor driver tube  2155 , positioner tube  2167  and rod  2170 , at the proximal end of the instrument as required by the above steps, and so as to move and hold the instrument in respective pre-deployment and/or retracted, and deployed and first and second actuated, positions, including but not limited to the handle assembly now to be described. 
   The right-hand side of  FIG. 83 , and  FIG. 85 , depict an example of a simple proximal end handle assembly  2200  which may be designed and configured to enable the surgeon to control and manipulate various embodiments of the instrument. Handle assembly  2200  comprises rod  2201  having affixed knob  2202 , fourth tube  2203 , third tube  2204  with integral stop collar  2205 , second tube  2207  with integral actuation collar  2209 , and first tube  2210 . Tubes  2210 ,  2207 ,  2204  and  2203 , and rod  2201 , may be substantially coaxial. Rod  2201  is longitudinally slidable with respect to fourth tube  2203 . Fourth tube  2203  is longitudinally slidable with respect to third tube  2204  and stop collar  2205 , and vice versa. First tube  2210  may be connected to third tube  2204  via connecting pins  2211 , thus making first tube  2210  and third tube  2204  integral. Second tube  2207  is coaxially located between first tube  2210  and third tube  2204 , and is longitudinally slidable therewithin, to the limits defined by longitudinal slots  2208  in second tube  2207  about pins  2211 . 
   Thus, it can be appreciated from  FIGS. 84 and 85  that handle assembly  2200  may be connected and made usable by the surgeon to manipulate and operate anastomotic instrument  2150  by connecting, or making integral, rod  2201  and rod  2170 , fourth tube  2203  and positioner tube  2167 , third tube  2204  and inner driver assembly tube  2158 , second tube  2207  and anchor driver tube  2155 , and first tube  2210  and outer driver assembly tube  2152 . As so configured, second tube  2207  may be longitudinally slid with respect to the remaining parts of the assembly by the surgeon gripping tube actuation collar  2209 , thus advancing or retracting anchor driver tube  2155  and correspondingly anchor driver pins  2156 , thereby actuating anchor driver assembly  2151 . Following installation of the anchors, the entire anchor driver assembly  2151  may be retracted from the patient&#39;s body by the surgeon gripping and pulling first tube  2210 , thus also retracting third tube  2204  via connecting pins  2211  and second tube  2207 , and correspondingly, retracting outer anchor driver assembly tube  2152 , inner driver assembly tube  2158 , and anchor driver tube  2155 . This can be accomplished while leaving behind fourth tube  2203  and rod  2201 , and thus positioner tube  2167  and rod  2170 , as described above. 
   It will be appreciated by those skilled in the art of design of mechanical surgical devices that the positioner need not be limited to the exemplary embodiment made of flexible and elastic polymeric shape memory material as described above, but that alternative designs for such positioner are possible, which cause the positioner to alternately assume a retracted position and a deployed position, the deployed position suitable for catching in the bladder opening and urging the bladder into contact with the pelvic floor, in response to forces exerted or transmitted by tubes or other members. The positioner may comprise, for example, any of the positioner assemblies depicted in  FIGS. 14 ,  19 ,  24  and  57 , and described hereinabove. Similarly, it will be appreciated by those skilled in the art of design of mechanical surgical devices that the anchor driver assembly need not be limited to the exemplary three-tube assembly described herein, but that alternative designs for such an assembly are possible, which are effective to install one or more anchors into the tissues of the bladder and the urethra about the respective openings when they are brought together, in response to forces exerted or transmitted by tubes or other members. 
   As previously noted, the combination of tubes, positioner and driver assembly may be configured in an instrument adapted for a retrograde anastomosis procedure, as described above, or configured in an instrument adapted for an antegrade procedure. In an antegrade procedure, instead of being inserted upwardly through the urethra and into the bladder opening proximate the site of excision of the prostate, the instrument is inserted downwardly through a small incision in the patient&#39;s abdomen, through a small incision on an upper surface of the patient&#39;s bladder, into the bladder, through the bladder opening, and into the urethra opening. The small incisions in the abdomen and upper surface of the bladder may be made and held open for insertion of the instrument therethrough with a cannula and trocar assembly. 
   Connecting Anchor Embodiment 
     FIG. 95  is a perspective view of another embodiment of an anastomotic instrument  2100  of the present invention, in its pre-deployment position, and  FIG. 96  is a longitudinal cross-sectional view of the distal end of the instrument, also shown in its pre-deployment position. The instrument may comprise anchor driver assembly  2101 , which may include outer driver assembly tube  2102 , having distal end  2104 , second anchor track collar  2105 , anchor driver tube  2109  which distally terminates with anchor driver pins  2108 , and inner driver assembly tube  2110  which distally terminates with first anchor track collar  2112 . The present embodiment may further comprise positioner tube  2121 , positioner  2122  affixed to the distal end of positioner tube  2121 , rod  2124  and rod cap  2125 . When the instrument is assembled and prepared for use, anchor driver assembly  2101  may be loaded with one or more anchor pairs, each pair comprising first anchor  700  with an attached length of suture  2117 , and second anchor  701 . 
   Referring to  FIG. 96  and as may be seen in more detail in  FIGS. 97 and 98 , positioner tube  2121 , inner driver assembly tube  2110  distally terminating in first anchor track collar  2112 , second anchor track collar  2105 , and outer driver assembly tube  2102 , may be assembled such that they are substantially coaxial, with first anchor tracks  2111 , second anchor tracks  2106  and anchor driver pins  2108  longitudinally aligned. First anchor track collar  2112  may have in its outer surface one or more longitudinally-oriented first anchor tracks  2111  including suture clearance tracks  2113 , which direct upwardly and radially outwardly, moving longitudinally, proximally to distally. Second anchor track collar  2105  may have in its outer surface one or more longitudinally-oriented second anchor tracks  2106 , which also direct upwardly and radially outwardly, moving longitudinally, proximally to distally. Second anchor track collar  2105  also has suture clearance tracks  2107  on its inside surface, situated opposite suture clearance tracks  2113  in first anchor track collar  2112 , and one or more longitudinally-oriented suture storage grooves  2103  on its outer surface. Distal end  2104  of outer driver assembly tube  2102  may have on its outer surface one or more longitudinally-oriented suture storage grooves  2103 , that align with and thereby form extensions of suture storage grooves  2103  on second anchor track collar  2105 . When the instrument is assembled and ready for use, inner driver assembly tube  2110 , with first anchor track collar  2112 , second anchor track collar  2105 , and outer driver assembly tube  2102 , may be made integral with respect to each other by any suitable means. 
     FIGS. 99-101  are enlarged views of exemplary anchors that may be used in the present embodiment. First anchor  700  may have barb  730  and suture holes  735 . Suture holes  735  may be used to attach a length of trailing suture or other suitable connecting member to first anchor  700  in preparation for use. Second anchor  701  may have barb  731  and suture notch  752 . Suture notch  752  is shaped and sized so as to be effective to capture and bindingly hold a free end of suture or other suitable connecting member as will be hereinafter described. Anchors  700  and  701  may be manufactured so as to be biased to assume the shapes shown in  FIGS. 99-101 , and may be made of a material having suitable properties of strength, flexibility, shape memory, non-reactivity with body tissues and fluids, and biocompatibility. Anchors  700  and  701  may also be made of dissolving bioabsorbable materials, or may be made of suitably treated nitinol or surgical stainless steel. 
     FIGS. 96-98  depict first anchors  700  and second anchors  701  loaded into the present embodiment of an anastomotic instrument, ready for deployment. As can be seen from the drawings, as loaded, first anchors  700  may reside in the spaces defined by first anchor tracks  2111  and the interior surface of second anchor track collar  2105 . Similarly, second anchors  701  may reside in the spaces defined by second anchor tracks  2106  and the interior surface of outer driver assembly tube  2102 . As can be appreciated from the drawings, the spaces defined by the anchor tracks  2111  and  2106  restrain the barbs  730  and  731  of anchors  700  and  701  while the anchors are loaded in the instrument. Sutures  2117  or other suitable connecting members may be attached to the rear ends of first anchors  700  via suture holes  735  (shown in  FIG. 99 ) and trail from the rear ends of first anchors  700 , upwardly through suture clearance tracks  2107 , radially out and over second anchor track collar  2105 , and downwardly in suture storage grooves  2103 , terminating with free ends. 
   As can be seen in  FIGS. 96-98 , when the instrument is ready for use anchor driver pins  2108  reside in first anchor tracks  2111  with their distal ends behind anchors  700  in preparation for driving first anchors  700  as will be hereinafter described. Anchor driver pins  2108  are integral with a distal end of anchor driver tube  2109  (shown in  FIG. 95 ). Anchor driver tube  2109  is longitudinally movable with respect to outer driver assembly tube  2102  and inner driver assembly tube  2110 . Anchor driver pins  2108  are made of a suitable flexible, shape memory material such as nitinol, and are biased so as to have their distal ends spring radially outwardly upon repositioning in preparation for driving second anchors  701 , as will be described below. 
   The instrument may comprise one or more pairs of anchors, each pair comprising a first anchor and a second anchor, and the associated tracks, grooves and anchor driver pins described above, situated radially about the instrument in positions such upon correct rotational orientation of the instrument, the anchors may be driven into tissues in directions selected to avoid nerve and/or circulatory system bundles or other sensitive areas. 
   Referring again to  FIG. 96 , the instrument of the present embodiment also may include positioner tube  2121 . Affixed at the distal end of positioner tube  2121  is positioner  2122 , shown in its pre-deployment shape in  FIGS. 95 and 96 . The pre-deployment shape of positioner  2122 , shown in  FIGS. 95 and 96 , can facilitate insertion of the instrument into the patient. Positioner  2122  may be made of a suitable elastic and flexible polymeric material having shape memory, manufactured so as to be biased to assume a normally transversely-oriented shape as shown in  FIG. 103 , upon retraction of rod  2124 . As shown in  FIG. 103 , positioner  2122  may have, about its perimeter, one or more drainage holes  2123  that can permit urine, fluids or clotted material to drain into positioner tube  2121  after the instrument has been deployed. Positioner  2122  may be, alternately, moved to a pre-deployment position shown in  FIGS. 95 and 96 , or allowed to return via shape memory to a normal (deployed) position shown in  FIG. 103 , by longitudinal movement of rod  2124 , and correspondingly, end cap  2125 , which may be integrally affixed to rod  2124 . Positioner tube  2121  is longitudinally movable with respect to inner driver assembly tube  2110 , and vice versa. 
   Outer driver assembly tube  2102 , anchor driver tube  2109 , inner driver assembly tube  2110 , positioner tube  2121  and rod  2124  may be made of a material having suitable combined properties of shape memory, flexibility, strength and stiffness that both enable the tubes and rod to flex during insertion into the patient&#39;s body and through the urethra as will be described below, but also will prevent them from collapsing, kinking, binding, or breaking during use. The selected material may also be substantially non-reactive with body fluids and tissues, and be substantially biocompatible, or be non-biocompatible with a biocompatible coating. The inventors have determined that nitinol, known in the art as suitable for a variety of surgical devices and tubes, is one example of a suitable material. 
   It will be appreciated that hollow tubes may be used in the instrument for positioner tube  2121  when a coaxial arrangement with rod  2124  is desirable, or when positioner tube  2121  is to serve as a catheter, such as will be further described below, but that a rod may be substituted for positioner tube  2121  and be used to provide substantially the same mechanical function, i.e., transmission of forces to actuate the positioner, and thus may be used when a catheter function, or a coaxial arrangement, and thus a tube, is not required. Conversely, a tube can serve the purpose of rod  2124 . Thus, for purposes of the claims set forth herein, unless otherwise specified in a claim, the term “tube” where such element is operably affixed or connected with, or contacts, the positioner, is intended to include and cover a rod, and vice versa. 
   A method for performing anastomosis of a patient&#39;s bladder and urethra using the above-described anastomotic instrument, following a prostatectomy, will now be described. Following a prostatectomy, the patient&#39;s bladder  1  and urethra opening  6  are separated by a void formerly occupied by the prostate, as shown in  FIG. 2 . It is necessary to connect the bladder  1  with the urethra  5 , with bladder opening  4  and urethra opening  6  aligned, to restore urinary functions after recovery and healing. 
   As shown in  FIG. 102 , the anastomotic instrument may be inserted upwardly into and through the patient&#39;s urethra  5 , through the bladder opening  4 , and into the bladder  1 . The surgeon then may retract rod  2124  and correspondingly, end cap  2125 , which will permit positioner  2122  to assume its normal shape via shape memory, as shown in  FIG. 103 . The now-transverse orientation of positioner  2122  will prevent it from being retracted without pulling bladder wall  2  surrounding bladder opening  4  with it. 
   Next, the surgeon may retract the entire instrument downwardly through the urethra, which will cause positioner  2122  to pull bladder walls  2  surrounding bladder opening  4  into contact with pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, to the position shown in  FIG. 104 . 
   Next referring to  FIG. 105 , anchor driver tube  2109  may be moved longitudinally distally, which correspondingly will cause anchor driver pins  2108  to move upwardly and distally inside first anchor tracks  2111 , driving first anchors  700  radially outwardly into the surrounding tissues of bladder wall  2 , as shown in  FIG. 105 . When anchors  700  are driven out of the instrument, they are no longer restrained from their normal biased shapes, and thus barbs  730  can spring away from anchors  700  as shown, enabling anchors  700  to lodge in the tissues. After anchors  700  are driven into the bladder wall tissues, the attached sutures  2117  will trail from the rear ends of anchors  700 , back out of the tissues, with their free ends continuing to reside in suture storage grooves  2103 , passing over the exits of second anchor tracks  2106 . 
   Next, referring to  FIG. 106 , anchor driver tube  2109  and correspondingly, anchor driver pins  2108 , may be longitudinally retracted proximally. When the distal ends of anchor driver pins  2108  are retracted past the proximal end of second anchor track collar  2105 , the shape-memory bias of anchor driver pins  2108  will cause their distal ends to move radially outwardly into position behind second anchors  701 , into the position shown in  FIG. 106 , ready to drive second anchors  701  upwardly and outwardly through second anchor tracks  2106 . 
   Next, referring to  FIG. 107 , anchor driver tube  2109  and correspondingly anchor driver pins  2108  may again be pushed longitudinally distally, while will cause the distal ends of anchor driver pins  2108  move distally into and through second anchor tracks  2106 , and drive second anchors  701  radially outwardly into the surrounding tissues of pelvic floor  7 , as shown in  FIG. 107 . As the fore ends of second anchors  701  are driven out of the instrument, suture notches  752  (see  FIG. 100 ) will contact the trailing lengths of sutures  2117  passing over the exits of second anchor tracks  2106  (see  FIG. 106 ), and capture and bindingly hold these trailing lengths as second anchors  701  are driven into the tissues, as shown in  FIG. 107 . Thus, for each installed pair of anchors comprising first and second anchors  700  and  701 , a suture  2117  (or other suitable connecting member) may be anchored into a position holding the tissues of bladder wall  2  surrounding bladder opening  4  in contact with the tissues of pelvic floor  7  surrounding urethra opening  6 , with the bladder opening  4  and urethra opening  6  aligned. Thus held in contact, the tissues of the bladder wall  2  and pelvic floor  7  may knit and heal together and the bladder opening and urethra opening aligned. 
   Next, the entire anchor driver assembly, comprising inner driver assembly tube  2110  and first anchor track collar  2112 , anchor driver tube  2109 , second anchor track collar  2105 , and outer driver assembly tube  2102 , may be retracted as a unit (as shown in progress in  FIG. 108 ), down the urethra and out of the patient&#39;s body, leaving behind positioner tube  2121 , positioner  2122  and rod  2124 . Remaining positioner  2122  and positioner tube  2121  may now be used to exert supplemental downward pressure on bladder walls  2  surrounding the bladder opening  4  so as to enhance contact and knitting between the tissues of bladder walls  2  surrounding the bladder opening  4 , and the tissues of pelvic floor  7  surrounding the urethra opening  6 . Additionally, or alternatively, positioner  2122 , including drainage holes  2123 , and positioner tube  2121 , may now be used to seal off the junction between the bladder and urethra and drain urine, fluids and/or clotted material from the bladder during recovery and healing. Used for this purpose, positioner tube  2121  would be connected to a urine collection bag (not shown) via intermediate tubing. Following recovery and healing, rod  2124  and correspondingly end cap  2125  may be moved longitudinally upwardly or distally with respect to positioner tube  2121 , thus urging positioner  2122  into its pre-deployment position as shown in  FIG. 109 , and enabling retraction of these remaining parts of the instrument out of the bladder, down through the urethra, and out of the patient&#39;s body. 
   Those skilled in the art of the design of mechanical surgical devices will appreciate that a variety of simple mechanical devices may be configured or adapted to actuate and manipulate outer driver assembly tube  2102  and inner driver assembly tube  2110 , anchor driver tube  2109 , positioner tube  2121  and rod  2124 , at the proximal end of the instrument as required by the above steps, and so as to move and hold the instrument in respective pre-deployment and/or retracted, and deployed and first and second actuated, positions, including the handle assembly depicted in  FIGS. 83 and 85  and described above, or a variation thereof. 
   It will be appreciated by those skilled in the art of design of mechanical surgical devices that the positioner need not be limited to the embodiment made of flexible and elastic polymeric shape memory material as described herein, but that alternative designs for such positioner are possible, which can cause the positioner to alternately assume a retracted position and a deployed position, the deployed position suitable for catching in the bladder opening and urging the bladder into contact with the pelvic floor, in response to forces exerted or transmitted by tubes or other members. The positioner may comprise, for example, any of the positioner assemblies depicted in  FIGS. 14 ,  19 ,  24  and  57 , and described hereinabove. Similarly, it will be appreciated by those skilled in the art of design of mechanical surgical devices that the anchor driver assembly need not be limited to the three-tube assembly described herein, but that alternative designs for such an assembly are possible, which cause the anchor driver assembly to install one or more connected pairs of anchors into the tissues of the bladder and the urethra radially about the respective openings of these lumens when they are brought together, in response to forces exerted or transmitted by tubes or other members. 
   As previously noted, the combination of tubes, positioner and driver assembly may be designed and configured in an instrument adapted for a retrograde anastomosis procedure, as described above, or configured in an instrument adapted for an antegrade procedure. In an antegrade procedure, instead of being inserted upwardly through the urethra and into the bladder opening proximate the site of excision of the prostate, the instrument is inserted downwardly through a small incision in the patient&#39;s abdomen, through a small incision on an upper surface of the patient&#39;s bladder, into the bladder, through the bladder opening, and into the urethra opening. The small incisions in the abdomen and upper surface of the bladder may be made with a cannula and trocar assembly and held open by the cannula for insertion of the instrument therethrough. 
   Deformable Fastener Embodiment 
     FIG. 110  is a perspective view of another embodiment of an anastomotic instrument  2050  of the present invention, in its pre-deployment position, and  FIG. 111  is a longitudinal cross-sectional view of the instrument, also shown in its pre-deployment position, after insertion into and through the patient&#39;s urethra and into the bladder  1 . The instrument may comprise fastener driver assembly  2052  including outer tube  2051  and second tube  2060 . Outer tube  2051  may terminate with flexible fingers  2053 , which in turn terminate with proximal fastener anvils  2054 . Second tube  2060  may be immediately inside and substantially coaxial with outer tube  2051 . Second tube  2060  may terminate with flexible fingers  2061 , which in turn terminate with distal fastener anvils  2062 , which may be longitudinally aligned with and may longitudinally oppose proximal fastener anvils  2054 . 
   When the fastener driver assembly  2052  is being assembled in preparation for its use, fastener set  2070  in its pre-deployment shape (shown in enlarged perspective view in  FIG. 119 ) is placed onto second tube  2060  and moved over flexible fingers  2061  to a position in which the upper prongs of fasteners  2072  of fastener set  2070  are proximate to upper anvils  2062 . Next, outer tube  2051  may be slid over and up second tube  2060 , until lower anvils  2054  are in a position proximate to the lower prongs of fasteners  2072  of fastener set  2070 , thus holding fastener set  2070  in a position on the fastener driver assembly ready for deployment (as shown in  FIG. 110 ) via actuation of the fastener driver assembly as will be described below. 
   Thus, it can be seen in  FIGS. 110 and 111  that fastener driver assembly  2052  may comprise outer tube  2051  with its flexible fingers  2053  and lower anvils  2054 , second tube  2060 , with its flexible fingers  2061  and upper anvils  2062 . When fastener assembly  2052  is assembled and made ready for use, it may include fastener set  2070  in a pre-deployment shape, placed as shown. 
     FIG. 119  shows an exemplary fastener set  2070  in a pre-deployment shape. One or more individual fasteners  2072  may have upper and lower prongs with ends turned slightly outwardly, and may be linked together via serpentine links  2071 .  FIG. 120  shows fastener set  2070  as it would appear following installation. In its installed shape, fastener set  2070  has been expanded in circumference and diameter via deformation of serpentine links  2071 , and fasteners  2072  have been pushed and deformed so as to hook into tissues. Fastener set  2070  may be made of a suitable substantially permanently deformable material that is non-reactive with body fluids and tissues, and substantially biocompatible. The inventors have determined that suitably treated surgical stainless steel is one example of a suitable material. Alternatively, if it is desired that the fastener set be bioabsorbable, a suitably deformable substantially biocompatible and bioabsorbable material may be selected. The inventors have determined that flexible absorbable polymers (e.g., polydioxanone polymers, or polymers containing lactides, glycolides, polyglactin, etc., such as the polymers marketed by Johnson &amp; Johnson and/or Ethicon, Inc. under the trademarks “Vicryl” and “PDS II”) such that the fastener set can be absorbed (i.e., dissolved) in the patient&#39;s body after anastomosis is complete. If the selected material is one that might not sufficiently retain its position after deformation during installation, the design of the fastener set may be modified so as to include barbs on the prongs or other suitable lodging structures, or include features that cause the prongs to meet and interlock upon installation, to form substantially closed rings. 
   Referring back to  FIGS. 110 and 111 , the instrument of the present embodiment may also include third tube  2080 , which may terminate with expander collar  2081 . Affixed at the distal end of expander collar  2081  is positioner  2090 , shown in a pre-deployment shape in  FIGS. 110 and 111 . 
   The pre-deployment shape of positioner  2090 , shown in  FIGS. 110 and 111 , can facilitate insertion of the instrument into the patient. Positioner  2090  may be made of a suitable elastic and flexible polymeric material having shape memory, manufactured so as to be biased to assume a normally transversely oriented shape as shown in  FIG. 112 , upon retraction of actuator rod  2092 . As shown in  FIG. 112 , positioner  2090  may have situated thereabout one or more drainage holes  2091  which can permit urine, fluids or clotted material to drain into third tube  2080  after the instrument has been deployed. Positioner  2090  may be, alternately, moved to a pre-deployment position shown in  FIGS. 110 and 111 , or allowed to return via shape memory to a normal position shown in  FIG. 112 , by longitudinal movement of rod  2092 , and correspondingly, end cap  2093 , which may be integrally affixed to rod  2092 . 
   As shown in  FIG. 121 , end cap  2093  may have thereabout one or more flutes  2094  which can serve to allow urine or other fluids draining out of the bladder, through drainage holes  2091  in positioner  2090 , past end cap  2093  and down into third tube  2080 , by which they can be drained out of the patient. 
   Outer tube  2051 , second tube  2060 , third tube  2080  and rod  2092  may be made of a material having suitable combined properties of shape memory, flexibility, strength and stiffness that both enable the tubes and rod to flex during insertion into the patient&#39;s body and through the urethra as will be hereinafter described, but also will prevent them from collapsing, kinking, binding, or breaking during use. The selected material may also be substantially non-reactive with body fluids and tissues, and be substantially biocompatible. The inventors have determined that nitinol, known in the art as suitable for a variety of surgical devices and tubes, is one example of a suitable material. 
   It will be appreciated that hollow tubes may be used in the instrument for third tube  2080  when a coaxial arrangement with rod  2092  is desirable, or when third tube  2080  is to serve as a catheter, such as will be further described below, but that a rod may be substituted for third tube  2080  and be used to provide substantially the same mechanical function, i.e., transmission of forces to actuate the positioner, and thus may be used when a catheter function, or a coaxial arrangement, and thus a tube, is not required. Conversely, a tube can serve the purpose of rod  2092 . Thus, for purposes of the claims that may be set forth, unless otherwise specified in a claim, the term “tube” where such element is operably affixed or connected with, or contacts, the positioner, is intended to include and cover a rod, and vice versa. 
   Referring to  FIG. 110 , the instrument  2050  may also comprise a movable, removable, or releasable, collar or sleeve (not shown) sheathing fastener driver assembly  2052  and/or the space between expander collar  2081  and fastener driver assembly  2052 , so as to give the instrument a smoother longitudinal cross-sectional profile, to ease insertion and/or retraction of the instrument from a patient. 
   A method for performing anastomosis of a patient&#39;s bladder and urethra using the above-described anastomotic instrument, following a prostatectomy, will now be described. Following a prostatectomy, the patient&#39;s bladder  1  and urethra opening  6  are separated by a void formerly occupied by the prostate, as shown in  FIG. 2 . It is necessary to connect the bladder  1  with the urethra  5 , with bladder opening  4  and urethra opening  6  aligned, to restore urinary functions after recovery and healing. 
   As shown in  FIG. 111 , the anastomotic instrument may be inserted upwardly into and through the patient&#39;s urethra  5 , through the bladder opening  4 , and into the bladder  1 . The surgeon then may proximally retract rod  2092  and correspondingly, end cap  2093 , which allows positioner  2090  to assume its normal shape via shape memory, as shown in  FIG. 112 . The now-transverse orientation of positioner  2090  will prevent it from being retracted without pulling bladder wall  2  surrounding bladder opening  4  with it. 
   Next, the surgeon may proximally retract third tube  2080 , and correspondingly, expander collar  2081 , drawing expander collar  2081  inside and between distal fastener anvils  2062 , to the position shown in  FIG. 113 . Drawing expander collar  2081  inside and between distal fastener anvils  2062  will urge distal fastener anvils  2062 , and correspondingly, flexible fingers  2061  (shown in  FIG. 110 ) radially outwardly as indicated in  FIG. 113 . This movement of flexible fingers  2061  radially outwardly forces fastener set  2070 , residing on and around flexible fingers  2061  below distal fastener anvils  2062 , to expand in diameter and circumference, via deformation of serpentine links  2071  (shown in detail in  FIG. 119 ). 
   Next, the surgeon may retract the entire instrument downwardly through the urethra, which will cause positioner  2090  to pull bladder walls  2  surrounding bladder opening  4  into contact with pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, to the position shown in  FIG. 114 . 
   Next, outer tube  2051  may be moved distally, while second tube  2060  and the remaining portions of the instrument are held immobile. As can be appreciated from  FIGS. 115 and 116 , this movement correspondingly moves proximal fastener anvils  2054  toward distal fastener anvils  2062 , such that they opposingly contact, urge and deform upper and lower prongs of fasteners  2072  of fastener set  2070  such that they are pushed into the surrounding tissues of the bladder wall and pelvic floor, such that they form substantially opposing, joined hooks in the respective tissues, or even, possibly, ring shapes (see also  FIG. 120 ). The fasteners, thus installed, can serve to secure the tissues of the bladder wall  2  to the tissues of the pelvic floor  7 , proximate the openings of the bladder and urethra, with these openings aligned. 
   Next, the surgeon may move outer tube  2051  proximally while holding second tube  2060  immobile, causing proximal fastener anvils  2054  and distal fastener anvils  2062  to release their grip on fasteners  2072  and move apart, to the position shown in  FIG. 117 . The surgeon then may move third tube  2080  and correspondingly, expander collar  2081 , distally while holding second tube  2060  immobile, pushing expander collar  2081  distally out from between upper anvils  2062  and flexible fingers  2061 , permitting flexible fingers  2061  and upper anvils  2062  to return to their pre-deployment positions, circumscribing a circle of a diameter smaller than that of the now-enlarged, deployed fastener set, so as to permit retraction of the fastener driver assembly therethrough. 
   Next, entire fastener driver assembly  2052 , comprising outer tube  2051 , flexible fingers  2053 , proximal fastener anvils  2054 , second tube  2060 , flexible fingers  2061  and distal fastener anvils  2062 , may be retracted from the patient, leaving behind third tube  2080 , expander collar  2081 , positioner  2090 , rod  2092  and end cap  2093  as shown in  FIG. 118 . Remaining positioner  2090  and third tube  2080  may now be used to exert supplemental downward pressure on bladder walls  2  surrounding the bladder opening so as to enhance contact and knitting between the tissues of bladder walls  2  surrounding the bladder opening, and the tissues of pelvic floor  7  surrounding the urethra opening. Additionally, or alternatively, positioner  2090 , including drainage holes  2091 , and third tube  2080  may now be used to seal off the junction between the bladder and urethra and drain urine, fluids and/or clotted material from the bladder during recovery and healing. Fluids are permitted to flow past end cap  2093  via flutes  2094  in end cap  2093 , shown in  FIG. 121 . Used for this purpose, third tube  2080  would be connected to a urine collection bag (not shown) via intermediate tubing. Following recovery and healing, rod  2092  and correspondingly end cap  2093  are moved distally with respect to third tube  2080 , thus urging positioner  2090  into its pre-deployment position shown in  FIGS. 110 and 111 , and enabling retraction of these remaining parts of the instrument out of the bladder, down through the urethra, and out of the patient&#39;s body. 
   Those skilled in the art of the design of mechanical surgical devices will appreciate that a variety of simple mechanical devices may be configured or adapted to operate and hold outer tube  2051 , second tube  2060 , third tube  2080  and rod  2092 , at the proximal end of the instrument as required by the above steps, and so as to move and hold the instrument in respective pre-deployment and/or retracted, and deployed and actuated, positions, including the handle assembly depicted in  FIGS. 83 and 85  and described above, or a variation thereof. 
   It will be appreciated by those skilled in the art of design of mechanical surgical devices that the positioner need not be limited to the embodiment made of flexible and elastic polymeric shape memory material as described immediately above, but that alternative designs for such positioner are possible, which cause the positioner to assume, alternately, a retracted position and a deployed position, the deployed position suitable for catching in the bladder opening and urging the bladder into contact with the pelvic floor, in response to forces exerted or transmitted by tubes or other members. The positioner may comprise, for example, any of the positioner assemblies depicted in  FIGS. 14 ,  19 ,  24  and  57 , and described above. Similarly, it will be appreciated by those skilled in the art of design of mechanical surgical devices that the fastener driver assembly need not be limited to the two-tube assembly described herein, but that alternative designs for such an assembly are possible, which can cause the fastener driver assembly to install one or more fasteners in the tissues of the bladder and the urethra about the respective openings of these lumens when they are brought together, in response to forces exerted or transmitted by tubes or other members. 
   As previously noted, the combination of tubes, positioner and driver assembly may be configured in an instrument adapted for a retrograde anastomosis procedure, as described above, or configured in an instrument adapted for an antegrade procedure. In an antegrade procedure, instead of being inserted upwardly through the urethra, and into the bladder opening proximate the site of excision of the prostate, the instrument is inserted downwardly through a small incision in the patient&#39;s abdomen, through a small incision on an upper surface of the patient&#39;s bladder, into the bladder, through the bladder opening, and into the urethra opening. The small incisions in the abdomen and upper surface of the bladder may be made with a cannula and trocar assembly and held open by the cannula for insertion of the instrument therethrough. 
   Lodging Member Embodiment 
     FIG. 122  illustrates in longitudinal cross-section another embodiment of an anastomotic instrument  2010  of the present invention, in its pre-deployment position. The instrument may comprise inner tube  2011 , outer tube  2012  and rod  2019 , which may be of sizes such that inner tube  2011  can be placed and be movable within outer tube  2012 , and rod  2019  can be placed and be movable within inner tube  2011 , in an approximately coaxial arrangement. Inner tube  2011 , outer tube  2012  and rod  2019  may be made of a material having suitable combined properties of shape memory, flexibility, strength and stiffness that both enable the tubes to flex during insertion into the patient&#39;s body and through the urethra as will be hereinafter described, but also will prevent them from collapsing, kinking, binding, or breaking during use. The selected material may also be substantially non-reactive with body fluids and tissues, and be substantially biocompatible. The inventors have determined that nitinol, known in the art as suitable for a variety of surgical devices and tubes, is an example of suitable material. 
   As shown in  FIG. 122 , instrument  2010  comprises positioner  2017 . In its pre-deployment position positioner  2017  may be substantially cylindrical, having a radius smaller or approximately equal to the radius of first tube  2012 , and may have a rounded distal end. The pre-deployment shape of positioner  2017  will facilitate insertion of the instrument into the patient. Positioner  2017  may be made of a suitable elastic and flexible polymeric material having shape memory, manufactured so as to be biased to assume a normally transversely-oriented shape as shown in  FIG. 124 , upon retraction of rod  2019 . As shown in  FIG. 124 , positioner  2017  may have, about its perimeter, one or more drainage holes  2018  which can permit urine, fluids or clotted material to drain into inner tube  2011  when the instrument is deployed. 
   Instrument  2010  may also comprise lodging member  2013 . Lodging member  2013  also may be a tube-like member, with a proximal end  2015  affixed to the distal end of outer tube  2012 , and a distal end  2014  affixed to the distal end of inner tube  2011 . In the present embodiment lodging member  2013  is operable upon deployment to present transversely-extending ribs or other projections that enable it, upon appropriate placement and longitudinal compression, to lodge within the patient&#39;s urethra. As shown in  FIG. 126 , lodging member  2013  may have a series of circumferential, pre-formed folds  2016 , which enable lodging member  2013  to longitudinally compress when outer tube  2012  is pushed in a distal direction while inner tube  2011  is held immobile. Thus, upon longitudinal compression, lodging member  2013  can fold in accordion-like fashion to present transversely-extending ribs or other projections that when in position within the patient&#39;s urethra, can serve to lodge the instrument in place. Lodging member  2013  may be formed of polyurethane but may also be formed of any other suitable material. 
   Referring again to  FIG. 122 , rod  2019  is capped with end cap  2020 , which may be rounded and adapted to spread the force exerted by rod  2019  against the inside of positioner  2017  so as to prevent rod  2019  from puncturing positioner  2017 . Referring to  FIG. 127 , end cap  2020  may have thereabout one or more flutes  2021  which can allow urine, fluids or clotted material to flow past end cap  2020  when rod  2019  is retracted. As affixed to rod  2019 , end cap  2020  is substantially integral therewith. 
   It will be appreciated that hollow tubes may be used in the instrument for inner tube  2011  and outer tube  2012  when a coaxial arrangement is desirable, or when one or more of these members is to serve as a catheter, such as will be further described below, but that one or more rods may be substituted for tubes and be used to provide substantially the same mechanical functions, i.e., transmission of forces to actuate the positioner and the lodging member, and thus, may be used when a catheter function, or a coaxial arrangement, and thus a tube, is not required. Thus, for purposes of the claims that may be set forth, unless otherwise specified in a claim, the term “tube” is intended to include and cover a rod. 
   A method for performing anastomosis of a patient&#39;s bladder and urethra, using the above-described retrograde anastomotic instrument, following a prostatectomy, will now be described. Following a prostatectomy, the patient&#39;s bladder  1  and urethra opening  6  are separated by a void formerly occupied by the prostate, as shown in  FIG. 2 . It is necessary to connect the bladder  1  with the urethra  5 , with bladder opening  4  and urethra opening  6  aligned, to restore urinary functions after recovery and healing. 
   As shown in  FIG. 123 , anastomotic instrument  2010  may be inserted upwardly into and through the patient&#39;s urethra  5  (as can be appreciated from  FIG. 127 ), through the bladder opening  4 , and into the bladder  1 . The surgeon may then proximally retract rod  2019  with attached end cap  2020 , which will allow positioner  2017  to assume its normal shape, which extends transversely to the longitudinal axis of the instrument within the bladder, beyond the diameter of the bladder opening  4 , as shown in  FIG. 124 . The now-transverse orientation of positioner  2017  prevents it from being retracted without pulling bladder wall  2  surrounding bladder opening  4  with it. 
   Next, the surgeon may retract the entire instrument downwardly through the urethra, which causes positioner  2017  to pull bladder walls  2  surrounding bladder opening  4  into contact with pelvic floor  7 , with bladder opening  4  and urethra opening  6  aligned, in the position shown in  FIG. 125 . 
   Next, outer tube  2012  may be moved distally, while inner tube  2011  is held immobile. As can be appreciated from  FIG. 126 , because the proximal end of lodging member  2013  is affixed to the distal end of outer tube  2012  at point A, and the distal end of lodging member  2013  is affixed to the distal end of inner tube  2011  at point B as shown, this distal movement of outer tube  2012  relative to immobile inner tube  2011  will cause longitudinal compression of lodging member  2013 . Pre-formed circumferential folds  2016  in lodging member  2013  cause lodging member  2013  to compress in accordion-like fashion, resulting in the presentation of transversely-extending ribs as shown, which enable the lodging member  2013 , and consequently, the entire instrument, to lodge in the urethra in the position shown in  FIG. 126 . 
   As shown by way of example but not of limitation in  FIGS. 131-133 , lodging member  2013  may be configured in various embodiments as shown, such as including perforations which can serve to alleviate radial stresses in the material and thereby facilitate deployment, and also cause lodging member  2013  to present transversely-extending projections  2042 , when longitudinally compressed, enhancing its effectiveness in lodging within the urethra. Lodging member  2013  may also be manufactured so as to have a rough outer surface, which can also serve to enhance its effectiveness in lodging within the urethra. It may be desirable to design the lodging member so that any lodging projections that enhance its effectiveness in lodging within the urethra are limited in length so as not to substantially pierce or penetrate surrounding tissues, so as to minimize the possibility of causing permanent damage to sensitive areas in the tissues. 
   Those skilled in the art of the design of mechanical surgical devices will appreciate that a variety of simple mechanical devices may be configured or adapted to operate and hold inner tube  2011 , outer tube  2012  and rod  2019  at the proximal end of the instrument as required by the above steps, and so as to move and hold the instrument in respective retracted, and then deployed and lodged, positions, including the handle assembly depicted in  FIGS. 83 and 85  and described above, or a variation thereof. 
   In the lodged position shown in  FIG. 126 , the instrument may be used to hold the bladder wall  2  surrounding the bladder opening  4  in contact with the pelvic floor  7  surrounding the urethra opening  6  with bladder opening  4  and urethra opening  6  aligned, during the period of time necessary for these tissues to knit and heal together naturally. 
   While the instrument is lodged in position shown in  FIG. 126  during the time required for healing, urine, fluids and/or clotted material may be drained out of bladder  1  via drainage holes  2018  in positioner  2013 , and flow past end cap  2020  of rod  2019  through flutes  2021  in end cap  2020  (shown in enlarged perspective view in  FIG. 127 ), and generally out of the patient via inner tube  2011 . As shown in  FIG. 128 , the instrument may be connected via tubing to a urine collection bag  2023 . 
   It will be appreciated by those skilled in the art of design of mechanical surgical devices that the positioner need not be limited to the embodiment made of flexible and elastic polymeric shape memory material as described herein, but that alternative designs for such positioner are possible, which cause the positioner to alternately assume a retracted position and a deployed position, the deployed position suitable for catching in the bladder opening and urging the bladder into contact with the pelvic floor, in response to forces exerted or transmitted by tubes or other members. The positioner may comprise, for example, any of the positioner assemblies depicted in  FIGS. 14 ,  19 ,  24  and  57 , and described hereinabove. Similarly, it will be appreciated by those skilled in the art of design of mechanical surgical devices that the lodging member need not be limited to the hollow pre-folded polyurethane member described herein, but that alternative designs for such lodging member are possible, which cause the lodging member to alternately assume a retracted position and a deployed position, the deployed position presenting one or more ribs or projections that enable the lodging member to lodge within the urethra, in response to forces exerted or transmitted by tubes or other members. 
   As previously noted, the combination of tubes, positioner and lodging member may be configured in an instrument adapted for a retrograde anastomosis procedure, as described above, or configured in an instrument adapted for an antegrade procedure, as will now be described. In an antegrade procedure, instead of being inserted upwardly through the urethra, and into the bladder opening proximate the site of excision of the prostate, the instrument is inserted downwardly through a small incision in the patient&#39;s abdomen, through a small incision on an upper surface of the patient&#39;s bladder, into the bladder, through the bladder opening, and into the urethra opening. The small incisions in the abdomen and upper surface of the bladder may be made with a trocar and cannula assembly (not shown), and held open by the cannula for insertion of the instrument therethrough. 
   As shown in  FIG. 129 , an antegrade anastomotic instrument  2030  may comprise outer tube  2031 , first inner tube  2032  and second inner tube  2034 . Similar to the retrograde anastomotic instrument described previously, these tubes may be sized such that first inner tube  2032  can be placed and be longitudinally movable within outer tube  2031 , and second inner tube  2034  can be placed and be longitudinally movable within first inner tube  2032 . First inner tube  2032  may have one or more drainage passages  2033  at its distal end. Second inner tube  2034  may have one or more drainage passages  2035  at its distal end. 
   End cap  2036  may be affixed to the distal end of second inner tube  2034 . As shown, end cap  2036  may have a rounded distal end that facilitates insertion of the instrument, and an extended section  2037  that terminates at rim  2038 . 
   As shown in  FIG. 129 , instrument  2030  may also comprise lodging member  2013 , which may be similar to the lodging member of the retrograde anastomotic instrument previously described, and can also be configured as shown by way of example in  FIGS. 131-133 . Referring again to  FIG. 129 , lodging member  2013  may be affixed at its proximal end to the distal end of first inner tube  2032  (at point A as shown), and is affixed at its distal end to extended section  2037  of end cap  2036  beneath rim  2038  (at point B as shown). Thus, it can be appreciated that moving second inner tube  2034  longitudinally with respect to first inner tube  2032  will cause either, alternately, longitudinal extension, or longitudinal compression of lodging member  2013 , and that extension of lodging member  2013  will cause ribs or projections presented thereby to retract into the pre-deployment position, and compression of lodging member  2013  causes ribs or projections presented thereby to extend to the deployed position (shown in  FIG. 129 ), in a manner substantially similar to that of the lodging member of the retrograde anastomotic instrument previously described. 
   Antegrade anastomotic instrument  2030  also comprises positioner  2017 . Similar to the positioner of the retrograde anastomotic instrument previously described, in its pre-deployment position positioner  2017  may be substantially cylindrical. The pre-deployment shape of positioner  2017  facilitates insertion of the instrument. Positioner  2017  may be made of a suitable elastic and flexible polymeric material having shape memory, manufactured so as to be biased to normally assume a transversely-oriented shape as shown in  FIG. 129 , upon retraction of first inner tube  2032  relative to outer tube  2031 . Positioner  2017  may be affixed at its proximal end to the distal end of outer tube  2031  (at point C as shown in  FIG. 129 ), and may be affixed at its distal end to the distal end of first inner tube  2032  (at point A as shown as  FIG. 129 ). 
   Thus, it can be appreciated that longitudinal movement of outer tube  2031  with respect to first inner tube  2032  will cause positioner  2017  to assume its retracted, pre-deployment cylindrical position (similar to that shown in  FIG. 122 ), or its deployed position as shown in  FIG. 129 . 
   As shown in  FIG. 129 , positioner  2017  may have, situated thereabout, one or more drainage holes  2018  which can permit urine, fluids or clotted material to drain, through drainage passages  2033  in first inner tube  2032 , though drainage passages  2035  in second inner tube  2034 , and into second inner tube  2034 . 
   A method for performing anastomosis of a patient&#39;s bladder and urethra using the above-described antegrade anastomotic instrument, following a prostatectomy, will now be described, with reference to  FIG. 2  for identification of parts of the patient&#39;s anatomy and  FIG. 129  for identification of parts of the instrument. Following a prostatectomy, the patient&#39;s bladder  1  and urethra opening  6  are separated by a void formerly occupied by the prostate, as shown in  FIG. 2 . It is necessary to connect the bladder  1  with the urethra  5  with bladder opening  4  and urethra opening  6  aligned, to restore urinary functions after recovery and healing. 
   A cannula with a trocar (not shown) is inserted into the patient&#39;s abdomen, and through an upper surface of the patient&#39;s bladder. The trocar is then removed and the cannula is left in place. The antegrade anastomotic instrument in its pre-deployment position is inserted into the cannula, until the entire positioner  2017  is within the bladder lumen. The surgeon then may move outer tube  2031  in a distal direction with respect to first inner tube  2032 , or alternatively or simultaneously, move first inner tube  2032  in a proximal longitudinal direction with respect to outer tube  2031 . This relative movement of the outer tube  2031  and first inner tube  2032  will permit positioner  2017  to assume its transversely-oriented position, shown in  FIG. 129 . The surgeon then may manipulate the instrument to locate the bladder opening  4  with end cap  2036 , and insert end cap  2036  through bladder opening  4 . Positioner  2017  in its deployed position will contact bladder wall  2  and catch in bladder opening  4 , and cannot pass therethrough. The surgeon then may manipulate the instrument to urge bladder wall  2  surrounding bladder opening  4  downward toward pelvic floor  7 , and further manipulate the instrument to locate urethra opening  6 , and insert end cap  2036  into urethra opening  6 . Thus, bladder wall  2  surrounding bladder opening  4  may be urged into contact with pelvic floor  7  surrounding urethra opening  6 , with bladder opening  4  and urethra opening  6  aligned. Next, holding outer tube  2031  and first inner tube  2032  immobile, the surgeon may retract second inner tube  2034  proximally. This will cause longitudinal compression of lodging member  2013 , so that it will assume the position shown in  FIG. 129 , and lodge within the urethra. 
   Those skilled in the art of design of mechanical surgical devices will appreciate that a variety of simple mechanical devices may be configured to operate and hold outer tube  2031 , first inner tube  2032  and second inner tube  2034  by actuation and manipulation at the proximal end of the instrument as required by the above steps, and so as to operate the instrument and hold it in the lodged position, including the handle assembly depicted in  FIGS. 83 and 85  and described above, or a variation thereof. 
   In the lodged position, the instrument may be used to hold the bladder wall  2  surrounding the bladder opening  4  in contact with the pelvic floor  7  surrounding the urethra opening  6  with bladder opening  4  and urethra opening  6  aligned, during the period of time necessary for these tissues to knit and heal together naturally. 
   While the instrument is lodged in position during the time required for healing, urine and other fluids may be drained out of bladder  1  via drainage holes  2018  in positioner  2017 , through drainage passages  2033  and  2035 , and generally out of the patient via second inner tube  2034 . As shown in  FIG. 129 , the instrument may be connected via tubing to a urine collection bag  2023 . 
     FIG. 130  depicts an alternative embodiment of instrument  2030 . As compared with the embodiment depicted in  FIG. 129 , first inner tube  2032  may be reduced in radius and second inner tube  2039  may be a rod. Second inner tube  2039  may terminate at its distal end with end cap  2036 , having rim  2038  and extended section  2037 . Use and function of the instrument depicted in  FIG. 130  may be substantially similar to use and function of the instrument depicted in  FIG. 129 , except that following deployment and lodging of the instrument, urine and other fluids can be drained from the bladder through drainage holes  2018  in positioner  2017 , and directly into outer tube  2031 , which is connected to urine collection bag  2023 , eliminating the necessity for additional drainage passages  2033 ,  2035  in internal tubes within the instrument as shown in  FIG. 129 . 
   Other Refinements 
   The exemplary embodiments described herein for an instrument in accordance with the present invention comprise one or more tubes and/or rods, used for the translation of forces and movement from a proximal handle assembly to an assembly or assemblies proximate to a distal end of an instrument, and also, potentially, used as catheters for, among other purposes, the transmission of gas or fluid pressure, and the draining of urine or other fluids during recovery and healing. The inventors have determined that nitinol, which when suitably treated and formed, has combined properties of strength, flexibility, elasticity, stiffness, hardness and biocompatibility that make it suitable as a material for such members, by way of example. Other materials may suffice, particularly when one or more of the above-mentioned properties may not be so stringently required. Thus, for example, a polymer such as styrene might be used where it is not necessary, for example, to translate force and movement (such as, for example, when the tube functions only as a catheter). Of course, any other materials having the necessary properties for the particular application may be used. 
   With respect to instruments designed for a retrograde post-prostatectomy bladder-urethra anastomosis procedure such as described herein, it may be desirable to have a bend angle in the tube assembly, such as in tube assembly  500  ( FIG. 3 ), tube assembly  3200  ( FIG. 134 ), or other tube assembly supporting an end effector. A bend proximate to the end effector assembly, of about 80 to about 90 degrees (expressed as the angle at which a distal portion of the tube assembly is bent away from a straight axis projected distally from a proximal portion of the tube assembly), and preferably about 85 degrees (wherein the tube assembly defines an obtuse angle of about 95 degrees), may be desirable. Such a bend angle may serve to better facilitate manipulation of the instrument within the anatomical architecture involved in the procedure, and facilitate control of the positioning of the end effector assembly within the bladder lumen to enable driving anchors at a desired or selected angle with respect to the pelvic floor. 
   In order to be most effective at operating within the limited space provided by the anatomical architecture involved in a procedure to effect anastomosis of the bladder and urethra following a prostatectomy, it is desirable that the end effector assembly, including any positioner assembly, anchor driver assembly and/or end cap or harness assembly, be limited in length. Preferably, but not by way of limitation, the length of the end effector assembly, following opening of the positioner, will be less than about 2 inches, and more preferably, less than about 1½ inches, from the proximal surfaces of the positioner when opened to the distal end of the instrument. For similar reasons, for an instrument of the present invention designed for use in a retrograde procedure (involving insertion upwardly through the urethra), the size of the urethra and other anatomical features make it preferable that the end effector and the tube assembly be limited to a diameter of about 28 french, or about 9.3 millimeters. 
   The inventors also have determined that it may be advantageous for an instrument configured for retrograde insertion (upwardly into and through the urethra) to have a detachable and reattachable, or detached and attachable, end effector assembly. For example, if the end effector assembly (comprising a positioner assembly and an anchor driver assembly such as positioner  400  and anchor driver  300  shown in  FIG. 3 , shuttlecock assembly  800  shown in  FIG. 17 , umbrella assembly  900  shown in  FIG. 22 , or end effector assembly  3400  shown in  FIG. 134 ) is detached from and attachable to the supporting tube assembly or other supporting longitudinal member assembly, the end effector assembly may be separate or detached from the supporting assembly prior to insertion. The supporting assembly may then be inserted through the urethra without the end effector assembly, which may ease insertion and eliminate the possibility for components of the end effector assembly, otherwise attached, to catch or cause tissue damage within the urethra during insertion. Upon insertion, and after the distal end of the supporting assembly is past the urethra and/or above the pelvic floor, the end effector assembly may be introduced into the patient&#39;s abdomen via a cannula through the abdominal wall, and attached to the supporting assembly for use in the anastomosis procedure, using any suitable means of guidance such as an endoscope, external imaging techniques and/or tactile feel. It can be appreciated that the supporting assembly and the end effector assembly can have a variety of designs that enable operable connection of their respective structural and operational members to effect attachment and operability of the end effector assembly. 
   Tubes, rods or other members that are to be inserted and/or remain inside the patient for a substantial period of time during the anastomosis procedure, such as but not limited to central rod or guide wire  3230 , catheter tube  3510  ( FIGS. 141-144 ) and/or other components may be provided with an antimicrobial coating, such as that described in copending U.S. patent application Publication No. 2004/0220614. Additionally or alternatively, such components may be provided with a hydrophilic or other friction-reducing coating. 
   Several embodiments of a method for effecting anastomosis of the bladder and urethra following a prostatectomy, as depicted and described herein, involve the driving of anchors into the pelvic floor. In such a procedure it may be desirable for anchors to be driven into the pelvic floor in locations that avoid sensitive areas and thus reduce the potential for complications. For example, referring to  FIG. 147 , it may be desirable to avoid driving anchors into areas proximate to the dorsal veins D of the penis, other neurovascular bundles N, the rectum R, or other sensitive anatomical features. Accordingly, referring to  FIG. 147 , the inventors have determined that anchors are preferably driven into the pelvic floor at locations within the zones of about 8 to about 10 o&#39;clock, and about 2 to about 4 o&#39;clock, about the urethra U, as shown at “A” and “B” respectively in  FIG. 147 . More preferably, as may be the case, for example, with use of the balloon and harness systems depicted and described herein, two anchors are driven into the pelvic floor at locations at about 9 and about 3 o&#39;clock about the urethra. 
   It also is important, when using an instrument of the present invention to install anchors, to avoid driving anchors into, through or across the ureteric orifices of the bladder. The various embodiments of an instrument described herein facilitate avoidance of this event. 
   Anchors 
   As described herein, anchors  700  or other suitable fasteners perform a holding function, holding the bladder wall to the pelvic floor and/or holding a harness to the bladder wall and/or pelvic floor. Each of the anchoring and/or fastening features discussed herein is only exemplary of a large number of designs and configurations possible within the scope of the invention. 
   An anchor  700  or other fastener may have one or more suitable lodging structures that function to cause the anchor to lodge in tissues after being driven thereinto, so as to resist withdrawal from the tissues. Such lodging structures may comprise barbs, circumferential ridges, projections or any other features effective to cause the anchor to lodge in the tissues when driven into them. The size, shape and number of suitable lodging structures may vary. Additionally, the inventors have determined that, whenever barbs are included on an anchor it may be desirable when manufacturing such an anchor, to round off, or radius, the protruding ends of the barbs (as viewed from the anchor forward end), in order to reduce the possibility that the barbs will snag on loose bladder wall tissue during insertion and opening of an anchor driver assembly, on which the anchor is loaded, inside the bladder. 
   An anchor or other fastener may also have a head or other suitable penetration-limiting structure that may function to limit the depth to which the anchor or other fastener may be driven and may also function to assist in securing proximal tissues to underlying, distal tissues. It will be appreciated that such a penetration-limiting structure need not necessarily be located at the rearward end of an anchor shaft to be effective. 
   It may be desirable that the forward end of an anchor be pointed or have a chisel-like shape, to facilitate more effective and/or less damaging penetration of tissues. Additionally, the inventors have determined that a point formed on the forward end of a cylindrical anchor shaft comprising three sloping flat faces in planes intersecting each other at equal angles, facilitates penetration of the anchor into tissues in a manner that minimizes the potential for the anchor to veer off-target or off-direction during driving. 
   When used to secure the walls of the bladder to the pelvic floor, it may be desirable for anchors to be of a length sufficient to penetrate through the bladder walls and the fascia layer of the pelvic floor. For example but not by way of limitation, such anchors are preferably about ½-inch to 2½-inches in length. For anchors that are to be installed near the rectum, it may be desirable for them to be at the shorter end of the preferred range of length. 
   Anchors  700  or other suitable fasteners may be formed from a substantially biocompatible polymer or metal. Where shape memory and elasticity may be desired, anchors may be manufactured using elements made of an elastic material, such as an elastic metal alloy or a thermally activated or activatable alloy, such as a nickel-titanium alloy (for example nitinol) or stainless steel alloy, so that the anchors or other fasteners may be preformed and biased with shaped ends or barbs along the shaft, which can be deployed by pushing them out of an instrument so that when they pass into the target tissue, they resume their shape within the target tissue. 
   If bioabsorbability is desired, anchors  700  or other suitable fasteners may be formed of a suitably substantially biocompatible and bioabsorbable material. The inventors have determined that flexible absorbable polymers (e.g., polydioxanone polymers, or polymers containing lactides, glycolides, polyglactin, etc., such as the polymers marketed by Johnson &amp; Johnson and/or Ethicon, Inc. under the trademarks “Vicryl” and “PDS II”) are potentially suitable materials. Other bioabsorbable materials having the necessary physical properties may be used. 
   When used to anchor harness straps for a balloon and harness system such as depicted and described herein, bioabsorbable anchors may be used to provide a bioabsorbable harness release mechanism that avoids the necessity for, or reduces the importance of, a structure or device capable of attaching a harness to, and then releasing a harness from, an anchor by mechanical means. By way of example but not of limitation, referring to  FIG. 145 , it can be appreciated that if a structure such as harness hook  760  on anchor  700  is bioabsorbable, with a time degradation characteristic that corresponds to the time required for the anastomosis procedure, the degradation and dissolution of harness hook  760  through bioabsorption will serve to release harness  3430 , facilitating removal from the patient. 
   Additionally, there may be situations when the control of the degradation and absorption profile and/or particle breakup size of a bioabsorbable anchor or other suitable fastener may be desirable. For example, should one or more pieces of a bioabsorbable anchor, such as, for example, the head of an anchor, break away in a large piece as the anchor material is degrading after deployment, it could cause a blockage. Accordingly, bioabsorbable anchors or other suitable fasteners may be designed and manufactured in a manner in which degradation rates and particle breakup size may be controlled. For example, a bioabsorbable anchor or other fastener may be formed with a cast, molded, embossed or machined-in arrangement of scoring, perforation, or grooving that creates areas of reduced thickness and increased stress of the part in selected locations, encouraging earlier fracture proximate to such areas for the purpose of reducing the size of portions that may break away as the material degrades. Alternatively, or additionally, a bioabsorbable anchor or other fastener may be formed of joined materials, or comprise joined components, having differing degradation/absorption profiles such that zones of faster and slower degradation within the part may be created, such that the possibility of breakaway and release within a body lumen of pieces that are large enough to create a possibility of blockage or other adverse effect is reduced. 
   An anchor shaft may be hollow so as to slidably fit over a driver pin, and be substantially releasably held thereon by friction fit or any other suitable means. Alternatively, an anchor may have a solid shaft wherein a driver pin pushes against the proximal end of the anchor or alternatively, fits over the proximal end of the anchor and releasably grips it by friction fit or any other suitable means. 
   It would be apparent to a person having skill in the art field that there are various designs for anchors that would be effective for anchoring the bladder to the pelvic floor over the urethra opening. Anchors may be provided that have a plurality of shafts, barbs and tips operatively linked to a driver assembly. It is not necessary that the anchors are individual anchors, only that each anchor&#39;s size and shape, alone or in combination, are sufficient to effect and maintain contact between proximal and underlying, distal target tissues for an appropriate period of time. 
   In still a further embodiment, an anchor may be formed of a bi-metallic or other combination of at least two materials having differing expansion properties, that will cause the part formed therefrom to take a desired shape after heating, for example, by the patient&#39;s body. In such a case, the anchor would be supplied in a cold or room-temperature state and then allowed to attain the final desired shape after installation, when heated by the patient&#39;s body. 
   Although nitinol may be used in this service because of its physical properties and its significant history in implantable medical devices, it may also be suitable for use as an anchor because of its overall suitability for use in conjunction with or contemplation of use of magnetic resonance imaging (MRI) technology. 
   In summary, numerous benefits are apparent which result from employing the concepts of the invention. The foregoing description of one or more embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiments were chosen and described in order to best illustrate the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to best utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. It is intended that the scope of the invention be limited only by the claims appended hereto.