A surgical fastener apparatus, which comprises: a handle; a flexible elongate segment extending from the handle, the elongate segment defining a longitudinal axis (k) and having proximal and distal ends (18, 20); an end effector mounted to the distal end of the elongate segment, the end effector including a fastener cartridge and an anvil, the fastener cartridge including a plurality of fasteners, the fastener cartridge and the anvil configured for relative movement between an open condition and an approximated condition of the end effector; an approximator member (30, 32) coupled to the end effector, the approximator member movable relative to the longitudinal axis to cause relative movement of the fastener cartridge and the anvil between the open condition and the approximated condition; a fastener drive operatively coupled to the fastener cartridge, the fastener drive movable to deploy the fasteners from the fastener cartridge for forming by the anvil; at least one tissue grasper at least partially extending along the end effector and movable relative to the longitudinal axis, the at least one tissue grasper configured to engage tissue portions and draw the tissue portions between the fastener cartridge and the anvil when in the open condition; at least one manual actuator mounted relative to the handle to actuate at least one of the approximator member, the fastener drive or the at least one tissue grasper; and wherein the elongate segment includes an outer tube and a vacuum conduit extends through the outer tube, the vacuum conduit being couplable to a vacuum source, the vacuum conduit being in communication with a vacuum distributor, characterised in that the outer tube has a plurality of vacuum apertures and is coaxially mounted about the vacuum distributor, the vacuum distributor including a plurality of vacuum grooves (240, 242) in fluid communication with the plurality of vacuum apertures for conveying negative pressure to tissue surrounding the elongate segment. a handle; a flexible elongate segment extending from the handle, the elongate segment defining a longitudinal axis (k) and having proximal and distal ends (18, 20); an end effector mounted to the distal end of the elongate segment, the end effector including a fastener cartridge and an anvil, the fastener cartridge including a plurality of fasteners, the fastener cartridge and the anvil configured for relative movement between an open condition and an approximated condition of the end effector; an approximator member (30, 32) coupled to the end effector, the approximator member movable relative to the longitudinal axis to cause relative movement of the fastener cartridge and the anvil between the open condition and the approximated condition; a fastener drive operatively coupled to the fastener cartridge, the fastener drive movable to deploy the fasteners from the fastener cartridge for forming by the anvil; at least one tissue grasper at least partially extending along the end effector and movable relative to the longitudinal axis, the at least one tissue grasper configured to engage tissue portions and draw the tissue portions between the fastener cartridge and the anvil when in the open condition; at least one manual actuator mounted relative to the handle to actuate at least one of the approximator member, the fastener drive or the at least one tissue grasper; and wherein the elongate segment includes an outer tube and a vacuum conduit extends through the outer tube, the vacuum conduit being couplable to a vacuum source, the vacuum conduit being in communication with a vacuum distributor, characterised in that the outer tube has a plurality of vacuum apertures and is coaxially mounted about the vacuum distributor, the vacuum distributor including a plurality of vacuum grooves (240, 242) in fluid communication with the plurality of vacuum apertures for conveying negative pressure to tissue surrounding the elongate segment.