An intestinal steerable endoscopic stapler for stapling tubular tissue is provided comprising a circular anvil member having a circular anvil stapling surface and a cutting block surface radially inwardly of the stapling surface. A head assembly has a circular staple driver for driving staples in an array corresponding to the anvil surface and a circular cutting blade corresponding to the cutting block. A flexible tube has a distal end at the head assembly and a handpiece end. A scope in the form of an eyepiece in the handpiece optically connected to a lens in the head assembly is provided for viewing a region of space beyond the head assembly. A steering arrangement is provided for pivoting the head assembly relative the flexible tube to thereby steer the head assembly in a body cavity. A stapler activator is provided located at the handpiece end for driving staples from the head assembly toward the anvil member and for driving the cutting blade toward the cutting block, whereby two ends of tubular tissue may be joined by an array of staples and excess tubular tissue ends may be trimmed off with the cutting blade. A number of tissue approximating devices are also disclosed.