Abstract:
A suturing device includes an elongated body having an outer wall defining an interior space of the body, a shaft located in the interior space, and a needle mounted on a distal end of the shaft. The needle has a distal section transverse to a longitudinal axis of the shaft. The distal section of the needle terminates in a first jaw and a second jaw forming a forceps defining a piercing tip. The first jaw and second jaw have a grasping position wherein the first jaw and second jaw grasp a suturing material, and a release position wherein the first jaw and second jaw release the suturing material. After grasping the suturing material with the needle, the shaft rotates the needle to advance the needle and suturing material through tissue and mesh placed on the tissue. Spaced apart portions of the suturing material are then fused to create a suture.

Description:
CROSS-REFERENCE To RELATED APPLICATIONS 
       [0001]    This application claims priority from U.S. Patent Application No. 61/641,069 filed May 1, 2012. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH 
       [0002]    Not applicable. 
       FIELD OF THE INVENTION 
       [0003]    The invention relates to a suturing device suitable for laparoscopic procedures. In one non-limiting example surgical use, the suturing device is used in performing laparoscopic sacrocolpopexy or sacrocervicopexy. 
       BACKGROUND OF THE INVENTION 
       [0004]    Pelvic organ prolapse is a common medical condition, affecting almost half of women over the age of  50 . (See, Subak et al., “Cost Of Pelvic Organ Prolapse Surgery In The United States”,  Obstet Gynecol.  2001;98(4):646-651.) As the population in the United States ages, there will be an increasing number of women who require treatment for this condition. This medical condition results in lifestyle restriction, social limitations, sexual dysfunction, and pain, but can also lead to more critical conditions such as urinary retention, urinary tract infection, and sepsis. 
         [0005]    Laparoscopic sacrocolpopexy is the current gold standard for the surgical treatment of apical pelvic organ prolapse. (See, Ganatra et al., “The Current Status Of Laparoscopic Sacrocolpopexy: A Review”,  Eur Urol.  2009. See, also, U.S. Pat. No. 6,592,515 and PCT International Publication No. WO 2011/037837.) Interest in laparoscopic mesh placement has increased considerably in the current environment of mesh erosion that is associated with transvaginal placement of mesh. 
         [0006]    Sacrocolpopexy suspends the apex of the vagina by affixing a Y-shaped piece of synthetic mesh to the anterior and posterior vaginal walls and suspending this from a strong ligament on the anterior part of the sacrum. This procedure is typically performed via a laparoscopic approach, entering the abdominal cavity to access the sacrum and vaginal tissues, both of which are retroperitoneal (behind the lining of the abdominal cavity). Tackers are not acceptable for use on the vagina, and laparoscopic mesh placement is quite challenging and requires advanced laparoscopic suturing skills in order to fasten the mesh. 
         [0007]    Therefore, there is a need for a suturing device and associated method that can automate the process of fastening tissue and mesh laparoscopically and that enable a very rapid and secure fixation of mesh using a suturing material. 
       SUMMARY OF THE INVENTION 
       [0008]    The present invention satisfies the foregoing needs by providing a suturing device for laparoscopic procedures. In one form, the device is comprised of a handle and a five millimeter shaft. At the end of the shaft, there is a needle that drives a fusible suture through the tissue and a loop is formed. A fusion device is then fired on the two ends of the suture loop which fastens the sutures together to form a knot. The suture is also cut. The suture driving, knot forming and cutting are all done by manipulating features on the handle. 
         [0009]    In one aspect of the invention, there is provided a device for suturing tissue in a patient. The suturing device includes an elongated body having an outer wall defining an interior space of the body, a rotatable shaft located in the interior space of the body, and a needle mounted on a distal end of the shaft. The needle has a distal section transverse to a longitudinal axis of the shaft. The distal section of the needle terminates in a first jaw and a second opposed jaw forming a forceps. At least one of the first jaw and the second jaw is movable relative to the other of the first jaw and the second jaw such that the first jaw and the second jaw have a grasping position in which the first jaw and the second jaw can grasp a suturing material and such that the first jaw and the second jaw have a release position in which the first jaw and the second jaw release the suturing material. The first jaw and the second jaw define a piercing tip of the needle when the first jaw and the second jaw are in the grasping position. In one form, the distal section of the needle is arcuate thereby forming a rotary needle. The suturing device can include a handle mounted to the elongated body, and the shaft can be fixed to a transverse disc shaped projection located on the handle for rotating the shaft. 
         [0010]    The needle has a first position in which the piercing tip faces away from the interior space of the body, and the needle has a second position in which the piercing tip faces toward the interior space of the body. The rotary needle follows a curved path through tissue from the first position to the second position when the shaft is rotated about its longitudinal axis. The first jaw and the second jaw are in the grasping position thereby grasping the suturing material when the needle moves through tissue from the first position to the second position when the shaft is rotated about its longitudinal axis. The suturing material can be provided from a supply reel of suturing material, and a distal segment of suturing material is arranged in the interior space of the body such that the first jaw and the second jaw can grasp the suturing material when the needle is in the first position. The outer wall of the body can include a slot, and the needle passes through the slot when the needle moves from the first position to the second position when the shaft is rotated about its longitudinal axis. 
         [0011]    The suturing device can further include a transfer arm located in the interior space of the body. The transfer arm terminates in a first holding member and a second opposed holding member. At least one of the first holding member and the second holding member is movable relative to the other of the first holding member and the second holding member such that the first holding member and the second holding member have a holding position in which the first holding member and the second holding member hold the suturing material and the first holding member and the second holding member have a disengaged position in which the first jaw and the second jaw disengage the suturing material. 
         [0012]    The suturing device can further include an attachment device for securing together spaced apart portions of the suturing material thereby forming a closed length of the suturing material. In one form, the attachment device comprises a pair of heating elements movable between an open position in which the heating elements are spaced apart and a heat sealing position for contacting the spaced apart portions of the suturing material and heat sealing the spaced apart portions of the suturing material together. 
         [0013]    The suturing material can be transferred from the first jaw and the second jaw of the needle to the first holding member and the second holding member of the transfer arm when the needle is in the second position, and the transfer arm can orient the spaced apart portions of the suturing material between the heating elements when the heating elements are in the open position. The heating elements are moved into the heat sealing position for contacting the spaced apart portions of the suturing material and heat sealing the spaced apart portions of the suturing material together. 
         [0014]    In one form of the suturing device, a button is located on the handle of the suturing device, and a proximal end of the transfer arm is fixed to the button for moving the transfer arm. In another form of the suturing device, a first lever is located on the handle, and the first jaw and the second jaw are operatively coupled to the first lever such that movement of the first lever moves the first jaw and the second jaw between the grasping position and the release position. In yet another form of the suturing device, a second lever is located on the handle, and the first holding member and the second holding member are operatively coupled to the second lever such that movement of the second lever moves the first holding member and the second holding member between the holding position and the disengaged position. 
         [0015]    In another aspect of the invention, there is provided method for suturing tissue in a patient. The method for suturing tissue uses a suturing device including an elongated body having an outer wall defining an interior space of the body, a rotatable shaft located in the interior space of the body, and a needle mounted on a distal end of the shaft. The needle has a distal section transverse to a longitudinal axis of the shaft, and the distal section of the needle terminates in a first jaw and a second opposed jaw. At least one of the first jaw and the second jaw is movable relative to the other of the first jaw and the second jaw. A leading portion of a length of suturing material is grasped within the interior space of the body with the first jaw and the second jaw of the needle such that the first jaw and the second jaw define a piercing tip, and the piercing tip is located near the tissue. 
         [0016]    The shaft is rotated about its longitudinal axis thereby penetrating the tissue at an entry point of the tissue. The rotation of the shaft is continued until the leading portion of the length of suturing material has passed through the tissue and out of an exit point of the tissue. The leading portion of the length of suturing material is moved to a location near the entry point such that the leading portion of the length of suturing material is near or contacts a trailing portion of the length of suturing material. The leading portion of the length of suturing material and the trailing portion of the length of suturing material are attached together thereby forming a closed length of the suturing material. 
         [0017]    In one version of the method, the leading portion of the length of suturing material is moved to the location near the entry point using a transfer arm located in the interior space of the body. In one version of the method, the leading portion of the length of suturing material and the trailing portion of the length of suturing material are fused together using a pair of heating elements that are moved into contact with the leading portion and the trailing portion of the length of suturing material. The length of suturing material can be provided from a supply of suturing material located in the device. 
         [0018]    In one version of the method, a mesh is placed over the tissue and thereafter the shaft is rotated about its longitudinal axis thereby penetrating the mesh and the tissue at the entry point. The method can fasten the mesh and the tissue laparoscopically. In one non-limiting example, the method is used in performing laparoscopic sacrocolpopexy or sacrocervicopexy. 
         [0019]    In yet another aspect of the invention, there is provided a device for suturing tissue in a patient. The suturing device includes an elongated body having an outer wall defining an interior space of the body, and a needle positioned inside the body for translating in the body. A distal end of the needle terminates in a piercing tip suitable for grasping a suturing material. The piercing tip is movable between a first position in which the piercing tip is positioned in a first section of the interior space of the body and a second position in which the piercing tip is positioned in a second section of the interior space of the body. A length of suturing material is arranged in the second section of the interior space of the body. The piercing tip of the needle follows a first path when moving from the first position to the second position in which the piercing tip exits the first section of the interior space of the body, enters and exits an external space located outside of the body, and enters the second section of the interior space of the body where the piercing tip of the needle grasps a leading portion of the length of suturing material. The piercing tip of the needle follows a second path when moving from the second position to the first position in which the piercing tip exits the second section of the interior space of the body, enters and exits the external space, and is positioned near or in the first section of the interior space of the body. Preferably, the first path and the second path are substantially the same. The first path and/or the second path may be curved. The suturing material can be provided from a supply of suturing material, and a distal segment of suturing material is arranged in the second section of the interior space of the body such that the piercing tip can grasp the suturing material when the needle is in the second position. 
         [0020]    The suturing device further includes an attachment device for securing together a leading portion of the length of suturing material and a trailing portion of the length of suturing material thereby forming a closed length of the suturing material. The leading portion of the length of suturing material and the trailing portion of the length of suturing material are positioned near each other when the piercing tip of the needle is at an end of the second path. The attachment device can be include a heating element movable between an initial position and a heat sealing position for placing the leading portion of the length of suturing material and the trailing portion of the length of suturing material in contact and heat sealing the leading portion of the length of suturing material and the trailing portion of the length of suturing material together. The attachment device can be a plunger that terminates in the heating element. The plunger can move transversely with respect to a longitudinal axis of the body when the plunger moves between the initial position and the heat sealing position. 
         [0021]    In one form, the piercing tip of the needle has a slit for receiving the leading portion of the length of suturing material thereby grasping the leading portion of the length of suturing material in the piercing tip of the needle. In one form, the second section of the interior space of the body comprises a hollow extension that extends longitudinally outward beyond the first section of the interior space of the body. 
         [0022]    In still another aspect of the invention, there is provided method for suturing tissue in a patient. The method uses a suturing device including an elongated body having an outer wall defining an interior space of the body, and a needle positioned inside the body for translating in the body. A distal end of the needle terminates in a piercing tip suitable for grasping a suturing material. The piercing tip is movable between a first position in which the piercing tip is positioned in a first section of the interior space of the body and a second position in which the piercing tip is positioned in a second section of the interior space of the body. The piercing tip is located near the tissue with the piercing tip in the first position. The piercing tip is moved from the first position to the second position such that the piercing tip exits the first section of the interior space of the body, enters and exits tissue positioned in an external space located outside of the body of the device, and enters the second section of the interior space of the body where the piercing tip of the needle grasps a leading portion of the length of suturing material. The length of suturing material can be provided from a supply of suturing material located in the device. 
         [0023]    The piercing tip and the leading portion of the length of suturing material are moved from the second position to the first position in which the piercing tip and the leading portion of the length of suturing material exit the second section of the interior space of the body, enter and exit the tissue positioned in the external space, and are positioned near or in the first section of the interior space of the body. A trailing portion of the length of suturing material is then moved to a location near the leading portion of the length of suturing material. The leading portion of the length of suturing material and the trailing portion of the length of suturing material are then attached thereby forming a closed length of the suturing material. 
         [0024]    The trailing portion of the length of suturing material can be moved to the location near the leading portion of the length of suturing material using a plunger located in the body. The leading portion of the length of suturing material and the trailing portion of the length of suturing material can be fused together using a heating element on the plunger wherein the heating element is moved into contact with at least one of the leading portion and the trailing portion of the length of suturing material. The plunger can move the trailing portion of the length of suturing material laterally with respect to a longitudinal axis of the body. 
         [0025]    A mesh can be placed over the tissue before locating the piercing tip near the tissue. The piercing tip and the leading portion of the length of suturing material can be moved through the mesh. In one version of the method, the mesh and the tissue are fastened laparoscopically. In one non-limiting example, the method is used in performing laparoscopic sacrocolpopexy or sacrocervicopexy. 
         [0026]    These and other features, aspects, and advantages of the present invention will become better understood upon consideration of the following detailed description, drawings, and appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0027]      FIG. 1  is a top, right perspective view of a first embodiment of a suturing device according to the invention. 
           [0028]      FIG. 2  is a top, right detailed perspective view of the distal end of the suturing device of  FIG. 1 . 
           [0029]      FIG. 3  is a side view of the needle of the suturing device of  FIG. 1 . 
           [0030]      FIG. 4  is a top, right detailed perspective view of the proximal end of the suturing device of  FIG. 1 . 
           [0031]      FIG. 5  is a side view of needle jaws with a guide wire and associated lever of the suturing device of  FIG. 1 . 
           [0032]      FIG. 6A  is a cross-sectional view of the suturing device of  FIG. 1  beginning a suturing method of the invention. 
           [0033]      FIG. 6B  is a cross-sectional view of the suturing device of  FIG. 1  after the piercing tip of the needle and attached suturing material have entered and exited tissue of the patient. 
           [0034]      FIG. 6C  is a cross-sectional view of the suturing device of  FIG. 1  during transfer of the suturing material from the piercing tip of the needle to the transfer arm. 
           [0035]      FIG. 6D  is a top, right detailed perspective view of the suturing device of  FIG. 1  after the transfer arm has moved a leading portion of a length of the suturing material next to a trailing portion of the length of suturing material before fusing the length of the suturing material. 
           [0036]      FIG. 6E  is a cross-sectional view of a suture with a fused length of the suturing material prepared using the suturing device of  FIG. 1 . 
           [0037]      FIG. 7  is a top, right detailed perspective view of a second embodiment of a suturing device according to the invention. 
           [0038]      FIG. 8  is a top, right detailed perspective view of the needle of the suturing device of  FIG. 7 . 
           [0039]      FIG. 9A  is a cross-sectional view of the suturing device of  FIG. 7  after the piercing tip of the needle has entered an entry point of the tissue and exited an exit point tissue of the patient. 
           [0040]      FIG. 9B  is a cross-sectional view of the suturing device of  FIG. 7  after the piercing tip of the needle has pulled attached suturing material back through the entry point of the tissue of the patient. 
           [0041]      FIG. 9C  is a cross-sectional view of the suturing device of  FIG. 7  after the plunger head has moved a trailing portion of a length of the suturing material next to a leading portion of the length of suturing material. 
           [0042]      FIG. 9D  is a cross-sectional view of a suture with a fused length of the suturing material prepared using the suturing device of  FIG. 7 . 
       
    
    
       [0043]    Like reference numerals will be used to refer to like parts from Figure to Figure in the following description of the drawings. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0044]    Referring to  FIGS. 1 to 6E , there is shown a first embodiment of a suturing device  10  having an elongated body  12  with an outer wall  13  including first wall section  14  having a generally semi-circular shape in a cross-section transverse to a longitudinal axis A of the body  12 , and a second flat wall section  15 . The outer wall  13  defines an interior space  16  of the body  12 . The interior space  16  generally has a semi cylindrical shape. The body  12  may comprise a polymeric material such as polyethylene or polypropylene. The suturing device  10  includes a handle  18  attached to the body  12 . The surgeon can hold on to the suturing device  10  by the handle  18  which may also comprise a polymeric material such as polyethylene or polypropylene. The body  12  of the suturing device  10  can be introduced through an anatomical cavity wall using known laparoscopic surgical techniques. Suitable illumination devices (e.g. optical fibers) can be provided in one or more lumens of the body  12 , or can be provided in a separate device that is introduced through the anatomical cavity wall using known laparoscopic surgical techniques. The suturing device  10  includes a rotatable hollow shaft  20  located centrally in the interior space  16  of the body  12 . The shaft  20  has a distal end  21  and a transverse projection  22  fixed to the proximal end of the shaft  20  for rotating the shaft. In the embodiment of the suturing device  10  shown, the projection  22  is disc shaped and includes surface notches for a good grip. 
         [0045]    The suturing device  10  includes a hollow needle  24  having a shank  25  and a distal section  26 . The distal section  26  is transverse to the longitudinal axis A of the shaft  20 . A first jaw  27  and a second opposed jaw  28  are located at the end of the distal section  26  of the needle  24 . The first jaw  27  and the second jaw  28  are movable relative to each other. This can be accomplished by one of the first jaw  27  and the second jaw  28  being movable, or both of the first jaw  27  and the second jaw  28  being movable. Operation of the first jaw  27  and the second jaw  28  will be further described below. The first jaw  27  and the second jaw  28  define a piercing tip  29  of the needle  24 . 
         [0046]    The suturing device  10  includes a continuous length of a suturing material  32 . The suturing material  32  is provided on a supply reel  33  with an attached feed knob  34  that can be rotated to feed the suturing material  32  from the reel  33 . A first feed guide  35  and a second feed guide  36  keep the suturing material  32  suitably tensioned in the interior space  16  of the body  12  when feeding the suturing material  32 . The suturing material  32  is preferably thermoplastic to allow for heat sealing of sections of the suturing material  32  together. The suturing material  32  can be, for example, an absorbable material, such as polyglycolic acid, polylactic acid, and polydioxanone, or a non-absorbable material such as nylon and polypropylene (e.g. Prolene®). 
         [0047]    The suturing device  10  includes a hollow transfer arm  40  having a distal end  41  and a push button  42  at its proximal end. A positioner  43  is located near the distal end  41  of the transfer arm  40 . A first holding member  44  (see  FIG. 6A ) and a second holding member  45  (see  FIG. 6A ) are located at the distal end  41  of the transfer arm  40 . The first holding member  44  and the second holding member  45  are movable relative to each other. This can be accomplished by one of the first holding member  44  and the second holding member  45  being movable, or both of the first holding member  44  and the second holding member  45  being movable. Operation of the first holding member  44  and the second holding member  45  will be further described below. 
         [0048]    The suturing device  10  includes a first fusion block  48  and a second fusion block  49 . The first fusion block  48  and the second fusion block  49  fuse spaced apart portions of the length of suturing material  32  together as described below. The first fusion block  48  and the second fusion block  49  each include heating element sections that are resistance heated by a suitable source of electricity such as a battery or external AC power supply. Alternatively, just one of the first fusion block  48  and the second fusion block  49  includes a heating element section. The first fusion block  48  and the second fusion block  49  are movable relative to each other. This can be accomplished by one of the first fusion block  48  and the second fusion block  49  being movable, or both of the first fusion block  48  and the second fusion block  49  being movable. In one form, the second fusion block  49  is attached to a guide wire that has a proximal lever on the handle  18 . The proximal lever can move the second fusion block  49 , which is arranged in a suitable guide support, toward and away from the first fusion block  48 . 
         [0049]    Looking now at  FIG. 5 , operation of the first jaw  27  and the second jaw  28  of the needle  24  can be further described. The first jaw  27  and the second jaw  28  are connected to a first linkage  52  that is attached to a first guide wire  53  having a first lever  54  at its proximal end. The first lever  54  protrudes through the top of the handle  18  (see  FIGS. 1 and 4 ). The first guide wire  53  is contained in the hollow shaft  20  and the hollow needle  24 . The first linkage  52  mounts the first jaw  27  and the second jaw  28  at the end of the distal section  26  of the needle  24 . Moving the first lever  54  in direction F in  FIG. 5  causes the first jaw  27  and the second jaw  28  of the needle  24  to come together, and moving the first lever  54  in direction B in  FIG. 5  causes the first jaw  27  and the second jaw  28  of the needle  24  to move apart. Movement of one or both of the first jaw  27  and the second jaw  28  can accomplish this, and the first linkage  52  can be suitably designed to move either one or both of the first jaw  27  and the second jaw  28  when the first lever  54  is moved. 
         [0050]    Likewise, the first holding member  44  and the second holding member  45  are connected to a second linkage that is attached to a second guide wire having a second lever  56  at its proximal end. The second lever  56  protrudes through the top of the handle  18  (see  FIGS. 1 and 4 ). The second guide wire is contained in the hollow transfer arm  40 . The second linkage mounts the first holding member  44  and the second holding member  45  at the distal end of the hollow transfer arm  40 . Moving the second lever  56  in direction F in  FIG. 5  causes the first holding member  44  and the second holding member  45  of the transfer arm  40  to come together, and moving the second lever  56  in direction B in  FIG. 5  causes the first holding member  44  and the second holding member  45  of the transfer arm  40  to move apart. Movement of one or both of the first holding member  44  and the second holding member  45  can accomplish this, and the second linkage can be suitably designed to move either one or both of the first holding member  44  and the second holding member  45  when the second lever  56  is moved. 
         [0051]    Looking now at  FIGS. 6A to 6E , operation of the suturing device  10  in suturing tissue can be explained. In  FIG. 6A , the suturing device  10  is in its initial position, and the second wall section  15  of the body  12  has been placed in contact with a mesh  59  placed on tissue  60 . One non-limiting mesh is a polypropylene mesh. The first lever  54  is moved in direction F (as shown in  FIG. 5 ) which causes the first jaw  27  and the second jaw  28  of the needle  24  to come together to grasp a leading portion  61  of the suturing material  32 . A trailing portion  63  of the suturing material  32  is located in the body  12 . 
         [0052]    The shaft  20  is then rotated in direction R by moving projection  22  in direction Ron the handle  18  (see  FIG. 1 ). The piercing tip  29  of the needle  24  passes through a slot  71  (see  FIG. 6D ) in the second wall section  15  of the body  12  and then penetrates the mesh  59  and an entry point  66  of the tissue  60 . By continuing to rotate the shaft  20  in direction R, the piercing tip  29  and the leading portion  61  of the length of suturing material  32  pass through the mesh  59  and the tissue  60  at an exit point  68 . The needle  24  and the leading portion  61  of the length of suturing material  32  are then in the position shown in  FIG. 6B . Thus, the needle  24  holds the suturing material  32  and pierces the mesh  59  and tissue layer  60  and moves in a rotary path with the suturing material  32  following the rotary path of the needle  24 . In  FIG. 6B , it can be seen that the transfer arm  40  has located the first holding member  44  and the second holding member  45  near the leading portion  61  of the length of suturing material  32 . 
         [0053]    Referring now to  FIG. 6C , the first holding member  44  and the second holding member  45  of the transfer arm  40  are moved next to the leading portion  61  of the length of suturing material  32  by way of button  42  on the handle  18  (see  FIG. 1 ). Movement of the second lever  56  in direction F in  FIG. 5  causes the first holding member  44  and the second holding member  45  of the transfer arm  40  to come together and grasp the leading portion  61  of the length of suturing material  32  as shown in  FIG. 6C . The button  42  on the handle  18  can then be rotated transverse to the longitudinal axis A of the body  12 . This moves the leading portion  61  of the length of suturing material  32  to a location near the entry point  66  of the tissue  60  such that the leading portion  61  of the length of suturing material  32  is near or contacts the trailing portion  62  of the length of suturing material  32 . The leading portion  61  and the trailing portion  62  of the length of suturing material  32  intersect between the first fusion block  48  and the second fusion block  49 . This is shown in  FIG. 6D . 
         [0054]    When the leading portion  61  and the trailing portion  62  of the length of suturing material  32  are in the position shown in  FIG. 6D , the heating element sections of the first fusion block  48  and the second fusion block  49  are brought together on the leading portion  61  and the trailing portion  62  of the length of suturing material  32 , and the heating elements are resistance heated. This heat seals together the leading portion  61  of the length of suturing material  32  and the trailing portion  62  of the length of suturing material  32  at a fusion point  73  as shown in  FIG. 6E , thereby forming a closed length  82  of the suturing material  32 . After fusion of suturing material  32 , a cutter on the first fusion block  48  and/or the second fusion block  49  cuts the suturing material  32  near the fusion point  73 . The needle  24  can then be rotated back to the initial position shown in  FIG. 6A  by moving projection  22  on the handle  18  in a direction opposite to direction R. The steps described above with reference to  FIGS. 6A to 6E  can then be repeated to create another closed length  82  of the suturing material  32  at a different location on the mesh  59  and the tissue  60 . 
         [0055]    Thus, operation of the suturing device  10  as shown in  FIGS. 6A to 6E  can be summarized as follows: (1) the suturing device  10  is provided with pre-loaded reel  33  of suturing material  32 ; (2) the leading portion  61  of the length of suturing material  32  is grasped by the jaws  27 ,  28  of the rotary needle  24  by moving the first lever  54 ; (3) the rotary needle  24  pierces the mesh  59  and the tissue  60 ; (4) the leading portion  61  of the length of suturing material  32  is picked up by the holding members  44 ,  45  of the transfer arm  40  by moving the second lever  56 ; (5) the leading portion  61  of the length of suturing material  32  is then taken back near the initial position of the piercing tip  29  of the needle  24 ; (6) the fusion blocks  48 ,  49  are then operated; (7) the rotary needle  24  is reverted back to the initial position; and (8) the procedure is repeated for the next suturing. 
         [0056]    Although  FIGS. 6A-6E  describe attaching together the leading portion  61  and the trailing portion  62  of the length of suturing material  32  using fusion blocks  48 ,  49  to create a heat sealed fusion point  73 , alternative methods such as knotting, metal strips, plastic strips, and glue can be used for attaching together the leading portion  61  and the trailing portion  62  of the length of suturing material  32  to form the closed length  82  of the suturing material  32 . 
         [0057]    Referring now to  FIGS. 7 to 9D , there is shown a second embodiment of a suturing device  110  having an elongated body  112  including a main outer wall  113  and a transverse wall  114  with an opening  115 . The body  112  defines an interior space  116  of the suturing device  110 , and the body  112  has a longitudinal axis A. The body  112  can comprise a polymeric material such as polyethylene or polypropylene. The body  112  includes a top extension wall  118 , a side extension wall  119 , and a bottom extension wall  120  that extend longitudinally outward from the body  112 . The bottom extension wall  120  includes an oblong slot  121 . 
         [0058]    The suturing device  110  includes a handle (similar to handle  18  in  FIG. 1 ) attached to the body  112 . The surgeon can hold on to the suturing device  110  by the handle, which may also comprise a polymeric material such as polyethylene or polypropylene. The body  112  of the suturing device  110  can be introduced through an anatomical cavity wall using known laparoscopic surgical techniques. Suitable illumination devices (e.g. optical fibers) can be provided in one or more lumens of the body  112 , or can be provided in a separate device that is introduced through the anatomical cavity wall using known laparoscopic surgical techniques. 
         [0059]    The suturing device  110  includes a needle  124  that slidingly translates in a sleeve  125  (see  FIG. 8 ). The needle  124  has a distal section  126  having a longitudinal slit  127 . The distal section  126  of the needle  124  defines a piercing tip  129  of the needle  124 . 
         [0060]    The suturing device  110  includes a continuous length of a suturing material  132 . The suturing material  132  is provided on a supply reel with an attached feed knob that can be rotated to feed the suturing material  132  from the reel (similar to reel  33  and feed knob  34  in  FIG. 1 ). Suitable feed guides keep the suturing material  132  suitably tensioned in the interior space  116  of the body  112  when feeding the suturing material  132 . The suturing material  132  is preferably thermoplastic to allow for heat sealing of sections of the suturing material  132  together. The suturing material  132  can be, for example, an absorbable material, such as polyglycolic acid, polylactic acid, and polydioxanone, or a non-absorbable material such as nylon and polypropylene (e.g. Prolene®). 
         [0061]    The suturing device  110  includes a suturing material attachment mechanism. A guide wire  139  includes a plunger  140  that terminates in a heating element  141 . The heating element  141  is resistance heated by a suitable source of electricity such as a battery or external AC power supply. A plunger guide  143  transitions the plunger  140  from proximal to distal motion to motion transverse to the longitudinal axis A of the body  112 . 
         [0062]    Looking now at  FIGS. 7 and 9A  to  9 D, operation of the suturing device  110  in suturing tissue can be explained. In  FIG. 9A , a mesh  159  has been placed on tissue  160 . One non-limiting example mesh is a polypropylene mesh. The needle  124  has been advanced in the sleeve  125  and the piercing tip  129  of the needle  124  has penetrated the mesh  159  and an entry point  166  of the tissue  160 , and has passed through the tissue  160  at an exit point  168  and the mesh  159 , and has passed through the slot  121  into a section of the interior space  116  defined by the top extension wall  118 , the side extension wall  119 , and the bottom extension wall  120  that extend longitudinally outward from the body  112 . The slit  127  of the needle  124  has grasped a leading portion  161  of the length of suturing material  132 . This position is shown in  FIGS. 7 and 9A . 
         [0063]    Referring now to  FIG. 9B , the needle  124  has been retracted in the sleeve  125  and the piercing tip  129  and the leading portion  161  of the length of suturing material  132  have passed through the mesh  159  and the tissue  160  at the exit point  168 , and have passed through the tissue  160 , and have passed through the tissue  160  at the entry point  166  and the mesh  159 . The needle  124  and the leading portion  161  of the length of suturing material  132  are then in the position shown in  FIG. 9B  in which the-leading portion  161  of the length of suturing material  132  is positioned near or in a section of the interior space  116  of the body  112 . 
         [0064]    When the leading portion  161  of the length of suturing material  132  is in the position in  FIG. 6B , the plunger  140  with heating element  141  exits the plunger guide  143  and moves transverse to the longitudinal axis A of the body  112 . See direction T in  FIG. 9B . The end surface of the plunger  140  contacts a trailing portion  162  of the length of suturing material  132  and moves the trailing portion  162  of the length of suturing material  132  into contact with the leading portion  161  of the length of suturing material  132  as shown in  FIG. 9C . The heating element  141  is resistance heated, and this fuses together the leading portion  161  of the length of suturing material  132  and the trailing portion  162  of the length of suturing material  132  at a fusion point  173  as shown in  FIG. 9D , thereby forming a closed length  182  of the suturing material  132 . After fusion of suturing material  132 , a cutter on the plunger  140  cuts the suturing material  132  near the fusion point  173 . The steps described above with reference to  FIGS. 9A to 9D  can then be repeated to create another closed length  182  of the suturing material  132  at a different location on the mesh  159  and the tissue  160 . 
         [0065]    Looking at  FIGS. 9A and 9B , the needle  124  follows a generally curved path between the entry point  166  of the tissue  160  and the exit point  168  of the tissue  160 . The distal section  126  of the needle  124  can be formed of a highly elastic material (e.g., a superelastic nickel-titanium alloy) to facilitate the curved path through the tissue  160 . Specifically, the distal section  126  of the needle  124  can have a curved shape similar to the curved path desired through the tissue  160 . When located in the sleeve  125 , the curved shape of the distal section  126  of the needle  124  can assume the straight configuration of the inner space of the sleeve  125 . When the distal section  126  of the needle  124  is moved out of the distal end of the sleeve  125  and through the opening  115  in the transverse wall  114  of the body  112 , the distal section  126  of the needle  124  elastically returns to a curved shape similar to the curved path desired through the tissue  160 . Preferably, the needle  124  follows substantially the same generally curved path when moving in either direction between the entry point  166  of the tissue  160  and the exit point  168  of the tissue  160 . However, as long as the length of suturing material  132  is guided through the tissue  160 , the path of the needle can vary when moving in opposite directions between the entry point  166  of the tissue  160  and the exit point  168  of the tissue  160 . 
         [0066]    Thus, the invention provides suturing devices and associated methods that can automate the process of fastening tissue and mesh laparoscopically. While the suturing devices are especially advantageous for performing laparoscopic sacrocolpopexy or sacrocervicopexy, the suturing devices can be used in any procedure where tissue is sutured. 
         [0067]    Although the present invention has been described in detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the invention should not be limited to the description of the embodiments contained herein.