Devices are provided for a suturing device used during laparoscopic surgical procedures. A suturing needle includes a shaft forming a rod axis; a curved body having a piercing tip at a first end and a base at a second end; and an arm extending from the shaft to the base of the curved body such that the curved body is rotatable about the shaft. The suturing device includes a housing, a suturing needle, one or more sutures, a suture magazine configured to hold the one or more sutures, and a drive system, whereby the drive system may actuate the suturing needle to rotate, allowing the suturing needle to drive into and out of tissue to apply a suture.

BACKGROUND

Laparoscopic surgical procedures are becoming increasingly common as an alternative to open surgical procedures. Pain, hemorrhaging, and recovery time may be reduced when performing a laparoscopic surgical procedure versus an open surgical procedure. However, laparoscopic procedures can take longer to perform, which can increase the cost of performing the laparoscopic procedure and limit the amount of laparoscopic procedures that can be performed daily.

Suturing is a common method employed in surgeries to close tissue openings and secure synthetic objects to tissue, among other things. The suturing process is more challenging when being used in laparoscopic surgical procedures as there is a smaller space to work within and the degrees of movement that a surgeon is afforded is restricted as compared to open surgical procedures. Given the benefits of laparoscopic procedures and other procedures with reduced invasiveness, technologies for improving access and facilitating efficient, reliable, and robust mechanisms for suturing can improve treatment and recovery outcomes for patients.

BRIEF SUMMARY

A suturing needle is provided that has a shaft forming a rod axis, a curved body having a piercing tip at one end and a base at another end; and an arm extending radially from the shaft to the base of the curved body such that the curved body is positioned in a plane orthogonal to the rod axis of the shaft and rotatable about the shaft in the plane orthogonal to the rod axis.

A suturing device incorporating the above described suturing needle can include one or more sutures, and a drive system. The drive system is coupled to the shaft and configured to actuate the rotation of the suturing needle in a first direction into tissue and a second direction that is opposite the first direction. The one or more sutures each include a fastener end, an anchor end, and a suture thread extending between the fastener end and the anchor end. A suture magazine can be used to hold the one or more sutures. The suturing needle and the suture magazine are positioned within a housing that allows for the suturing needle to exit the housing, catching the suture at the fastener end, as the suturing needle rotates in the first direction in the plane orthogonal to the rod axis.

A drive system for a suturing device can include a tube having a proximal end that may abut a hub that couples to a manual or robotic arm, a distal end that couples to a shaft of a suturing needle, and a rod having the hub at its distal end and one more protrusions on the rod in a position towards the proximal end of the rod and one or more grooves, each groove being for a corresponding one of the one protrusions, the one or more grooves extending in a spiral manner from a proximal end of the tube towards the distal end of the tube. The one or more protrusions on the rod are configured to move along the one or more grooves of the tube. The rod is configured to remain fixed along a direction of a tube axis of the shaft while being able to rotate about the tube axis. The tube is configured to remain fixed in a radial direction while being moveable forward and backward along the tube axis, the moving of the tube in the forward and backward direction causing the one or more protrusions of the rod to move along the one or more grooves and thereby rotate the rod and the shaft that would be coupled thereto about the tube axis. In another implementation, the protrusions may be in the tube and the grooves on the rod.

The invention(s) also relate a system for advancing a set of sutures forward after each suture is placed at a repair site (e.g., tissue associated with a laparoscopic procedure or other procedure). In embodiments, the system includes a ratcheting mechanism that includes one or more tracks for retaining and/or supporting a set of sutures in operation modes associated with suture advancement (and in baseline operation modes without suture advancements, and for advancing remaining sutures forward. In an embodiments, the system includes a first track (i.e., suture positioning track) for retaining a set of sutures at a first side within a suture magazine, and second track (i.e., suture moving track) for supporting the set of sutures at a second side and facilitating forward advancement of sutures as leading sutures are used. In one or more of these embodiments, the second track moves relative to the first track as sutures are placed, thereby advancing remaining sutures forward (e.g., as leading sutures are used or otherwise displaced from the system). In an embodiment, the second track is coupled to one or more biasing elements (e.g., linear springs, non-linear springs, wave springs, etc.) that facilitate lifting and/or forward advancement of remaining sutures in the suture positioning tray as each leading suture is placed. The biasing element(s) may have asymmetric configurations in relation to bilateral sides of the suture moving tray, in order to provide delayed timing of advancement associated with different sides of the suture moving tray.

In particular, embodiments of the invention(s) can include needle features that increase range of delivery rotation of the needle into a tissue or other repair site.

Additionally or alternatively, embodiments of the invention(s) can include suture magazine components providing compact and reliable mechanisms for advancing sutures of a set of sutures toward a deployment position. Such components and configurations can provide improvements over mechanisms that tend to apply high deployment force when all sutures are loaded, with decreased deployment force as sutures are deployed. Such embodiments can implement “lost-motion” designs that allow ratcheting components of the mechanisms to travel only as far as needed between instances of suture deployment in a consistent manner appropriate to the suture capacity of the suture magazine.

These and other features and advantages will be apparent from a reading of the following detail description, and a review of the appended drawings. It is to be understood that the foregoing summary, the following detail descriptions, and the appended drawings are only explanatory and are not restrictive of various aspects claimed.

DETAILED DESCRIPTION

Implementations of the invention provide devices to improve suturing techniques in laparoscopic surgical procedures. Certain implementations of the invention enable surgeons to perform suturing procedures more efficiently even with the challenges presented by the restricted movement inherent in laparoscopic procedures.

Laparoscopic procedures can be performed manually or with a robotic-assisted surgical system. Manual laparoscopic surgical procedures involve cutting small incisions into the patient and placing tubes called ports through the incision site. The ports can include surgical instruments such as forceps, hooks, scissors, and more to mimic the movement and ability of the surgeon's hands. This allows the surgeon to perform the entire surgery ex vivo without physically placing their hands into the patient's body.

Alternatively, robotic-assisted laparoscopic procedures use a robotic-assisted surgical system that generally includes three or four robotic arms that the surgeon can manipulate from a distance at a console. Similar to the ports used in manual laparoscopic surgical procedures, at the console, the surgeon operates haptic controls that mimic the movement and ability of the surgeon's hands. With both manual laparoscopic procedures and robotic-assisted laparoscopic procedures, the surgeon must use instruments rather than their own hands to interact with tissue, making it difficult to reproduce functions that would normally be performed with a human hand. As a result, applying sutures to tissue during laparoscopic surgical procedures have become more cumbersome and tedious resulting in longer surgery times.

In particular, laparoscopic sacrocolpopexy, a surgical procedure used to treat vaginal vault or uterine prolapse, is susceptible to the challenges that current laparoscopic procedures present. A uterine prolapse results when the uterus descends from its normal position within the pelvis. Every year in the United States, approximately 300,000 women participate in pelvic organ prolapse corrective surgery. Sacrocolpopexy is a surgical technique that aims to reduce prolapse and restore the anatomy and function of the vagina by suturing a synthetic mesh to the vaginal wall. The mesh provides the vagina with support and requires about 12-15 sutures. Overall, the procedure can take three to four hours to complete, where the suturing process alone may require 60 to 100 minutes.

In order to address these challenges, certain implementations provide an efficient suturing device that, with a single motion, can stitch and tighten a suture, which diminishes the time, cost, and difficulty of laparoscopic surgeries.

Certain implementations involve automated stitching and tightening of sutures.

As used herein, the term “distal” end generally refers to the end that is further from the surgeon when the surgeon is operating the device.

Additionally, the term “proximal” end generally refers to the end that is closer to the surgeon when the surgeon is operating the device.

FIGS. 1A-1Cdepict a suturing needle100that can be used in a suturing device in accordance with one or more embodiments (explained, for instance, in further detail below with respect toFIGS. 3A-3E). The suturing needle100has a curved body101, an arm102, and a shaft103. The curved body101may have a piercing tip104at one end and a base106at the other end. The shaft103can form a rod axis107. In one implementation, the suturing needle100may have a needle grasping edge105that is formed by the tube of the curved body101having a larger diameter than the base of the piercing tip104. This allows the suture to be held along the needle grasping edge105as the curved body101rotates about the shaft103. In an alternate implementation, the suturing needle100may also have a grasping element112that is configured to form a recess between the grasping element112and the piercing tip111so that a suture may be held in the recess as the curved body101rotates about the shaft103. In another implementation, the needle may include a groove113extending from the piercing tip104along at least a portion of an outer surface of the curved body101. The groove113can be configured to maintain a fastener portion of a suture in a position along the outer surface of the curved body101of the suturing needle100.

As shown inFIGS. 1A-1C, the arm102extends radially from the shaft103. The curved body101is positioned in a plane orthogonal to the rod axis107of the shaft103and rotatable about the shaft103in the plane orthogonal to the rod axis107to drive in to and out of a tissue108to apply a suture200(described in more detail below).

FIG. 2Adepicts a suture200that may be used with a suturing device, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). The embodiment of the suture200and variations of the suture can include a fastener end201, an anchor end202, and a suture thread203connected to and extending between the fastener end201and the anchor end202. The fastener end201and the anchor end202can be made of polydllactide (PDLLA) or another biodegradable material. The suture thread203may be made of biodegradable material such as polydioxanone (PDS), polypropylene, or the like.

The embodiment of the suture200and variations of the suture can include a first fastener mechanism204and a second fastener mechanism205. Referring toFIG. 1andFIGS. 2A-2C, as the suturing needle100rotates about the shaft103, the piercing tip104is inserted through the first fastener mechanism204. As the suturing needle100continues rotation, the needle grasping edge105secures the first fastener mechanism204and pulls it through the tissue108and through the chamber206of the anchor end202of the suture200. The first fastener mechanism204can then be used to pull the second fastener mechanism205through the chamber206to tighten the suture200to pull the tissue108together.

In this embodiment, as the first fastener mechanism204is moved through the chamber206(seeFIG. 2C) of anchor housing207of the anchor end202, the geometrical configuration locks the fastener grasping edge208A of the first fastener mechanism204on top of the chamber206such that the first fastener mechanism204cannot be moved backwards through the chamber206.

Referring toFIG. 2A, the fastener end201has a top209and a bottom210. The suture thread203may be embedded in, molded in, or otherwise fixed to the top209of the fastener end201. The bottom of the fastener end201may include a suture guide loop that performs part of the function of the first fastener mechanism, meaning that the suture guide loop can be secured by the grasping element112or other functionally similar structure and moved through the tissue108and into or through the anchor end202of the suture200.

Referring now toFIG. 2C, the chamber206is contained within the anchor housing207. The chamber206may have a conical shape. However, the shape of the chamber206and even the anchor end202can vary. For example, the chamber may be rectangular, curved, semi-spherical, or any other known shape that can function to receive the fastener end201of the suture200and secure the fastener end201to the anchor end202. In an alternate embodiment, the suture thread203may be looped through the chamber206and tied around the anchor housing207, and extend and connect to the fastener end201. In another implementation, the suture thread203may be embedded in, molded in, or otherwise fixed to the anchor housing207of the anchor end202.

When the first fastener mechanism204of the fastener end201passes through the chamber206in an upward direction, the conical shape of the chamber206receives the first fastener mechanism204and locks the first fastener mechanism204over the top of the chamber206. This inhibits the fastener end201from returning backwards through the chamber206.

It should be understood that the fastener end201and the anchor end202may utilize any known geometrical configurations and/or locking mechanisms and are not limited to any one particular configuration. For example, the fastener end may have one or more ridges, the ridges being similar to a barb on a fish hook. These ridges may be designed to lock into a chamber of the anchor end. The chamber can have a structure to facilitate the locking of the fastener end into the anchor end, such as a curved shoulder to allow for the ridges to enter the chamber, but not allowing the ridges to exit the chamber in the direction that the ridges entered into the chamber. Of course, the shape of the fastener end can vary and is not limited to having a surface with one or more ridges. For example, in another alternate implementation of the fastener end, the fastener end may have a flat surface and a surface with one or more ridges opposite from the flat surface.

The chamber may have one or more shoulders configured to allow the fastener end to enter the chamber in a unidirectional manner.

When the fastener end passes through the chamber in an upward direction, the ridges of the fastener end pass the shoulders. The ridges lay on top of the shoulders to inhibit the fastener end from moving in a downward direction. This inhibits the fastener end from escaping the chamber and secures the fastener end inside the anchor end. As stated above, the shape of the fastener end and the anchor end are not limited to the implementations previously stated, and various other shapes and configurations may be used to secure the fastener end to the anchor end.

FIGS. 3A-3Eshow views of a suturing device and housing, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below).FIG. 3Ashows a view of a suturing device over tissue in a middle position;FIG. 3Bshows a view of a suturing device over tissue in an end position;FIG. 3Cshows a cross-sectional view of a suturing device over tissue in an end position;FIG. 3Dshows a view of a suture housing that is filled with sutures;FIG. 3Eshows a view of an empty suture housing. As illustrated inFIGS. 3A-3E, a suturing device300, in accordance with various implementations of the invention includes a suture housing301, a suturing needle302, one or more sutures304, a suture magazine303configured to hold the one or more sutures304, and a drive system305configured to actuate the rotation of the suturing needle302in a first direction into a tissue310and a second direction that is opposite the first direction to apply one or more sutures304to the tissue310, or to apply one or more sutures304to mount an implant (e.g., synthetic mesh) onto the tissue310.

FIG. 4, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below) depicts a laparoscope with suturing device, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). A laparoscope with suturing device400can be implemented, for example, with suturing device300mounted at a distal end of a standard laparoscope. The laparoscope may include a stem402and a trigger (not shown). The stem402of the laparoscope has a length long enough to allow the surgeon to operate the suturing device (e.g., device300) from a location outside of the patient while the suturing device is in contact with tissue. The stem402is coupled to a drive system, for example, drive system305, of the suturing device via clamps404. The trigger (not shown) is located at the proximal end of the laparoscope. The surgeon can squeeze the trigger (not shown) to apply a force to the drive system305(via clamps404), and thus engage the suturing device300to apply a suture.

In another implementation, the suturing device300may be mounted to the distal end of a robotic-assisted surgical forceps arm. A sheath made of a non-ridged sterile material may be used to connect the proximal end of the suture housing301to the distal end of the robotic-assisted surgical forceps arm. The sheath allows flexibility in orienting the suturing device300in different directions. The surgeon can close the forceps on the robotic-assisted surgical forceps arm to apply a force to the drive system305, and thus engage the suturing device300to apply a suture304. Alternatively, the suturing device300may be actuated as a robotic arm that works in tandem with a robotic-assisted surgical system. The surgeon can operate the suturing device300at a console to administer sutures304.

Referring back toFIGS. 3A and 3B, the suture housing301of the suturing device300encloses the suturing needle302, the one or more sutures304, the suture magazine303configured to hold the one or more sutures304, and the drive system305. The suturing needle302can have a shaft311forming a rod axis107, a curved body306having a piercing tip308at one end and a base312at another end, and an arm307extending radially from the shaft311to the base312of the curved body306so that the curved body306is positioned in a plane orthogonal to the rod axis107of the shaft311and rotatable about the shaft311in the plane orthogonal to the rod axis107. The suturing needle302may also be designed in accordance with the suturing needle100or110as described inFIGS. 1A, 1B, and 1C.

The one or more sutures304of the suturing device300each comprises a fastener end, an anchor end, and a suture thread extending between the fastener end and the anchor end. The one or more suture may be designed in accordance with the suture illustrated inFIG. 2A. Additionally, the fastener end and the anchor end may be designed as described with respect to the fastener end illustrated inFIG. 2A, and the anchor end illustrated inFIGS. 2A, 2B, and 2C.

Referring now toFIGS. 5A and 5B, one or more embodiments (e.g., including embodiments described in Sections 2.1 and 2.2 below) of the suture housing301of the suturing device300has an aperture in the plane orthogonal to the rod axis of the suturing needle302that permits exiting of the suturing needle302and one of the one or more sutures304from the suture housing301. The suture housing301can have a curved upper interior surface and a flat lower interior surface, where the aperture is in the flat lower interior surface. The curved upper interior surface of the suture housing301is slightly longer than the flat interior lower surface to allow the suturing needle302to rotate in to and out of the tissue310to apply a suture304(seeFIGS. 3A, 3B, and 3C). However, the shape of the suture housing301can vary and is not limited to having a curved upper interior surface and a flat lower interior surface. In one implementation, the curved upper interior surface of the suture housing301may have a needle track that maintains the suturing needle302within the plane orthogonal to the rod axis of the suturing needle302.

The suture housing301may be made of a rigid sterile material, and the suture housing301may be discarded after use, or sterilized and re-used for numerous procedures. Additionally, in one implementation, the suture magazine303may be discarded after use, and may be replaced with another suture magazine303. The suture magazine303is configured to hold the one or more sutures304within the suture housing301so that the fastener end201of the one or more sutures304can be positioned to be grasped by one end of the curved body101of the suturing needle302as it exits the aperture in the suture housing301at one side of the shaft103of the suturing need302, and the anchor end202can be positioned to exit the aperture in the suture housing301at another side of the shaft103of the suturing needle302. The suture magazine303is seated on to the flat lower surface of the suture housing301towards the distal end of the suturing device300.

FIG. 6Adepicts an implementation of a suture magazine600that may be used in the suturing device300as shown inFIG. 3A, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). Each suture can have a fastener end602, an anchor end603, and a suture thread604connected to and extending between the fastener end602and the anchor end603. The suture thread604may be made of biodegradable material such as polydioxanone (PDS), polypropylene, or the like. In one implementation, the suture may be designed in accordance with the suture illustrated inFIG. 2A. Additionally, the fastener end602and the anchor end603may be designed in accordance with the fastener end201illustrated inFIG. 2Aand the anchor end202illustrated inFIGS. 2B and 2C. The suture magazine600can include elastic members601. The elastic members601can be made of rubber or another elastic material. The elastic members601have a distal end that is towards the suture needle100and a proximal end that is towards the hub. The distal end of the elastic members601is attached to the suture housing cover605and the proximal end is attached to the suture movers606. The suture movers606are configured to slide within the suture magazine600such that when a suture is used and leaves through the aperture in the suture housing301, the force created by the elastic members601pulls the suture movers606forward which in turn pushes any remaining sutures forward towards the distal end of the suturing device300. In an alternate embodiment, a spring can be placed on the proximal end (behind) of the suture movers606so that the sutures can be moved forward when a suture is used and leaves through the aperture in the suture housing301. The spring can be used as a replacement to or in combination with the elastic members601to move the sutures forward each time a suture is used and leaves through the aperture in the suture housing301. The spring/suture movers combination or the elastic members/suture movers combination may be used as a loading mechanism in contact with the suture magazine600. The loading mechanism is not limited to these combinations. The loading mechanism may be any structure that can be tensioned to apply a force to the suture magazine600.

FIG. 6Bshows the suture magazine600positioned inside the suture housing301of the suturing device300, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). When the suture magazine600is seated on to the flat lower interior surface of the suture housing301, the suture thread604lays laterally behind the suturing needle302and across the flat lower interior surface of the suture housing301. The suturing needle302can be actuated to rotate in the plane orthogonal to the tissue to drive in to and out of the tissue to apply a suture.

In embodiments, the suturing needle302has a curved body306, an arm307, and a shaft311. The curved body306may have a piercing tip308at one end and a base312at the other end. The shaft311can form a rod axis. In one implementation, the suturing needle302may also have a grasping edge309that is configured to form an edge between the grasping edge309and the piercing tip308. This allows for the piercing tip308to enter the tissue in a curved motion with the first fastener mechanism313in tow, and exit the tissue while simultaneously inserting the first fastener mechanism313through the chamber314or the anchor housing315.

In alternate embodiments, the needle may also include a groove113extending from the piercing tip111along at least a portion of an outer surface of the curved body306. The groove113can be configured to maintain the fastener end602in a position along the outer surface of the curved body306of the suturing needle302. In another implementation, the fastener end602can include a suture guide loop, and the grasping element312of the suturing needle302may grab the suture guide loop to pull the fastener end602from the belt and enter the tissue in a curved motion with the fastener end602in tow, and exit tissue while simultaneously inserting the fastener end602into the anchor end603.

In one implementation, the suturing needle302can be actuated by the drive system305. The drive system305is coupled to the shaft311of the suturing needle302, whereby the curved body306is positioned in a plane orthogonal to drive system305. The suturing needle302can rotate in a first direction and a second direction that is opposite the first direction, in the plane orthogonal to tissue from a starting position to an end position. In the starting position (seeFIG. 1B), the curved body306of the suturing needle302is stationary inside the suture housing301in the plane orthogonal to the drive system305, the fastener end602of the suture is in place for grasping by the suturing needle302, and the anchor end603of that suture is positioned away from the aperture in the suture housing301. In a motion to the end position, the needle302rotates in the first direction from the starting position, grasps the fastener end602while the anchor end603is moved into position over the aperture in the suture housing301, and continues to rotate into tissue in a curved path on a plane orthogonal to tissue, inserting the fastener end602into the anchor end603. At the end position (seeFIGS. 3A and 3C), the suturing needle302automatically rotates in the second direction to return to the starting position. As the suturing needle302returns to the starting position, the arm307of the suturing needle302comes into contact with the anchor end603. The anchor end603is pushed out of the aperture in the suture housing301by the arm307of the suturing needle302, allowing a next suture to have its fastener end602to move into position for grasping by the suturing needle302. The fastener end602is released from the suture magazine600as the suture needle302and grasping edge309grasp the fastener end602and drag the fastener end602along a curved path to be inserted through the anchor end603. The elastic members601apply a pulling force to the suture movers606which in turn apply a pushing force to the fastener end602and the anchor end603, allowing another fastener end602and anchor end603to move into position to be grappled by the needle302. When the fastener end602is inserted into the anchor end603, the fastener end602is configured to be pulled through or locked within the anchor end603upon insertion to retain the suture under tension.

In an implementation incorporating a spring, after the fastener end602is released from the notch of the belt as the suturing needle302grasps the fastener end602and drags the fastener end602along a curved path to be inserted into the anchor end603, the spring applies a pushing force to the anchor end603that urges the belt and the anchor end603forward, allowing another fastener end602to move into position to be grappled by the needle302. When the fastener end602is inserted into the anchor end603, the fastener end602is configured to lock with the anchor end603upon insertion to retain the suture under tension.

In an alternate embodiment, a suture magazine can include a belt having one or more notches, and at least one suture. The belt is positioned parallel to the anchor end603. The belt may be made of rubber or another elastic material. The fastener end602is releasably secured to the notch of the belt. In one implementation, a crossbar can be attached to the belt. The crossbar has a first end and a second end. The first end is fixed to the belt, and the second end is in contact with the anchor end603. A spring may be located behind the crossbar and positioned behind the anchor end603.

FIGS. 7A-7Dshow an automatic suture tightening technique, in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). InFIG. 7A, a suture700is shown in a starting position over top of tissue710. Next, as shown inFIG. 7B, the first fastener mechanism704of the fastener end701is inserted through an entry point of the tissue710and carried through the tissue710along a curved path by a suturing needle. In this embodiment, the suturing needle pushes the first fastener mechanism704along the fastener grasping edge708A. As the suturing needle continues along the curved path and reaches an ending position, as shown inFIG. 7C, the first fastener mechanism704is pushed through the chamber706of the anchor end702. The suture thread703pulls the second fastener mechanism705through the tissue710along the same curved path as first fastener mechanism704. As the suture700is released from the suturing device, the fastener grasping edge708A can rest on top of the anchor housing707. At this stage, there is no tension on the suture thread703. As shown inFIG. 7D, after the first fastener mechanism704is pulled in an upward direction, the second fastener mechanism705is pulled through the chamber706of the anchor end702and causes the tissue710to be pulled together. The suture700is designed so that when the second fastener mechanism704is pulled through the chamber706of the anchor end702, a predetermined tension is created throughout the suture thread703. At this point, the fastener grasping edge708B prevents the second fastener mechanism705from moving backward through the chamber706of the anchor end702.

In another implementation, as shown inFIG. 8, in accordance with an implementation of a suture as described with respect toFIG. 4, the surgeon may manually grasp the first fastener mechanism704with a separate laparoscopic instrument and pull the first fastener mechanism704upward to tighten the suture thread703until the second fastener mechanism705is pulled through the chamber706to provide the desired tension on the suture. In another implementation, the surgeon may manually grasp the suture guide loop with a separate laparoscopic instrument and pull the suture guide loop upward to tighten the suture thread703. Alternatively, the suturing device may have a hook positioned on the exterior of the suture housing, and the surgeon may manually tighten the suture using the hook rather than using an additional laparoscopic instrument.

As shown inFIG. 8, as the base709and the arm710return to the starting position, the base709pushes the anchor end702through the suture housing aperture711, allowing the next fastener end701to be moved into position by the elastic member601and the suture mover606(not shown in this figure).

In another implementation, the suture housing of the suturing device300may have a clamp positioned along the interior surface of the suture housing that grasps the suture guide loop as the fastener end702enters the anchor end703. As the suturing device is pulled away from tissue, the suture is tightened, and the clamp releases the suture guide loop once the suture reaches a predetermined tension. In an alternate embodiment, the clamp can grasp the suture guide loop as the fastener end702enters the anchor end703.

In another implementation, the suture housing may have a catch attached to the interior surface of the suture housing to a side of the aperture, as described with respect toFIG. 5B. The catch can releasably grasp the suture guide loop of the fastener end702as the arm710of the suturing needle pushes down on the anchor end703when returning to the starting position. The catch automatically releasing the suture guide loop once the suture reaches a predetermined tension. Alternatively, the catch can releasably grasp the suture guide loop as the suturing device is pulled away from tissue and the catch automatically releasing the suture guide loop once the suture reaches a predetermined tension. In an alternate embodiment, the catch can be adapted to perform the same functions with a fastener mechanism that is described above with respect to a suture guide loop.

FIGS. 9A-9Fshow a drive system900that can be used to operate the suturing device300(seeFIGS. 3A-3C), in accordance with one or more embodiments (e.g., including embodiments described in more detail in Sections 2.1 and 2.2 below). The drive system900includes a tube901and a rod902. The diameter of the rod902is smaller than the diameter of the tube901. The rod902may include one or more protrusions903positioned on the exterior surface of the rod902towards the proximal end. The tube901may have one or more grooves904that extend in a spiral manner from a proximal end of the tube901towards the distal end of the tube901. Each groove904can correspond to one of the one or more protrusions903. The one or more protrusions903attached to the rod902are configured to move along the one or more grooves904within the tube901.

In one implementation, the proximal end of the rod902may abut a hub905, and the distal end of the rod902is coupled to a shaft311of a suturing needle. The shaft can in the tube901and the rod902. The tube901can have the hub905positioned at the proximal end of the tube901. The rod902is configured to remain fixed along a direction of a rod axis of the shaft while being able to rotate about the rod axis. The tube901is configured to remain fixed in a radial direction while being movable forward and backward along the rod axis.

In a starting position, the rod902is positioned inside the tube901, where the protrusions903lay on the grooves904of the tube901, and the hub905of the tube901meets the proximal end of the rod902. As a force pushes on the hub905, the grooves904engage the protrusions903of the rod902and the tube901drives along the rod902from the proximal end of the rod902to the distal end of the rod902, thereby rotating the rod902forward as the protrusions903travel along the grooves904of the tube901. Once the force is withdrawn from the proximal end of the tube901, the tube901reverses direction from the distal end of the rod902to the proximal end of the rod902, thereby rotating the rod902backward as the protrusions903travel along the grooves904in the opposite direction.

In order to connect the drive system900to a surgical device, such as a laparoscopic device, the distal end of the hub handles906are attached to the hub905. At the proximal end of the hub handles906, clamp head receiving members907are attached to receive a grasping clamp909from a surgical device. Clips908are positioned around the clamp head receiving members907and the grasping clamp909so that the clamp head receiving members907and the grasping clamp909are secured to one another.

In one implementation, the rod902of the suturing needle302, as described with respect toFIG. 6B, is connected to the distal end of the rod902. Therefore, when the tube901drives along the rod902, both the rod902and the suturing needle302rotate in a first direction, which allows the suturing needle302to deploy from the suture housing301and grasp the fastener end602. As the suturing needle302rotates and inserts the fastener end602into the anchor end603, the protrusions903have traveled the complete length of the grooves904of the tube901, and the rod901ceases rotational movement. When the force is withdrawn from the proximal end of the tube901, the fastener end602remains locked in the anchor end603, and the tube901reverses direction causing both the rod902and the suturing needle302to rotate in a second direction until the protrusions903travel the length of the grooves904in the opposite direction, retracting the suturing needle302into the suture housing301. As the suturing needle302retracts back in to the suture housing301, the arm710of the suturing needle302will push down on the anchor end603, allowing the entire suture to release from the device.

In one implementation, the hub905of the tube901can be coupled to a manual trigger. A trigger, as described with respect toFIG. 4, may apply a force to the hub905of the tube901, engaging the drive system900. The trigger is connected to the proximal end of a manual arm. The manual arm can be the laparoscope. The drive system900can be connected to the distal end of the stem of the laparoscope. Upon the surgeon squeezing the trigger, the tube901is propelled forward along the rod902, resulting in both the rod902and the suturing needle302rotating in a first direction. Once the trigger is released, the tube901reverses direction, causing both the rod902and the suturing needle302to rotate in a second direction until the protrusions903travel the length of the grooves904in the opposite direction, retracting the suturing needle302into the suture housing301.

In another implementation, the hub905of the tube901can be coupled to a robotic arm or incorporated as a robotic arm as part of a robotic-assisted surgical system. A robotic-assisted surgical system forceps arm, may apply a force to the hub905of the tube901, engaging the drive system900. The robotic-assisted surgical forceps arm is attached to a main hub of the robotic-assisted surgical system at its proximal end, and includes forceps at its distal end. The main hub of the robotic-assisted surgical system contains one or more robotic arms that the surgeon can control from a distance at a console. A sheath made of a non-ridged sterile material may be used to connect the proximal end of the suture housing301of the suturing device300, to the distal end of the robotic arm.

Forceps may be positioned at the proximal end of the drive system900. A hinge may be inserted into the forceps of the robotic-assisted surgical forceps arm. The hinge may include a spring tensioned to keep the forceps open at a certain angle when the hinge is inserted into the forceps. Upon closing the forceps, the hinge compresses and lengthens the forceps. The lengthened forceps come into contact with the tube901and apply a force to the tube901that propels the tube901forward along the rod902, which causes the rod902and the suturing needle302to rotate in the first direction. When the surgeon opens the forceps, the tube901reverses direction causing both the rod902and the suturing needle302to rotate in a second direction until the protrusions903travel the length of the grooves904in the opposite direction, retracting the suturing needle302into the suture housing301.

FIG. 10shows a side view of an alternative drive system in accordance with an implementation of the invention. Referring toFIG. 10, drive system1000can be used to operate a suturing device. The drive system1000includes a tube1001and a rod1002. The diameter of the rod1002is smaller than the diameter of the tube1001. The tube1001may include one or more protrusions1003positioned on the interior surface of the tube1001towards the proximal end. The rod1002may have one or more grooves1004that extend in a spiral manner from a proximal end of the rod1002towards the distal end of the rod1002. Each groove1004can correspond to one of the one or more protrusions1003. The one or more protrusions1003attached to the tube1001are configured to move along the one or more grooves1004within the rod1002.

In one implementation, the proximal end of the tube1001may abut a hub1005, and the distal end of the tube1001is coupled to a rod1002of a suturing needle. The rod1002can have the hub1005positioned at the proximal end of the rod1002. The hub1005is attached to the hub handles1006which are configured to attach to a forceps or laparoscopic device. The tube1001is configured to remain fixed along a direction of a rod axis of the rod1002while being able to rotate about the rod axis. The rod1002is configured to remain fixed in a radial direction while being movable forward and backward along the rod axis.

In a starting position, the rod1002is positioned inside the tube1001, where the protrusions1003lay on the grooves1004of the rod1002and the hub1005of the rod1002meets the proximal end of the tube1001. As a force pushes on the hub1005, the grooves1004engage the protrusions1003of the tube1001and the rod1002drives along the tube1001from the proximal end of the tube1001to the distal end of the tube1001, thereby rotating the tube1001forward as the protrusions1003travel along the grooves1004of the rod1002. Once the force is withdrawn from the proximal end of the rod1002, the rod1002reverses direction from the distal end of the tube1001to the proximal end of the tube1001, thereby rotating the tube1001backward as the protrusions1003travel along the grooves1004in the opposite direction.

Suturing devices, needles, sutures, and drive systems are presented herein.

According to some embodiments, a suture is provided comprising: a fastener end; an anchor end; and a suture thread connected to and extending between the fastener end and the anchor end. The fastener end can comprise a first and second conical shaped structure, the first and second conical shaped structure having a top and a bottom, the suture thread fixed to the top, the bottom being larger than the top. The anchor end can comprise an anchor housing and a chamber, the interior surface of the chamber having a conical shape. The first conical shaped structure can be configured to slide through the anchor housing and remain locked in the anchor end once the first conical shaped structure is inserted through the chamber of the anchor end. The second conical shaped structure can be configured to be pulled through the chamber, wherein the pulling of the second conical shaped structure through the chamber tensions a suture to a predetermined tension level.

According to some embodiments, a suture magazine is provided comprising: a belt having one or more notches; at least one suture having a fastener end, an anchor end, and a suture thread connected to and extending between the fastener end and the anchor end, the anchor end positioned parallel to the fastener end, the fastener end releasably secured to the belt; a crossbar having a first end and a second end, the first end fixed to the belt, the second end in contact with the anchor end; and a spring in tension with the second end of the crossbar, wherein the spring applies a pushing force to the anchor end, urging the belt forward once a fastener has been released. The fastener end can comprise a curved enclosure having a ridged surface, a top, and a bottom, the suture thread fixed to the top, the bottom having a suture guide loop positioned laterally. The anchor end can comprise a rectangular enclosure and a chamber, the interior surface of the chamber having at least one shoulder.

2.1 System Variation

FIGS. 11A-11Cdepict a exploded views of a system for suturing, in accordance with one or more embodiments.FIGS. 11D-11Edepict cross sectional views of a system for suturing, the system including suture advancing components, in accordance with one or more embodiments.

Embodiments of the system1100depicted inFIG. 11A-11Eare configured to provide suture magazine components with compact and reliable mechanisms for advancing sutures of a set of sutures toward a deployment position. Such components and configurations can provide improvements over mechanisms that tend to apply high deployment force when all sutures are loaded, with decreased deployment force as sutures are deployed. Such embodiments can implement “lost-motion” designs that allow ratcheting components of the mechanisms to travel only as far as needed between instances of suture deployment in a consistent manner appropriate to the suture capacity of the suture magazine. For instance, a “lost-motion” design allows the ratcheting component to travel only as far as is required for the design of the suture, regardless of motion of other components.

Embodiments of the invention(s) can additionally or alternatively include needle features that increase range of delivery rotation of the needle into a tissue or other repair site.

As shown inFIGS. 11A-11E, an embodiment of the system1100for suturing includes a housing1101having an aperture1111. The system1101can also include a suturing needle1102retained within the housing1101and including: a shaft1103defining a rod axis1107, and a curved body1104comprising a piercing tip1105at a first region and a base1106coupled to the shaft1103at a second region of the curved body1104such that the base1106of the curved body1104is positioned in a first plane1107aintersected by the rod axis1107of the shaft1103, and the piercing tip1105is positioned in a second plane1107bintersected by the rod axis1107of the shaft1103.

In one variation, the first plane1107ais proximally displaced from the second plane1107b, relative to the shaft of the suturing needle. In another variation, the first plane1107ais distally displaced from the second plane1107b, relative to the shaft of the suturing needle. However, the first and the second planes1107a,1107bcan be oriented relative to each other in another suitable manner (e.g., with non-parallel spacing relative to each other). In variations, the first plane1107aand the second plane1107bcan be displaced from each other at a distance ranging from 0.1 mm to 15 mm; however, the first plane1107aand the second plane1107bcan be spaced apart by another suitable distance in other variations. In still other variations, the first plane1107aand the second plane1107bmay not be parallel and can otherwise be intersecting planes. In still other variations, the first plan1107aand the second plane1107bmay not be planar, and can define non-planar surfaces defining angular or curved surfaces of the suturing needle1102.

The system1101can also include a suture magazine1108retained within the housing1101and including a suture advancer1120comprising a first track1122coupled to an internal portion of the housing1101and supporting a set of sutures1130between a first end1109aand a second end1109bof the suture magazine, and a second track1124opposing the first track1122about the set of sutures1130and configured to move within the housing1101, each of the set of sutures1130comprising a fastener end1131coupled to an anchor end1133(shown inFIG. 11C). The first and the second tracks1122,1124can be configured as trays having “bottom” surfaces for retaining the set of sutures1130; however, the first track1122and/or the second track1124can be configured with one or more open regions, such that the first track1122and1124are not containers having continuous/contiguous surfaces.

As shown inFIGS. 11D and 11E, the first track1122can include a first set of teeth1125retaining and separating (e.g., providing spacing between) adjacent sutures of the set of sutures1130at a first side. The first set of teeth1125can define a series of recessed regions within an interior channel of the first track1125, or can define another suitable geometry for retaining and separating adjacent sutures. The series of recessed regions can include sloping features in an advancement direction, where, in embodiments, the sloping features promote advancement of the set of sutures serially in one direction, but prevent backward transmission of the set of sutures. The first set of teeth1125can thus contribute to smooth operation of the system in relation to advancing sutures through the aperture of the housing.

The second track1124can additionally or alternatively include a second set of teeth1127supporting the set of sutures1130at a second side in a suturing advancing mode provided by the system. The second set of teeth1127can define a series of recessed regions within an interior channel of the second track1124, or can define another suitable geometry for supporting and advancing adjacent sutures. The first set of teeth1125and/or the second set of teeth1127are complementary to surfaces of the set of sutures between the first track1122and the second track1124. As shown inFIGS. 11D and 11E, the first set of teeth1125and the second set of teeth1127can include a sawtooth morphology that is complementary to surfaces of the set of sutures1130between the first track and the second track. However, the sets of teeth1125,1127can have another toothed morphology for supporting the set of sutures and contributing to reliable operation of the system. Still other variations of the sets of teeth1125,1127can omit a toothed morphology and can define another suitable morphology for smooth operation in the suture advancing mode.

In embodiments, the first track1122and/or the second track1124can be composed of a polymer material, including one or more of: a polyvinyl chloride-derived material, a nylon-derived material, a polyethylene-derived material, a polycarbonate-derived material, an acrylonitrile butadiene styrene (ABS)-derived material, and another suitable polymeric material. However, variations of the first track1122and/or the second track can be composed of a non-polymeric material (e.g., a ceramic material, a metallic material, etc.).

Similar to embodiments described above, the system can include one or more biasing elements1129configured to ultimately transmit force for advancing sutures of the set of sutures1130as they are used during operation. The biasing element(s)1129can be coupled to one or more of the first track1122and the second track1124, and configured to apply pressure (e.g., in relation to a ratcheting mechanism) for advancing sutures forward.

The biasing element(s)1129can allow the second track1124to be displaced as necessary to move remaining sutures up and over the set of teeth of the first track1122appropriately when indexing sutures of the set of sutures1130forward. The biasing element(s)1129can be asymmetrically configured in relation to bilateral sides of the suture magazine1108. For instance, both sides of the second track1124can include biasing elements that can be compressed to generate a forward biasing force that advances remaining sutures forward. Additionally or alternatively, one side of the second track can be coupled to an additional coil spring (e.g., depicted inFIG. 13) that functions to delay the timing of advancement on that side until the leading suture has been displaced from the suture magazine. This configuration of the suture magazine thus generates potential energy in the biasing elements (e.g., spring combinations) that compresses the suture heads of the remaining sutures, where the compression is relieved when the leading suture is displaced from the suture magazine.

In embodiments, the biasing element(s)1129can include one or more linear wave springs spanning the channel and preventing rocking between the first track and the second track. The linear wave spring(s) can contribute to a mechanism that keeps the set of sutures1130level (e.g., all substantially along a similar axis) within the suture magazine1108, for reliable operation of the system. Additionally or alternatively, the biasing element(s)1129can include one or more of: non-linear springs, elastomeric elements, hydraulic elements, magnetic elements, and/or other suitable elements that store and release potential energy for advancement and indexing of the set of sutures1130in a forward direction.

In the embodiment shown inFIG. 11D, the second track1124includes a channel1123supporting a biasing element1129(e.g., linear wave spring), where the biasing element contributes to an advancing mode of the suture magazine1108. The channel1123opposes surfaces of the second track1124interacting with the set of sutures1130. In the advancing mode, a leading suture of the set of sutures1130is displaced from the first end of the suture magazine by a compressive force applied by at least one of the biasing element1129and the suture advancer1120to the second track1124. However, the biasing element(s) can additionally or alternatively be coupled to the first track1122(e.g., within a channel) and/or in another suitable manner.

The first track1122and second track1124, in cooperation with the biasing element1129, thus provide improvements over mechanisms that tend to apply high deployment force when all sutures are loaded, with decreased deployment force as sutures are deployed. Such a configuration provides a “lost-motion” designs that allow ratcheting components of the mechanisms to travel only as far as needed between instances of suture deployment in a consistent manner appropriate to the suture capacity of the suture magazine. For instance, a “lost-motion” design allows the ratcheting component to travel only as far as is required for the design of the suture, regardless of motion of other components.

The system can also include a drive system (e.g., such as the drive system components described in relation toFIGS. 9A-9F and 10) that transforms an applied force into rotation of the shaft1103of the suturing needle1102thereby engaging and inserting the fastener end1131into the anchor end1133of a leading suture1135of the set of sutures1130and displacing the leading suture1135from the aperture1111of the housing1101. In relation to configuration of the suturing needle1102relative to the housing1101and displacement between the piercing tip1105and the base1106of the suturing needle1102with respect to the first plane1107aand the second plane1107b, the drive system is configured to transition the curved body1104of the suturing needle through greater than 180° of delivery rotation through the aperture of the housing. However, alternative configurations between the suturing needle1102, the housing1101, and the drive system can be configured to provide another suitable range of delivery rotation.

Similar to mechanisms described above (e.g., in relation toFIGS. 7A-7D and 8), engagement of the drive system is configured to transition the suturing needle between a first operation mode and a second operation mode, wherein, in the first operation mode, the piercing tip1105of the curved body1104engages the fastener end1131of the leading suture as it exits the aperture1111for transmission of the fastener end1131and piercing tip1105into a tissue or other repair site material, and then insertion into the anchor end1133of the leading suture. Then, in the second operation mode, the curved body1104moves (e.g., rotates in reverse) and displaces the anchor end1133of the leading suture from the housing1101. The system can transition between the first and the second operation mode as described above in relation toFIGS. 7A-7D and 8, or in another suitable manner.

FIG. 12Adepicts a first needle component of a system for suturing, in accordance with one or more embodiments.FIG. 12Bdepicts a second needle component of a system for suturing, in accordance with one or more embodiments. As shown inFIGS. 12A and 12B, the suturing needle1202can include a curved body1204. The curved body1204can include a helical body1205, as shown inFIGS. 12A and 12B. The helical body1205contributes to the ability of the system to transition the curved body1204of the suturing needle through greater than 180° of delivery rotation through the aperture of the housing. The helical body1205can have constant curvature along its length in one embodiment, such that a projection of the helical body1205onto a plane perpendicular to its longitudinal axis defines a circle. In other embodiments, the helical body1205can have non-constant curvature, such that a projection of the helical body onto a plane perpendicular to its longitudinal axis defines a polygon or amorphous shape. In allowing reliable operation of the system, the aperture of the system can define an opening that allows the curved body1205to pass through the aperture through its entire range of motion during operation of the system. As such, the aperture can span a width of the housing, and open longitudinally along the housing in a manner that allows the curved body1205to pass through the aperture through its entire range of motion.

In the embodiment shown inFIGS. 12A and 12B, the curved body1204of the suturing needle1202includes a straight portion1206coupling the piercing tip1207to the helical body1205. The straight portion1206functions to facilitate driving of the piercing tip1207through tissue (or other material) at a repair site. Additionally or alternatively, in other embodiments, the suturing needle1202can include other suitable morphology (e.g., portions of reduced cross sectional area near the piercing tip, etc.) to facilitate driving of the piercing tip1207through tissue (or other material) at a repair site.

As shown inFIGS. 12A and 12B, the curved body1204of the suturing needle1202can additionally or alternatively include a recessed region1208configured to face a leading suture of the suture magazine during operation (e.g., in the configuration shown inFIGS. 11A-11C). The recessed region1208functions to provide clearance between the suture and the suturing needle1202during operation, while not impacting needle strength (e.g., given that, during operation, a position of maximum stress is positioned near the base1209of the suturing needle1202).

Embodiments of the suturing needle can additionally or alternatively include other morphologies configured to facilitate improved access to tissue or other material at a repair site, and/or to produce smoother operation in relation to other components of the system.

Embodiments of the system can also include a reduced subset of elements in order to operate. For instance, in one embodiment, a system for suturing can include: a housing having an aperture; a suturing needle retained within the housing and including a shaft defining a rod axis, and a curved body comprising a piercing tip at a first region and a base coupled to the shaft at a second region of the curved body such that the base of the curved body is positioned in a first plane intersected by the rod axis of the shaft, and the piercing tip is positioned in a second plane intersected by the rod axis of the shaft; a suture magazine retained within the housing and holding a set of sutures, each comprising a fastener end coupled to an anchor end; and drive system that transforms an applied force into rotation of the shaft of the suturing needle thereby engaging and inserting the fastener end into the anchor end of a leading suture of the set of sutures and displacing the leading suture from the aperture of the housing. Embodiments of such a system are depicted in the figures.

Furthermore, in relation to coupling to surgical instruments or other medical devices, embodiments of the system components depicted inFIGS. 11A-11E and 12A-12Bcan be configured to cooperate withFIGS. 1A through 10.

2.2 Additional System Elements and Variations

FIG. 13depicts an exploded view of an embodiment of a suture magazine, in accordance with one or more embodiments of a suturing system. In more detail,FIG. 13depicts components of a ratchet advancement mechanism that includes structures and biasing elements for moving the sutures through the suture magazine. The mechanism enabled by the components shown inFIG. 13enables the suture magazine to advance remaining sutures for placement into a tissue, without providing too high of a force when the suture magazine is full of sutures, and without providing too low of a force when the suture magazine has fewer sutures. As shown inFIG. 13, one side of the second track1324can be coupled to an additional coil spring1327that functions to delay the timing of advancement on that side until the leading suture has been displaced from the suture magazine. The additional coil spring1327can be positioned distally relative to the biasing element1329; however, the additional coil spring1327can be positioned relative to the biasing element1329in another suitable manner. In variations, the additional coil spring1327can be omitted, and the biasing element can alternatively include a region providing suitable elastic properties (e.g., in terms of stiffness) different from an opposing biasing element at the other track, in order to delay timing of advancement of different suture portions. This configuration of the suture magazine thus generates potential energy in the biasing elements (e.g., spring combinations) that compresses the suture heads of the remaining sutures, where the compression is relieved when the leading suture is displaced from the suture magazine.

FIG. 14depicts multiple views of a suturing needle1402for placing sutures, in accordance with one or more embodiments of a suturing system. The suturing needle includes a piercing tip1407and a base1408and is configured to rotate about an axis defined by a shaft coupled to the suturing needle, to place sutures of the suture magazine at a repair site.

FIG. 15Adepicts embodiments of a suture, in accordance with one or more embodiments of a suturing system. A first embodiment of the suture1501a(FIG. 15A, foreground) includes an anchor end1502a, a fastener end1503a, and a tensioning body1504a(positioned between the anchor end and the fastener end) along a suture thread1505a. A second embodiment of the suture1501b(FIG. 15A, background) includes an anchor end1502b, a fastener end1503b, and along a suture thread1505b.

The suture embodiments depicted inFIG. 15Acan be composed of a biodegradeable material, such that the suture embodiments are bioresorbable. However, the suture embodiments can additionally or alternatively be composed of other materials (e.g., non-bioresorbable materials). Biodegradable suture materials from which the suture embodiments are composed can include one or more of: polylactic acid (PLA)-derived materials, monocryl, polydioxanone, bioresorbable popypropylene, and other bioresorbable materials. Non-biodegradable suture materials from which the suture embodiments are composed can include one or more of: nylon, polyester, polypropylene, polyvinylidene fluoride, and other non-bioresorbable but biocompatible materials. In the embodiment shown inFIG. 15A, the anchor ends1502a,1502band the fastener ends1503a,1503bare composed of poly-d, l-lactic acid (PDLLA) or another biodegradable material. The suture threads1505a,1505bare composed of biodegradable material such as polydioxanone (PDS), polypropylene, or another biodegradable material.

FIG. 15Bdepicts an embodiment of a suturing needle interaction with a suture, in accordance with one or more embodiments of a suturing system. During placement of a leading suture, the piercing end of the suture needle interacts with the fastener end1503bof a suture to drive it (by rotation) into a repair site.

FIG. 15Cdepicts operation of an embodiment of a suture, in accordance with one or more embodiments of a suturing system. As shown inFIG. 15C, when a suture is placed at a repair site, the fastener end1503bpasses through a chamber of the anchor end1502b, and then is retained at a retention surface of the anchor. The retention surface shown inFIG. 15Ccontributes to a 10 degree angle between the retention surface and a corresponding base surface of the fastener end, that allows the fastener and the anchor to lock together in an efficient manner. Another suitable angle can be provided by the retention surface.

FIG. 16depicts an embodiment of an attachment for control of an embodiment of a suturing system. The embodiments of the attachment allow different surgical tools and/or robotic components to interface with the suturing needle and/or suture magazine to control operation of suture placement and/or driving of remaining sutures forward for placement. In related embodiments, the attachment can include one or more of: a flexible boot, a flexible sleeve, a snap configured to snap into corresponding slots, a band or tie to interface with jaws, a ring magnet, an elastomer tube, a C-channel slip, threaded fasteners, and any other suitable attachment structure.

Any reference in this specification to “one implementation,” “an implementation,” “example implementation,” etc., means that a particular feature, structure, or characteristic described in connection with the implementation is included in at least one implementation of the invention. The appearances of such phrases in various places in the specification are not necessarily all referring to the same implementation. In addition, any elements or limitations of any invention or implementation thereof disclosed herein can be combined with any and/or all other elements or limitations (individually or in any combination) or any other invention or implementation thereof discloses herein, and all such combinations are contemplated with the scope of the invention without limitation thereto.