Abstract:
Tissue fixation members  18  interact with a housing  12  to hold tissue relative to the housing and allow the orientation and position of the grasped tissue to be manipulated with improved efficacy. The tissue fixation members can be easily and quickly moved between deployed and retracted positions to reversibly grasp and release tissue.

Description:
BACKGROUND 
       [0001]    The present disclosure includes examples of tissue fixation devices. Specifically, the tissue fixation devices described herein may be used with a uterine manipulator to grasp, retain and release cervical tissue. It will be appreciated that the disclosed embodiments may have applications outside of uterine manipulation, and may be used on other bodily tissues. 
         [0002]    In some surgical procedures, it is desirable to control the position and orientation of an organ, such as a uterus, to help the surgeon operate on the uterus or on other parts of the body adjacent to the uterus. Uterine manipulator devices can be used to position and orient a uterus during surgery. U.S. Patent Application Publication No. US2012/0109147 discloses an example uterine manipulator system. Typical uterine manipulator systems consist of a bell-housing or cup shaped member that fits around the cervix and a rod member that is inserted through the cervix and into the uterus. The bell housing can be sized and shaped to compress the cervical tissue against the rod member to help the surgeon grasp the cervix and manipulate the position and orientation of the uterus. The bell housing can also provide a cutting guide to facilitate incision placement, for example colpotomy incisions and incisions requiring a safe distance from the ureters and uterine arteries. However, if the cervical tissue fixation within the bell housing is insufficient, a uniform colpotomy incision is difficult to achieve. Furthermore, the risk of damaging surrounding tissues, such as the ureters and uterine arteries, will increase if the tissue fixation is insufficient. The compressive forces imparted to the cervical tissue between the bell housing and the rod member are usually not sufficient enough to tightly grasp the cervix and ensure safe incision placement. Accordingly, it has been known to include a balloon in combination with the rod member which can be inflated inside of the uterus to provide additional pressure on the cervical tissue between the balloon and the bell housing to force the cervical tissue down into the bell housing and increase the gripping force of the bell housing on the cervix. However, the internal balloon may not create optimal tissue fixation, especially in patients with anatomical abnormalities, rigid tissues, scar tissue, and the like. Additionally, the balloon may leak or become accidentally “nicked” by other surgical instruments during the surgical procedure. This may result in loss of tissue fixation that can delay and complicate surgical incisions and/or removal of the uterus through the vagina in the case of a hysterectomy procedure. Moreover, it may not be desirable to use a balloon inside of a uterus containing cancerous cells, because the cancerous cells can be broken loose by the balloon and spread to other parts of the body. Sufficient tissue fixation is typically not achieved with a balloon, as is evidenced by workarounds currently used by many surgeons. For example, surgeons are known to use adjunctive stitches through the cervix which are then tied to the instrument to increase tissue fixation. This workaround adds additional steps to the surgery and further complicates things by making it difficult to quickly remove the bell housing and/or uterine manipulator from the patient if an emergency situation arises, such as the need to defibrillate the patient&#39;s heart. 
         [0003]    Accordingly, it is desirable to provide a device that achieves reliable tissue fixation, with or without a balloon, that will last throughout the entire surgical procedure and that will not be compromised by rigid tissue, anatomical abnormalities, scar tissue, cancerous tissue, or the like. In some cases, it may also be desirable to generate tissue fixation close to certain incision sites, such as the colpotomy incision site, to increase the control, placement and precision of the incision. It is also desirable to provide a device that employs a simple actuation mechanism to quickly and easily engage and disengage the tissue fixation mechanism during surgery. 
         [0004]    An example of the present technology disclosed herein includes a tissue fixation assembly shaped to be attached to a uterine manipulator. The assembly includes a housing, a fixation member carriage with deployable fixation members, and a cap. The fixation member carriage and fixation members are captured between the housing and the cap. In one example, a suture is attached to the fixation member carriage and is actuatable to move the fixation member carriage to deploy or retract the fixation members. The assembly may be inserted into a vagina and receive cervical tissue within the housing. The fixation members may then be deployed inwardly from the housing to grip the cervical tissue. The fixation members may also be locked in the deployed position to maintain the grip on the tissue. The fixation members may also be easily retracted to release the tissue and remove the device as needed. 
         [0005]    Those of skill in the art will recognize that the following description is merely illustrative of the principles of the disclosure, which may be applied in various ways to provide many different alternative embodiments and may be applicable outside the fields of surgery or medical devices. While the present disclosure is made in the context of tissue fixation related to the cervix, for the purposes of illustrating the concepts of the design, it is contemplated that the present design and/or variations thereof may be suited to other uses for grasping any bodily tissue. Moreover, the devices and methods set forth herein may be used in open, percutaneous, and/or minimally invasive procedures. 
         [0006]    All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope. 
         [0007]    Standard medical planes of reference and descriptive terminology are employed in this specification. A sagittal plane divides a body into right and left portions. A mid-sagittal plane divides the body into equal right and left halves. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions. Anterior means toward the front of the body. Posterior means toward the back of the body. Superior means toward the head. Inferior means toward the feet. Medial means toward the midline of the body. Lateral means away from the midline of the body. Axial means toward a central axis of the body. Abaxial means away from a central axis of the body. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body. These descriptive terms may be applied to an animate or inanimate body. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]    Various embodiments of the present disclosure will now be discussed with reference to the appended drawings. It will be appreciated that these drawings depict only typical examples of the present disclosure and are therefore not to be considered limiting of its scope. 
           [0009]      FIG. 1  is a perspective view of a tissue fixation device according to one example of the present disclosure having a housing, a cap, and deployable fixation members; 
           [0010]      FIG. 2  is a side view of the tissue fixation device of  FIG. 1 ; 
           [0011]      FIG. 3A  is a top view of the tissue fixation device of  FIG. 1  with the fixation members in a retracted position;  FIG. 3B  is a top view of the tissue fixation device of  FIG. 1  with the fixation members in a deployed position; 
           [0012]      FIG. 4  is an exploded view of the tissue fixation device of  FIG. 1 ; 
           [0013]      FIG. 5  is a top exploded view of the tissue fixation device of  FIG. 1 ; 
           [0014]      FIG. 6  is a bottom exploded view of the tissue fixation device of  FIG. 1 ; 
           [0015]      FIG. 7A  is a top view of the housing and fixation member carriage assembly of the tissue fixation device of  FIG. 1  with the fixation members in a retracted position and dashed lines indicating suture paths under the fixation member carriage assembly;  FIG. 7B  is a top view of the housing and fixation member carriage assembly of the tissue fixation device of  FIG. 1  with the fixation member in a deployed position; 
           [0016]      FIG. 8  is a side cross-sectional view of the tissue fixation device of  FIG. 1  with the fixation members in a retracted position, taken along section line  8 - 8  in  FIG. 7A ; 
           [0017]      FIG. 9  is a perspective view of another tissue fixation device in accordance with the present disclosure with the tissue fixation members in the deployed configuration; 
           [0018]      FIG. 10  is a perspective view of the tissue fixation device of  FIG. 9  with the tissue fixation members in the retracted configuration; 
           [0019]      FIG. 11  is an exploded view of the tissue fixation device of  FIG. 9 ; 
           [0020]      FIG. 12  is a perspective view of another tissue fixation device in accordance with the present disclosure with the tissue fixation member in the deployed configuration; 
           [0021]      FIG. 13  is a perspective view of the tissue fixation device of  FIG. 12  with the tissue fixation member in the retracted configuration; 
           [0022]      FIG. 14  is a perspective view of another tissue fixation device in accordance with the present disclosure with the tissue fixation members in the deployed configuration; 
           [0023]      FIG. 15  is a perspective view of the tissue fixation device of  FIG. 14  with the tissue fixation members in the retracted configuration; 
           [0024]      FIG. 16  is a perspective view of another tissue fixation device in accordance with the present disclosure with the tissue fixation members in the deployed configuration; 
           [0025]      FIG. 17  is another perspective view of the tissue fixation device of  FIG. 16  with the tissue fixation members in the deployed configuration; 
           [0026]      FIG. 18  is a perspective view of the tissue fixation device of  FIG. 16  with the tissue fixation members in the retracted configuration; 
           [0027]      FIG. 19  is a perspective view of another tissue fixation device in accordance with the present disclosure with the tissue fixation members in the deployed configuration; 
           [0028]      FIG. 20  is a perspective view of the tissue fixation device of  FIG. 19  with the tissue fixation members in the retracted configuration; 
           [0029]      FIG. 21  is a perspective view of a tissue fixation device having a cap attached by a snap fit, the device in a deployed configuration; 
           [0030]      FIG. 22  is a top-down view of the tissue fixation device of  FIG. 21 ; 
           [0031]      FIG. 23  is an exploded view of the tissue fixation device of  FIG. 21  showing a housing, fixation member carriage, fixation members, and cap of the device; 
           [0032]      FIG. 24  is a perspective view of the cap of  FIG. 23 ; 
           [0033]      FIG. 25  is a side cross-sectional view of the tissue fixation device of  FIG. 21 ; 
           [0034]      FIG. 26  is a perspective view of a tissue fixation device having a cap attached by a twisting fit, the device in a deployed configuration; 
           [0035]      FIG. 27  is a top-down view of the tissue fixation device of  FIG. 26 ; 
           [0036]      FIG. 28  is an exploded view of the tissue fixation device of  FIG. 27  showing a housing, fixation member carriage, fixation members, and cap of the device; 
           [0037]      FIG. 29  is a perspective view of the cap of  FIG. 28 ; 
           [0038]      FIG. 30  is a side cross-sectional view of the tissue fixation device of  FIG. 26 ; 
           [0039]      FIG. 31A  is a perspective view of another embodiment of a tissue fixation device having a housing, a fixation member carriage assembly and a cap, with tissue fixation members in a retracted configuration;  FIG. 31B  is a perspective view of the device of  FIG. 31B  with the tissue fixation members in a deployed configuration;  FIG. 31C  is a side view of the device of  FIG. 31A ; 
           [0040]      FIG. 32  is an exploded view of the device of  FIG. 31A ; 
           [0041]      FIG. 33  is a perspective view of a cap of the device of  FIG. 31A ; 
           [0042]      FIG. 34  is a side cross-sectional view of the tissue fixation device of  FIG. 31A ; 
           [0043]      FIG. 35A  is an inferior view of the cap and fixation members of the device of  FIG. 31A ;  FIG. 35B  is an inferior view of the cap and fixation members of the device in the configuration of  FIG. 32A ; 
           [0044]      FIG. 36A  is a superior view of a housing, carriage assembly and sutures of the device of  FIG. 31A ;  FIG. 36B  is a superior view of the housing, carriage assembly and sutures in the deployed configuration of  FIG. 32A ; dashed lines indicate the approximate paths of the sutures in a passage between the carriage assembly and the housing; 
           [0045]      FIG. 37A  is a top-down view of a fixation member captured in a fixation member carriage;  FIG. 37B  is a partial side cross sectional view of the fixation member carriage and fixation member of  FIG. 37A  and the cap of  FIG. 31A ; 
           [0046]      FIG. 38A  is a perspective partial view of a fixation member carriage with a capture feature;  FIG. 38B  is an exploded view of the fixation member and the fixation member carriage of  FIG. 38A ; 
           [0047]      FIG. 39  is a side partial cross sectional view of a fixation member captured in a fixation member carriage; 
           [0048]      FIG. 40A  is a side view of a needle, the needle curving into the page;  FIG. 40B  is a top view of the needle of  FIG. 40A ;  FIG. 40C  is a side cross-sectional view of the needle of  FIG. 40A  captured in a needle carriage; 
           [0049]      FIG. 41  is a partial perspective view of a needle captured in a needle carriage; 
           [0050]      FIG. 42A  is a perspective view of a needle carriage having several pins;  FIG. 42B  is a partial view of a needle mounted to the carriage of  FIG. 42A ;  FIG. 42C  is a top view of the needle of  FIG. 42B ;  FIG. 42D  is a side view of the needle of  FIG. 42B ; 
           [0051]      FIG. 43A  is a side view of a needle;  FIG. 43B  is a transverse cross section of the needle of  FIG. 43A  taken along line A-A 
           [0052]      FIG. 44  is a partial side view of a needle captured in a carriage; 
           [0053]      FIG. 45A  is a top view of a carriage with a plurality of needles and capture features;  FIG. 45B  is a top view of a needle of  FIG. 45A ;  FIG. 45C  is a perspective view of a retention block; 
           [0054]      FIG. 46A  is a perspective exploded view of a needle carriage assembly;  FIG. 46B  is a top view of the needle of  FIG. 46A ;  FIG. 46C  is a partial side cross-sectional view of the needle carriage assembly of  FIG. 46A ; 
           [0055]      FIG. 47A  is a top view of a needle;  FIG. 47B  is a side view of the needle of  FIG. 47A ;  FIG. 47C  is a perspective view of a needle carriage having a capture feature;  FIG. 47D  is a partial view of the needle of  47 A mounted to the carriage of  FIG. 47C  by a pin; 
           [0056]      FIGS. 48A ,  48 B and  48 C are various views of a needle;  FIG. 48D  is a perspective view of the needle of  FIG. 48A-48C  captured in a carriage; 
           [0057]      FIG. 49A  is a side view of a needle;  FIG. 49B  is a transverse cross section of the needle of  FIG. 49A  taken along line B-B; 
           [0058]      FIG. 50  is a perspective view of another carriage and needles stamped from a single piece of material; 
           [0059]      FIG. 51  is a perspective view of another carriage and needles stamped from a single piece of material; 
           [0060]      FIG. 52  is a top view of a carriage with several needles overmolded into the carriage; 
           [0061]      FIG. 53  is a perspective view of a carriage with needles mounted in slots in the carriage; 
           [0062]      FIG. 54  is a top view of a flexible needle captured in a carriage; 
           [0063]      FIG. 55  is a top view of a needle carriage with needles overmolded into the carriage, hinges formed between the needles and the carriage; 
           [0064]      FIG. 56  is a partial top view of a carriage, a needle, and suture for deploying the needle; 
           [0065]      FIG. 57  is a partial top view of a carriage and a plurality of straight needles; 
           [0066]      FIG. 58  is a perspective view of a carriage and an expandable capture member; 
           [0067]      FIG. 59A  is a side cross-sectional view of a tissue fixation device with two needles;  FIG. 59B  is a perspective view of the needles and a carriage of  FIG. 59A ; and 
           [0068]      FIG. 60  is a perspective view of a tissue fixation device having needles with compound curvature. 
       
    
    
     DETAILED DESCRIPTION 
       [0069]    While certain embodiments are shown and described in detail below by way of illustration only, it will be clear to the person skilled in the art upon reading and understanding this disclosure that changes, modifications, and variations may be made and remain within the scope of the technology described herein. Furthermore, while various features are grouped together in the embodiments for the purpose of streamlining the disclosure, it is appreciated that features from different embodiments may be combined to form additional embodiments which are all contemplated within the scope of the disclosed technology. 
         [0070]    Not every feature of each embodiment is labeled in every figure in which that embodiment appears, in order to keep the figures clear. Similar reference numbers (for example, those that are identical except for the first numeral) may be used to indicate similar features in different embodiments. 
         [0071]    Any of the devices described herein may be fabricated from metals, alloys, polymers, plastics, ceramics, glasses, composite materials, or combinations thereof, including but not limited to: titanium, titanium alloys, commercially pure titanium grade 2, ASTM F67, Nitinol, cobalt chrome, stainless steel, UHMWPE, PEEK, and biodegradable materials, among others. Different materials may be used within a single part. The devices disclosed herein may also encompass a variety of surface treatments or additives, including but not limited to: anti-microbial additives, analgesics, anti-inflammatories, etc. Any device disclosed herein may include a radiographic marker for imaging purposes. Any device disclosed herein may be color-coded or otherwise marked to make it easier for the surgeon to identify the type and size of the device. 
         [0072]    In a first aspect of the disclosure, a tissue fixation device includes a housing having an inner space configured to receive tissue therein and an enclosed section, wherein the enclosed section completely encloses at least one planar surface; and at least one fixation member movable between a retracted configuration and a deployed configuration, wherein when the at least one fixation member is in the deployed configuration, the at least one fixation member protrudes into the inner space, and wherein when the at least one fixation member is in the retracted configuration, the at least one fixation member is retracted relative to the inner space. Various embodiments of the tissue fixation device can include one or more of the following attributes: 
         [0073]    In an embodiment, the tissue fixation device can further include a fixation member carriage engaged with the at least one fixation member and configured to move the at least one fixation member between the deployed configuration and the retracted configuration. 
         [0074]    In an embodiment, the housing and the fixation member carriage are substantially circular, and rotational movement of the fixation member carriage along a circle defined by the housing moves the at least one fixation member between the retracted and deployed configurations. 
         [0075]    In an embodiment, the at least one fixation member is curved, and the diameter of the curvature of the at least one fixation member is less than the diameter of the circle. 
         [0076]    In an embodiment, the tissue fixation device can further include a cap detachable from the housing, wherein the fixation member carriage is captured between the cap and the housing. 
         [0077]    In an embodiment, the tissue fixation device can further include a plurality of tabs and a plurality of slots, wherein the tabs are received in the slots to attach the cap to the housing. 
         [0078]    In an embodiment, the tissue fixation device can further include a first line and a second line, the first and second lines connected to the fixation member carriage, wherein pulling the first line moves the fixation member carriage in a first direction to deploy the at least one fixation member, and wherein pulling the second line moves the fixation member carriage in a second direction to retract the at least one fixation member. 
         [0079]    In an embodiment, the at least one fixation member is deployed inwardly toward a lengthwise central axis of the housing in a plane substantially perpendicular to the lengthwise central axis. 
         [0080]    In an embodiment, the at least one fixation member has a sharp point capable of piercing tissue. 
         [0081]    In an embodiment, the at least one fixation member is curved with an arch shape that substantially lies in a single plane. 
         [0082]    In an embodiment, the at least one fixation member is connected to the fixation member carriage by a hinge type connection, about which the fixation member pivots. 
         [0083]    In an embodiment, the at least one fixation member is deflected by the cap as it moves to the deployed configuration. 
         [0084]    In an embodiment, the tissue fixation device includes three fixation members, each of the three fixation members being substantially coplanar with each other. 
         [0085]    In an embodiment, the at least one fixation member is helically shaped. 
         [0086]    In an embodiment, the housing is frustoconical in shape. 
         [0087]      FIGS. 1-8  illustrate one example of a tissue fixation device  10 . The tissue fixation device  10  can include a housing  12 , a cap  14 , and a fixation member carriage assembly  16  (shown first in  FIG. 4 ) which carries at least one fixation member  18 . In some examples, the fixation member  18  may be a needle. The fixation member carriage assembly  16  can be captured between the housing  12  and cap  14 , and may be rotatable within a track  26  ( FIG. 4 ) formed in the housing  12  and/or the cap  14 . It is appreciated that in other embodiments, the cap  14  may be integral with the housing  12  and not formed as a separate element. 
         [0088]    The cap  14  and housing  12  may be referred to as a bell cap or a bell housing, as they may form a bell shape in some examples. In some examples, the housing  12  can have at least one enclosed section that completely encloses at least one planar surface. The at least one planar surface can be defined by a cross-sectional plane through the housing that results in a planar surface that is completely enclosed or surrounded by a portion of the housing. In other words, the planar surface is an empty plane that is completely bounded by the housing  12 . For example, with reference to  FIG. 2 , if a cross section of the housing  12  is taken perpendicular to the longitudinal central axis  35  and through the top portion of the housing, or the cap  14 , a circular planar surface would be created which lies within the opening, or inner space  33  of the housing  12  and which is completely bounded by or surrounded by the housing  12  or cap  14 . On the other hand, if the perpendicular cross-sectional plane were moved lower on the housing to where it crosses the struts  22 , housing inner space  33 , and windows  23 , then this would result in a planar surface that is not completely bounded on all sides, or surrounded by the housing  12  because the windows  23  are open. 
         [0089]    In other examples, the housing  12  may not have at least one enclosed section. In these examples there may be discontinuities or breaks in the housing (not shown) of any size or shape. In these examples, the at least one fixation member can be deployed away from an inner surface  42  of the housing and into the opening, or inner space  33  to grip tissue. The at least one fixation member can be also be retracted away from the opening toward an inner surface of the housing to release the tissue. 
         [0090]    Referring to  FIGS. 3A and 3B , the device can be actuable between a fixation member  18  retracted configuration, and a fixation member  18  deployed configuration. From the top or bottom perspective, the device can be radially symmetric. The embodiment shown in  FIGS. 1-8  includes three curved fixation members  18 . It will be appreciated that other embodiments may include more or fewer fixation members  18 . 
         [0091]    Referring to  FIGS. 4 and 5 , housing  12  can be substantially circular or cylindrical in shape. However, the housing  12  can also be conical, frustoconical, funnel, ovoid, or polygonal in shape, or any combination of shapes thereof. The shape of the housing is not as important as the ability of the housing to enclose tissue to be grabbed by one or more fixation members, as will be apparent from the present disclosure. Continuing with  FIGS. 4 and 5 , housing  12  may include an attachment portion  20  which may be shaped to connect to a uterine manipulator (not shown). A plurality of struts  22  can project superiorly from the attachment portion  20  and terminate at a carriage support  24 . Windows  23  may be interspersed between the struts  22 . However, in other embodiments, the housing may not include struts  22  or windows  23 . The carriage support  24  can be ring-shaped, and include a carriage track  26 , which may be substantially circular. An outer rim  28  can circumscribe the outer diameter of carriage track  26 , and a step  30  may be formed intermediate the track  26  and the outer rim  28 . One or more apertures  32  can open through the carriage support  24 , and may pass through at least a portion of the outer rim  28  and step  30 . A housing inner wall  34  can circumscribe the inner diameter of the carriage track  26 , and may include a plurality of discontinuations, or wall gaps  36 . At least one edge  38  of each wall gap  36  may be beveled. When operatively assembled, the fixation members  18  are deployable through the wall gaps  36 ; the beveled edges  38  may promote smooth deployment of the fixation members  18  and prevent the fixation members  18  from hanging up or being caught in the wall gaps  36 . 
         [0092]    Housing  12  may be generally stepped in outer profile, wherein the carriage support  24  has the widest outer diameter, struts  22  form a circle of intermediate diameter, and attachment portion  20  has the narrowest outer diameter ( FIG. 2 ). The inner wall  34 , struts  22 , and attachment portion  20 , may surround and define a housing inner space  33 . A lengthwise central axis  35  may extend through the housing inner space  33 , also defined by the inner wall  34 , struts  22 , and attachment portion  20 . The number and width of struts  22  and windows  23  may vary, and in some embodiments the housing  12  may be formed as a continuous piece extending between the attachment portion  20  and the carriage support  24 , with no struts  22  or windows  23  present. The embodiment depicted in  FIGS. 1-8  is generally bell shaped; however in other embodiments the housing  12  and/or the device  10  may have a cylindrical shape and may include a tapered portion at either end. In other embodiments the device  10  may be cup or bowl shaped, or polygonal. 
         [0093]    Cap  14  may have a ring-shape, and may include an outer side  40  opposite an inner side  42 . An outer surface  44  ( FIG. 5 ) of the outer side  40  may be positioned as an upper surface, and may include a plurality of steps, ridges and/or grooves which may facilitate gripping and manipulating the cap  14 . As seen in  FIG. 6 , the inner side  42  may have circular outer and inner diameters. A cap inner wall  43  forms the inside diameter of the cap  14 , and may include a plurality of tabs  46  which project inferiorly from the inner wall  43 . Each tab  46  may include at least one beveled edge  48 . A cap outer wall  50  may extend inferiorly, intermediate to and adjoining cap inner wall  43  and cap outer wall  50  and form a track cover  52 . A plurality of cap bosses  54  can project inwardly from the cap outer wall  50 . Each cap boss  54  may include a ramp feature  56  which urges the fixation member  18  inward as it is deployed. The cap  14  can also have beveled edges  48  which can also help urge the fixation member  18  inward as it is deployed. Cap outer wall  50  can include a plurality of recessed alcoves  58  which allow space for the curved fixation members  18  to be retained within the cap outer wall  50  when the fixation members  18  are in the retracted position. Housing  12  and cap  14  may be formed of plastic, or other materials listed herein. 
         [0094]    Fixation carriage assembly  16  can include a generally circular fixation carriage  60 . A plurality of mounting features  62  can project superiorly from the fixation carriage  60 . Each mounting feature  62  may include a recess  64  through which an opening  66  is formed. Openings  66  can be sized to allow passage of a suture  90 . Each mounting feature  62  can further include a fixation member mount  68 . In the embodiment shown, fixation member mount  68  includes two pin holes  70  through which a mounting pin  72  passes. Fixation member carriage  60  can have a first or superior side  74  and a second or inferior side  76 . A circular setback or groove  78  can be formed on the inferior side  76 , and be sized to receive a suture. 
         [0095]    Each fixation member  18  can be curved, rigid, and may terminate at a beveled point. The rigid fixation members may be formed of stainless steel, or other materials disclosed herein. Other embodiments may include flexible fixation members, which may be straight or curved, and may be made of Nitinol, for example. The fixation member curvature may be non-concentric with the curvature of the carriage track  26 , for example the fixation member curvature may have a smaller diameter than the diameter of the carriage track ( FIG. 7A ). Each fixation member  18  may include a base portion  80 , a shaft  82 , and a point  84 , which may also be referred to as a tip. The point  84  may be sharpened and/or serrated in order to reduce the forces necessary to pierce the tissue, or deploy the fixation member. Any of the fixation members disclosed herein may also include a sharp tip or point for the same purpose. The fixation member  18  may have an arch shape that lies substantially in a single plane in some examples, in other examples, the fixation member can be substantially straight. In yet further examples, the fixation member can have a curved shape in multiple planes or in an infinite number of planes. When assembled into the fixation member carriage assembly  16 , base portion  80  is received in fixation member mount  68 , and a mounting pin  72  may pass through the fixation member mount  68  and base portion  80  to form a hinge type connection, about which the fixation member  18  may pivot. 
         [0096]    Referring to  FIGS. 7A ,  7 B, and  8 , fixation member carriage assembly  16  may be mounted in the upper portion of housing  12 , such that fixation member carriage  60  is received in carriage track  26 . A line passage or suture passage  86  may be formed between the groove  78  and outer rim  28 . A first line, or suture  90  may be threaded through one opening  66 , along suture passage  86  in a first direction  100  and through one aperture  32 . A knot  92  may be formed in the suture end remaining at opening  66 , the knot residing in recess  64  immediately adjacent opening  66 , and the knot preventing withdrawal of the first suture through the opening  66 . A second suture  94  may be threaded through a second opening  66 , along suture passage  86  in a second direction  102  opposite the first direction, and through another aperture  32 . The second suture  94  may also be knotted, forming knot  96  to prevent withdrawal. In another example, the first line  90  and/or second line  94  may be secured in one or more crimp tubes which reside in openings  66 , the crimp tube(s) preventing withdrawal of the first and/or second suture through the corresponding opening  66 . When the first and second sutures are thus placed, pulling on the first suture  90  will pull the fixation member carriage assembly  16  in the first direction  100 , and pulling on the second suture will pull the fixation member carriage assembly  16  in the second, or opposite, direction  102 . The sutures  90 ,  94  may be replaced by another type of line, flexible member, rigid member, filament, braid, yarn, cable, wire, chain, strap, lacing, or the like. 
         [0097]    In an alternative threading embodiment, a single suture can be used. A first end of the suture is passed down through one opening  66 , along suture passage  86  and out one aperture  32 . The first end is then passed partially around the housing  12 , up into a second aperture  32 , along suture passage  86  and up through a second opening  66 . The suture is knotted at both of the openings  66 , and a length of suture is left along the housing  12 , between the two openings  32 . With this threading, pulling on the first end of the length of suture will pull the fixation member carriage assembly  16  in one direction, and pulling on the second end of the length of suture will pull the fixation member carriage assembly  16  in the opposite direction. 
         [0098]    The sutures or portions of the sutures may be color-coded. For example, the first suture may be colored green and the second suture may be colored red; of course any color scheme may be used so long as the sutures are visually distinct. Similarly, if one suture is used, different portions of the one suture may be color coded differently. In one example, the green color may be used to indicate that pulling on the green suture (or green portion) will deploy the fixation members and the red color may be used to indicate that pulling on the red suture (or red portion) will retract the fixation members. Also, portions of the suture(s) may be colored to a specific length in order to be used as visual indicators to show when the fixation members are fully deployed or retracted. For example, if all the red color is hidden because it has been drawn into the suture passage  86 , that may provide indication that the fixation members are fully deployed. In some examples, only one suture, or one portion thereof, may be colored, a second portion or a second suture retaining its natural color. 
         [0099]    In other embodiments, one or more sliding tabs, levers or other actuation features may be used instead of the sutures to move the fixation member carriage and/or deploy the one or more fixation members. The actuation features may push, pull, twist, or otherwise urge movement of the fixation member carriage and/or fixation members. 
         [0100]    When the cap  14  is fitted to the housing  12 , tabs  46  may fit into wall gaps  36 , although inferior to each tab  46  an open portion of each gap can remain, the open portion sized to permit passage of the fixation member tip  84  and shaft  82 . Fixation member carriage assembly  16  can thus be captured in an enclosure formed between the carriage track  26  and track cover  52 . When the tissue fixation device  10  is in the retracted configuration, each fixation member  18  is substantially contained in a fixation member retention space  88  bounded by fixation member carriage  60 , track cover  52 , housing inner wall  34  and cap outer wall  50 . In this configuration, each fixation member tip  84  is adjacent to, but not extending beyond, a wall gap  36 . To move the device  10  into the deployed configuration, the appropriate suture is pulled, for example suture  90 , and fixation member carriage assembly  16  will be pulled along carriage track  26  in direction  100 . As the carriage assembly  16  travels along the circle defined by the housing, carrying fixation members  18 , fixation member tips  84  will encounter ramp features  56  of bosses  54  and be forced, or deflected, through the open portions of wall gaps  36 , thus being inwardly deployed. It is appreciated that a single movement, for example, pulling the suture  90 , may deploy some or all of the fixation members simultaneously. The deployment paths of fixation members  18  may be coplanar in some embodiments, and the fixation members  18  may be deployed along a plane perpendicular to a lengthwise central axis  35  of the housing  12 . The plane may also be described as transverse to the lengthwise central axis  35 . The plane may also be coplanar with or parallel to the planar surface which is completely enclosed by the housing. When the fixation members  18  are deployed into tissue along paths transverse to the lengthwise central axis  35 , this can advantageously result in fixing the position of the tissue within the housing  12 , and preventing the tissue from subsequently translating relative to the device  10  along the lengthwise central axis. In other words, gripping the tissue from a lateral or transverse direction can prevent the tissue from moving longitudinally within, or even out of, the housing inner space  33 . 
         [0101]    In other embodiments, the fixation members  18  may move up and/or down out of a plane perpendicular to a lengthwise central axis  35  of the housing  12 . In these embodiments, the deployment paths of the fixation members  18  may be parallel to the central housing axis, or at an acute angle to the axis; the paths themselves may be nonlinear, curved, helical, or the like. 
         [0102]    The fixation members  18  may pierce tissue, such as cervical tissue, positioned in the housing inner space  33 . Deployment can stop when the fixation member bases  80  become wedged between housing inner wall  34  and cap ramp feature  56 . Another stop to the carriage motion may be formed when mounting feature  62  of the carriage assembly  16  encounters cap boss  54 . Because of the wedging engagement of the fixation member bases between the housing  12  and cap  14 , the deployed fixation members can be locked in the deployed configuration and remain deployed until they are intentionally retracted. 
         [0103]    The fixation member tips  84  can be shaped similar to a hypodermic needle such that, minimum penetration force is needed to deploy the fixation members  18  into the tissue. Furthermore, in this example, when the three fixation members  18  are fully deployed, the fixation members  18  can engage with over 280 degrees of tissue, creating strong tissue fixation. Moreover, this embodiment allows the fixation members  18  to be close to the outer surface  44  of cap  14  which may serve as a cutting guide during colpotomy incisions. This allows the tissue fixation members to be less than about 0.25 inches from the cutting guide and the interiorly located fixation members  18  will not impinge on the cutting path. It will be appreciated that other size cutting guide tip designs can be made to adjust the distance and orientation of the cutting guide to achieve different incision placements as desired. 
         [0104]    To move the device  10  into the retracted configuration, the second suture  92  is pulled. The fixation member bases  80  will be disengaged from the inner wall  34  and ramp feature  56 , and fixation member carriage assembly  16  will be pulled in the opposite direction, or direction  102 . As the carriage moves, the inner curved side of the shaft  82  of each fixation member will be forced outward as it encounters inner wall  34 , and fixation members  18  will be retracted in through wall gaps  36 . 
         [0105]      FIGS. 9-20  show alternative embodiments of tissue fixation devices.  FIGS. 9-11  show a tissue fixation device  110  having a housing  112 , a cap  115 , fixation member carriage  116  and at least two fixation members  114  which rotate into the deployed position in opposite directions. In this example, tissue fixation device  110  has four fixation members  114 . Two of the fixation members rotate into the deployed position in the same direction and the other two fixation members rotate into the deployed position in the opposite direction; the second set of fixation members is also axially offset from the first set of fixation members. However, it will be understood that more or less fixation members  114  can be used in other embodiments without departing from the spirit or scope of the present disclosure. Similar to the example of  FIGS. 1-8 , the fixation members  114  can have beveled tips  118  which interact with ramp features (not shown) to force the fixation members inward toward the tissue as the fixation members  114  rotate into the deployed position, similar to other embodiments disclosed herein. The cap  115  can also have beveled edges  156  which may also help urge the fixation member  18  inward as it is deployed. 
         [0106]    Operation of this tissue fixation device can be similar to that described above with reference to  FIGS. 1-8 , except that multiple fixation member carriages  116 ,  117  can be stacked on top of each other, with each of the fixation member carriages  116 ,  117  being free to rotate in opposite directions. In this example, two fixation member carriages  116 ,  117  are used. However, in other embodiments, more than two fixation member carriages can be used. Actuation of the fixation members  114  into the deployed position can be accomplished by any mechanical means disclosed herein. In one embodiment, a first suture (not shown) with one end split into two suture portions, or limbs, can be used with one of the split ends connected to the first fixation member carriage  116  in a first direction and the other split end connected to the second fixation member carriage  117  in a second direction. When the first suture is pulled, the two fixation member carriages  116 ,  117  will rotate in opposite directions relative to each other. A second suture (not shown) with one end split into two suture portions can be used to reverse the rotation of the two fixation member carriages with the split ends of the second suture connected to the fixation member carriages  116 ,  117  in opposite directions relative to the split ends of the first suture. Thus, when the second suture is pulled, this causes the two fixation member carriages to rotate in opposite directions relative to pulling the first suture. 
         [0107]      FIGS. 12-13  show a tissue fixation device  210  having a housing  212 , and a helical fixation member  214  which may be formed of a material such as Nitinol.  FIG. 12  shows the helical fixation member  214  in the deployed position, and  FIG. 13  shows the helical fixation member  214  in the retracted position. The helical fixation member  214  can be engaged with a rotatable carriage member  216 . The helical fixation member can have a sharp beveled tip  218  that is angled upward toward the inserted tissue to help draw the fixation member  214  into the tissue as the fixation member is rotated into the deployed position. 
         [0108]    In use, tissue may be received within housing  212 , and the helical fixation member  214  can be rotatably advanced into the tissue by rotating carriage member  216  to engage and hold the tissue relative to the housing  212 . It will be appreciated that helical fixation member  214  advances along a deployment path which includes a rotational component and an axial component relative to the center housing axis. 
         [0109]      FIGS. 14-15  show a tissue fixation device  310  having a housing  312 , and multiple helical fixation members  314 ,  315  which may be formed of a material such as Nitinol.  FIG. 14  shows the helical fixation members  314 ,  315  in the deployed position, and  FIG. 15  shows the helical fixation members  314 ,  315  in the retracted position. The helical fixation members  314 ,  315  can be engaged with a rotatable carriage member  316 . The helical fixation members  314 ,  315  can have sharp beveled tips  318  that are angled upward toward the inserted tissue to help draw the fixation members  314 ,  315  into the tissue as the fixation members  314 ,  315  are rotated into the deployed position. The sharp beveled tips  318  of each of the helical fixation members  314 ,  315  can be positioned out of phase with each other by 180 degrees. 
         [0110]    In use, tissue may be received within housing  312 , and the helical fixation members  314 ,  315  can be rotatably advanced into the tissue by rotating carriage member  316  to engage and hold the tissue relative to the housing  312 . It will be appreciated that helical fixation members  314 ,  315  advance along a deployment path which includes a rotational component and an axial component relative to the center housing axis. It will be appreciated that other embodiments may include more than two helical fixation members without departing from the spirit or scope of the present disclosure. 
         [0111]      FIGS. 16-18  show a tissue fixation device  420  having a housing  422  and at least one curved fixation member  424 . In this embodiment there are three curved fixation members  424 , however, other embodiments may include more or fewer curved fixation members  424 .  FIGS. 16 and 17  show the curved fixation members  424  in the deployed position and  FIG. 18  shows the curved fixation members  424  in the retracted position. The curved fixation members  424  may be flexible, semi-flexible, or rigid. The curved fixation members  424  may be advanced upward from the housing  422 , through tissue, and the tips  418  of the curved fixation members  424  may then be received in capture features  426  formed in the housing  422  to hold the tissue relative to the housing  422 . Other embodiments may reverse the deployment direction of the curved fixation members  424 . For example, the curved fixation members  424  may be advanced downward from the housing  422 , through tissue, such that the tips  418  of the curved fixation members  424  are received in capture features  426  formed in the lower portion of the housing  422 . In this embodiment, the position of the apertures where the curved fixation members  424  exit the housing and the capture features  426  are reversed. In other embodiments, the curved fixation members  424  may be advanced sideways from the housing  422  and into capture features  426  formed on the sides of the housing  422  such that the apertures where the curved fixation members  424  exit the housing and the capture features  426  lie in a plane substantially perpendicular to the lengthwise central axis of the housing  422 . 
         [0112]      FIGS. 19-20  show a tissue fixation device  510  having a housing  522  and one or more fixation members  524 . In this example there are three fixation members, however in other examples there may be more or fewer fixation members  524 .  FIG. 19  shows the tissue fixation device  510  with the fixation members  524  in the deployed position.  FIG. 20  shows the tissue fixation device  510  with the fixation members  524  in the retracted configuration. The housing can have angled ramps  528  formed near the beveled tips  518  of the fixation members  524  which force the fixation members toward the center of the tissue fixation device  510  and into the tissue as the fixation members  524  are moved into the deployed position. The fixation members  524  can be moved between the deployed and retracted positions by means discussed herein including sutures, levers, sliding tabs, translating members or any other suitable mechanical means. 
         [0113]      FIGS. 21-25  illustrate an alternative embodiment of a tissue fixation device  610 . The tissue fixation device  610  includes a housing  612 , a cap  615 , and a fixation member carriage assembly  616  which carries at least one fixation member  614 . In the example, the fixation members  614  are needles formed from round stock and have pointed tips. In some embodiments, the needles may be hypodermic needles. The fixation member carriage assembly  616  is captured between the housing  612  and cap  615 , and is rotatable within a track  626  formed in the housing  612  and/or the cap  615  to deploy and retract the fixation members, in the same manner as described for device  10 . The housing may be referred to as a bell housing. The fixation members  614  are movable between a deployed configuration seen in  FIGS. 21 and 22  and a retracted configuration seen in  FIGS. 23 and 24 . The cap  615  attaches to the housing  612  via an interference fit which is a snap fit. To provide the interference fit, at least one flange  620  on the cap  615  engages with a shoulder  622  and recess  624  on the housing  612 . During assembly, the cap  615  is aligned with housing  612  with flange  620  adjacent shoulder  622 . The cap is pushed against the housing so that flange  620  moves past shoulder  622  and snaps into the recess  624  immediately below the shoulder  622 . Cap  615  includes one or more bosses  654  with ramps  656  which deflect portions of the fixation members out of the track and housing when the carriage assembly  616  is rotated. 
         [0114]      FIGS. 26-30  illustrate an alternative embodiment of a tissue fixation device  710 . The tissue fixation device  710  includes a housing  712 , a cap  715 , and a fixation member carriage assembly  716  which carries at least one fixation member  714 . In the example shown, the fixation members  714  are needles stamped from flat stock, and have pointed tips. The fixation member carriage assembly  716  is captured between the housing  712  and cap  715 , and is rotatable within a track  726  formed in the housing  712  and/or the cap  715  to deploy and retract the fixation members, in the same manner as described for device  10 . The housing may be referred to as a bell housing. The fixation members  714  are movable between a deployed configuration seen in  FIGS. 26 and 27  and a retracted configuration seen in  FIGS. 28 and 30 . The cap  715  attaches to the housing  712  via an interference fit which is a twisting fit. To provide the interference fit, at least one flange  720  on the cap  715  engages with shoulders  722  and recesses  724  on the housing  712 . The shoulders  722  may alternate with the recesses  724 . During assembly, the cap  715  is aligned with housing  712  with flanges  720  fitting into recesses  724 . The cap  715  is twisted so that upon rotation, each flange  720  moves out of its respective recess  724  and is captured under shoulder  722 . If the cap is twisted the opposite direction, the flanges are released from under the shoulders and the cap may be detached. Cap  715  includes one or more bosses  754  with ramps  756  which deflect portions of the fixation members out of the track and housing when the carriage assembly  716  is rotated. 
         [0115]    A method of use may be the same for devices  610  and  710 . In a method of use of device  710 , tissue is positioned in a central opening  708  of housing  712 . Carriage  716  is rotated in a first direction to deploy fixation members  714 . One or more sutures  90 ,  94  or other lines may be used to rotate the carriage and deploy the needles, as described herein with regard to device  10  and  FIGS. 7A and 7B . Fixation members  714  deflect circumferentially inward of the housing  712  and pierce the tissue, capturing the tissue and fixing it relative to the device  710 . At this point, the device  710  may be moved to manipulate the tissue as desired. After desired tissue movement has been carried out, the carriage  716  is rotated in a second direction to retract the fixation members  714 . The needles are pulled out of the tissue and back into the needle track  726 , and the tissue is released from capture. 
         [0116]    In some examples of use, the tissue is cervical tissue. The method of use may further include inserting a rod, tube or other elongated member (not shown) through the opening in the bottom of the housing, and into the cervix, with a portion of the elongated member extending out of the opening. After the needles are deployed, and the tissue is fixed relative to the device  610  or  710 , the portion of the elongated member extending out of the opening may be manipulated to move the attached device and cervical tissue. 
         [0117]      FIGS. 31A-36B  illustrate another embodiment of a tissue fixation device. Device  810  can include a housing  812 , a cap  815 , and a fixation member carriage assembly  816  which carries at least one fixation member  814 . In some examples, the fixation member  814  may be a needle. The fixation member carriage assembly  816  can be captured between the housing  812  and cap  815 , and may be rotatable within a track  826  formed in the housing  812  and/or the cap  815 . It is appreciated that many of the features and characteristics described for device  10  are found on and also apply to device  810 . 
         [0118]    The cap  815  and housing  812  may be referred to as a bell cap or a bell housing, respectively, as they may form a bell shape in some examples. The housing  812  includes at least one enclosed section that completely encloses at least one planar surface. The at least one planar surface can be defined by a cross-sectional plane through the housing that results in a planar surface that is completely enclosed or surrounded by a portion of the housing. In other words, the planar surface is an empty plane that is completely bounded by the housing  812 . For example, with reference to  FIG. 31C , if a cross section of the housing  812  is taken perpendicular to the longitudinal central axis  35  and through the top portion of the housing, or the cap  815 , a circular planar surface would be created which lies within the opening, or inner space  33  of the housing  812  and which is completely bounded by or surrounded by the housing  812  or cap  815 . 
         [0119]    Referring to  FIGS. 32 and 34 , housing  812  is substantially frustoconical and circular in shape. However, the housing  812  can also be conical, cylindrical, funnel, ovoid, or polygonal in shape, or any combination of shapes thereof. The housing may include a base  822  which may be circular, and a peripheral support wall  822  which terminates at a carriage support  824 . In the example shown, the base  822  has the narrowest diameter of the housing, and the housing slopes outward to a widest diameter at the carriage support  824 . Housing  812  may include an opening  823  which may be shaped to engage with uterine manipulator (not shown). The peripheral wall  834  and base  822  may surround and define a housing inner space  833 . The lengthwise central axis  35  may extend through the housing inner space  833 , also defined by the peripheral wall  834  and base  822 . 
         [0120]    The carriage support  824  can be ring-shaped, and include a carriage track  826 , which may be substantially circular. An outer rim  828  circumscribes the outer diameter of carriage track  826 , and a step  830  may be formed intermediate the track  826  and the outer rim  828 . One or more apertures  832  can open through the carriage support  824 , and may pass through at least a portion of the outer rim  828  and step  830 . A housing inner wall  834  can circumscribe the inner diameter of the carriage track  826 , and may include a plurality of discontinuations, or wall gaps  836 . At least one edge  838  of each wall gap  836  may be beveled. When operatively assembled, the fixation members  814  are deployable through the wall gaps  836 ; the beveled edges  838  may promote smooth deployment of the fixation members  814  and prevent the fixation members  814  from hanging up or being caught in the wall gaps  836 . Several slots  839  are formed in the housing  812  near the juncture of the peripheral support wall  822  and carriage support  824 . The slots  839  receive tabs  846  on the cap  815  to lock the cap to the housing  812 . Adjacent each slot  839  is a housing lip  841  formed along a portion of the peripheral wall  822 . 
         [0121]    Cap  815  may be annular, and may include an outer wall  50  generally opposite an inner wall  843 . An outer surface  844  of the cap  815  may be positioned as an upper surface, and may include a plurality of steps, ridges and/or grooves which may facilitate gripping and manipulating the cap  815 . The cap  815  may have circular outer and inner diameters, formed by the outer wall  850  and inner wall  843  respectively. The cap inner wall  843  includes a plurality of tabs  846  which project inferiorly from the inner wall  843 , alternating with a plurality of gaps  847 . Each tab  846  may include a cap lip  848  projecting from the tab. Tabs  846  and lips  848  may be semicircular to follow the outer shaped of the peripheral wall  822 . The cap outer surface  844  may extend between cap inner wall  43  and cap outer wall  50  and form a track cover  852 . A plurality of cap bosses  854  can project inwardly from the cap outer wall  850 . Each cap boss  854  may include a ramp feature  856  which urges one of the fixation members  814  inward as it is deployed. The cap track cover  852  includes one or more cap grooves  857 , which may be semicircular, and which guide the path of fixation members  814  as they are deployed and retracted. Housing  812  and cap  815  may be formed of plastic, or other materials listed herein. 
         [0122]    Fixation carriage assembly  816  can include a substantially circular fixation carriage  860 . Fixation member carriage  860  can have a first or superior side  874  and a second or inferior side  876 . A plurality of mounting features  862  can project superiorly from the fixation carriage  860 . Each mounting feature  862  may include a recess  864  through which an opening  866  is formed. Openings  866  can be sized to allow passage of a suture  90 , but may also be small enough to retain a knotted suture, not permitting the knot to pass through the opening. A circular setback or groove  878  can be formed on the inferior side  876  similar to groove  78  of device  10 , and be sized to receive a suture. 
         [0123]    Each fixation member  814  can be curved, rigid, and may terminate at a beveled point. The rigid fixation members may be formed of stainless steel, or other materials disclosed herein. Other embodiments may include flexible fixation members, which may be straight or curved, and may be made of Nitinol, for example. The fixation member curvature may be non-concentric with the curvature of the carriage track  826 , for example the fixation member curvature may have a smaller diameter than the diameter of the carriage track ( FIG. 36A ). Each fixation member  814  may include a base portion  880 , a shaft  882 , and a point  884 , which may also be referred to as a tip. The point  884  may be sharpened and/or serrated in order to reduce the forces necessary to pierce the tissue, or deploy the fixation member. Any of the fixation members disclosed herein may also include a sharp tip or point for the same purpose. The fixation member may have an arch shape that lies substantially in a single plane in some examples; in other examples, the fixation member can be substantially straight. In yet further examples, the fixation member can have a curved shape in multiple planes or in an infinite number of planes. When assembled into the fixation member carriage assembly  816 , a mounting pin  872  may pass through the fixation member base portion  880  and through carriage  860  to form a hinge type connection, about which the fixation member  814  may pivot. 
         [0124]    Cap  815  may be operatively assembled to housing  812  by insertion of cap tabs  846  into housing slots  839 . When the tabs  846  are fully inserted into the slots  839 , each cap lip  848  may snap over and positively engage a housing lip  841  to lock the cap  815  to the housing  812 . Fixation member carriage  816  and the attached fixation members  814  may be captured between the housing and the cap. In the example shown in  FIG. 34 , cap tabs  846  are exterior to housing peripheral wall  822 . In another embodiment, the tabs  846  may be interior to the peripheral wall. Attachment of the cap  815  to the housing  812  encloses a fixation member retention space  888  bounded by fixation member carriage  816 , track cover  852 , housing inner wall  834  and cap outer wall  850 . The mounting pins  872  project superiorly to the fixation carriage assembly  816  and are captured in the cap grooves  857 . 
         [0125]    A line passage or suture passage  886  may be formed between the groove  878  and outer rim  828 . Suture  90  may be threaded through one opening  866 , along suture passage  886  in the first direction  100  and through one aperture  832 . A knot  92  may be formed in the suture end remaining at opening  866 , the knot residing in recess  864  immediately adjacent opening  866 , and the knot preventing withdrawal of the first suture through the opening  866 . A free end  93  of suture  90  remains outside of the device  810 . The second suture  94  may be threaded through a second opening  866 , along suture passage  886  in the second direction  102  opposite the first direction, and through another aperture  832 . The second suture  94  may also be knotted, forming knot  96  to prevent withdrawal. In another example, the first line  90  and/or second line  94  may be secured in one or more crimp tubes which reside in openings  866 , the crimp tube(s) preventing withdrawal of the first and/or second suture through the corresponding opening  866 . A free end  95  of suture  94  remains outside of the device  810 . When the first and second sutures are thus placed, pulling on the first suture free end  93  will rotate the fixation member carriage assembly  816  in the first direction  100 , and pulling on the second suture free end  95  will rotate the fixation member carriage assembly  816  in the second, or opposite, direction  102 . 
         [0126]    With reference to  FIGS. 36A and 36B , device  810  may be deployed in the same manner as device  10 . The device may be place in the retracted configuration, with the fixation members  814  retracted into the fixation member retention space  888 . Device  810  may be positioned so that tissue, for example cervical tissue, is received in housing inner space  833 , with cap  815  and housing peripheral wall  822  enclosing the tissue. The free end  93  of suture  90  may then be pulled, rotating fixation member carriage assembly  816  in first direction  100 . As the fixation member carriage assembly  816  rotates, the fixation member tips  884  will encounter the ramps  856  on the cap  815 , and be deflected and forced inward through wall gaps  836  to protrude into the housing inner space  833 , thus attaining the deployed configuration. Pins  872  translate in grooves  857 , further guiding the fixation member deployment. The deployment paths of fixation members  814  may be coplanar in some embodiments, and the fixation members  814  may be deployed along a plane perpendicular to the lengthwise central axis  35  of the housing  812 . The plane may also be described as transverse to the lengthwise central axis  35 . The plane may also be coplanar with or parallel to the planar surface which is completely enclosed by the housing. The fixation members  814  may pierce and grip the tissue captured in the housing inner space  833 . As described for device  10 , this can advantageously result in fixing the position of the tissue within the housing  812 , and preventing the tissue from subsequently translating relative to the device  810  along the lengthwise central axis. A stylus, tubular member, rod, or other elongated member (not shown) may be inserted into device  810  through housing opening  823  and pass through the tissue, and may pass out of device  810  through cap  815 , leaving a free end of the elongated member exterior to the housing end  820 . For example, an elongated tubular member may pass through housing opening  823  and into a cervix captured in housing inner space  833 . The elongated tubular member free end may be manipulated to move the device  810  and the tissue gripped within. Instruments, bodily tissues, or fluids may be passed through the elongated tubular member into or out of the tissue. When desired, free end  95  of suture  94  may be pulled to rotate the fixation member assembly  816  in the second direction  102  and withdrawing the fixation members  814  from the tissue and back into the retracted configuration. 
         [0127]      FIGS. 37-60  disclose embodiments of fixation members, fixation member carriages and carriage assemblies which may be used in tissue fixation devices  10 ,  110 ,  210 ,  310 ,  410 ,  510 ,  610 ,  710 ,  810  or other tissue fixation devices. For example, a fixation member carriage and the fixation members carried thereon can be substituted for fixation member assembly  816  in device  810 , or substituted for fixation member assembly  16  in device  10 . In each example, the fixation member(s) are deployable between a retracted configuration in which they are retracted and the tissue fixation device may be positioned relative to tissue to be captured, and a deployed configuration in which the fixation members are deployed to contact and capture the tissue, and subsequent movement of the device will move or manipulate the captured tissue. The fixation members may be needles. It is understood that each fixation member disclosed herein may have a sharp tip for piercing and/or engaging tissue such as cervical tissue. Each fixation member disclosed herein may be curved. The fixation members disclosed herein may be stamped, formed from round stock, formed from rod stock, or manufactured from materials and methods known in the art for making needles. 
         [0128]      FIGS. 37A and 37B  show a fixation member or needle  1314  mounted in a carriage  1316 . A cap  1315  can capture needle  1314  in carriage  1316 . Fixation member  1314  includes a convex attachment feature  1320  shaped as a portion of a circle, which is received in a concave capture feature  1322  to form a ball joint. The ball joint allows polyaxial movement of the fixation member  1314 . Fixation member  1314  has a sharp tip  1326 . 
         [0129]      FIGS. 38A and 38B  show a fixation member or needle  914  mounted in a carriage  916 . An attachment feature  920  on the needle  914  is shaped as a cylinder. A pin  924  within a capture feature  922  on carriage  916  receives the needle  914 . When captured as shown, needle  914  can rotate about a single axis. Pin  924  may be molded into carriage  916 . In other embodiments, pin  924  and other pins disclosed herein may be molded, press fit, glued, or welded. 
         [0130]      FIG. 39  shows a needle  1014  mounted on a carriage  1016  in a capture feature  1022 . The needle  1014  is pre-formed with bends  1030 ,  1032  and attachment feature  1020  folded into the needle. As carriage  1016  is rotated, attachment feature  1020  swings to allow the needle to deploy and retract. A cap (not shown) may hold needle  1014  in capture feature  1022 . 
         [0131]      FIGS. 40A-40C  show a needle  1114 , cap  1115  and carriage  1116 . In  FIG. 40C , the needle  1114  is captured in between the cap  1115  and carriage  1116 . The needle  1114  includes an attachment feature  1120  wherein the needle end is bent approximately 90° to allow capture in a capture feature  1122 . When captured, needle  1114  can rotate about at least one axis. Needle  1114  may be formed from stainless steel round stock, and sharpened. 
         [0132]      FIG. 41  shows a needle  1214  mounted on a carriage  1216  in a capture feature  1222 . The needle  1214  is pre-formed with bends  1230 ,  1232  and attachment feature  1220  folded into the needle. As carriage  1216  is rotated, attachment feature  1220  swings within capture feature  1222  to allow the needle to deploy and retract. A cap (not shown) may hold needle  1214  in capture feature  1222 . 
         [0133]      FIGS. 42A-42D  show a metal carriage  1416  with pins  1424  press fit or welded to the carriage. One or more needles  1414  include an attachment feature  1420  which is a hole shaped to receive pin  1424 . One end of pin  1424  may be deformed to retain the needle. The metal carriage  1416  may be stamped or machined. 
         [0134]      FIGS. 43A and 43B  show a needle  1514  which may be created by stamping out of flat stock. The needle  1514  may then be bent or folded to create the V-shape seen in the cross-section of  FIG. 20B . The needle  1520  may include one or more attachment features  1520 , which may be shaped as pegs or posts, to attach to a carriage and/or cap as disclosed elsewhere herein. The needle  1514  may be described as a stylet. 
         [0135]      FIG. 44  shows a needle  1614  mounted on a carriage  1616 . Carriage  1616  includes a capture feature  1622  formed as a tab which extends over the carriage  1616  to capture a pin  1624 . Needle  1614  includes an attachment feature shaped to receive the pin  1624  so that when mounted, the needle  1614  is captured on the pin  1624 , between the carriage  1616  and the capture feature  1622 . In an embodiment formed from steel, capture feature  1622  may be connected to the carriage  1616  at a hinge  1626 . In an embodiment formed from plastic, capture feature  1624  may be folded over and/or formed around a mold, and welded to carriage  1616 . Needle  1614  may be a stylet, sharing the same features as needle  1514 . 
         [0136]      FIGS. 45A-45C  show a carriage  1716  with capture features  1722  and a needle  1714  having a hole  1720 . A cap is not shown, but includes a number of retention blocks  1725  equal to the number of capture features  1722  on the carriage  1716 . Each capture feature  1722  includes a pin  1724  and two holes  1726 . Each retention block  1725  includes two pins  1734  and one hole  1717 , plus a bore  1719 . When assembled, needle  1714  is captured between carriage  1716  and cap  1715 , with pin  1724  extending from carriage  1716  through needle hole  1720  and bore  1719 . Retention block pins  1724  extend into holes  1726 . In another embodiment, the retention block  1725  may be part of the carriage  1716  instead of the cap  1715 . 
         [0137]      FIGS. 46A-46C  show an embodiment including a stamped carriage  1816 , a needle  1814  and a pin  1824 . Pin  1824  includes a head  1826  and a shoulder  1828 . Needle  1814  includes an attachment feature which is a hole  1820 . Pin  1824  may be received in hole  1820  to mount needle  1814  to carriage  1816 ; head  1826  retains the needle  1814  on the pin  1824 . The carriage  1816  include capture features  1822  which may be holes to receive pins  1824 . 
         [0138]      FIGS. 47A-47C  show an embodiment including a carriage  1916  and a needle  1914 , the needle having an attachment features which is a pin  1924 . A capture feature  1922  on the carriage  1916  includes a slot  1926  and a hole  1928 . The needle can be snapped or rocked into the capture feature  1922 , with pin  1924  moving through slot  1926  into hole  1928 . The edges  1930 ,  1932  of the slot  1926  may deform slightly as the pin  1924  is pushed in, then act as interference to keep the pin  1924  in place in the capture feature. 
         [0139]      FIGS. 48A-48D  shows an embodiment similar to  FIGS. 47A-47C . A needle  2014  includes a pin  2024  for attachment. Carriage  2016  includes a capture feature  2022  having a slot  2026 . The pin  2024  is captured in the slot  2026  as shown. Not shown, a cap  2015  includes an inner wall  2017  which holds the pin  2024  in the slot  2026 . 
         [0140]      FIGS. 49A and 49B  show an embodiment similar to  FIGS. 43A and 43B . Needle  2114  includes an attachment feature  2120 . A separate pin  2124  can attach the needle to a carriage. Needle  2114  may be formed in the same way as described for needle  1514 . 
         [0141]      FIG. 50  shows another carriage and needle assembly stamped from a single piece of stock. The assembly includes carriage  2316  and needles  2314 . The stock metal may be stamped, then the needles bent and sharpened. The needles  2314  project upward from carriage  2316 . 
         [0142]      FIG. 51  shows another carriage and needle assembly stamped from a single piece of stock. The assembly includes carriage  2416  and needles  2414 . The stock metal may be stamped, then the needles bent and sharpened. The needles  2414  project inward from carriage  2416 . A hinge  2420  is formed where each needle  2414  projects from carriage  2416 ; each hinge  2420  may be formed by cutting away portions of the material between the needle and the carriage. The hinge  2420  may be described as a living hinge. In  FIGS. 50-51 , the needles bend out of the plane of the carriage. 
         [0143]      FIG. 52  shows an embodiment of a carriage assembly including a carriage  2516  and needles  2514 . The carriage is formed from molded material such as polymer. Pins  2524  attach the needles to the carriage. In this embodiment, the pins  2524  and needles  2514  are in place when the carriage  2516  is molded; the pins and needles are over-molded into the carriage assembly. 
         [0144]      FIG. 53  shows an embodiment of a carriage assembly including a carriage  2616  and a needle  2614 . When deployed, needle  2614  slides in a slot  2622  on carriage  2616  along axis  2601 . 
         [0145]      FIG. 54  shows another carriage and needle assembly including carriage  2816  and needles  2814 . The needles may be formed from flexible steel, and may be insert molded into the carriage. A hinge  2820  is formed where each needle  2814  projects from carriage  2816  at capture feature  2822 ; each hinge  2820  may be formed by cutting away portions of the needle. The hinge  2820  may be described as a living hinge, and may result in a springy needle. Capture feature  2822  may be rigid. 
         [0146]      FIG. 55  shows another carriage and needle assembly including carriage  2916  and needle  2914 . Carriage  2916  include capture feature  2922  having a living hinge  2926 . Needle  2914  is attached to the capture feature  2922  through overmolding; the needle is overmolded directly into the carriage. 
         [0147]      FIG. 56  shows another carriage and needle assembly including carriage  3116  and at least one needle  3114 . A suture  90  is attached to the needle and can be manipulated to activate the needle. In this embodiment, the carriage  3116  does not move within a housing such as housing  3012 , but instead the needles  3114  are deployed by one or more sutures. 
         [0148]      FIG. 57  shows another carriage and needle assembly including carriage  3216  and a plurality of needles  3214 . Carriage  3222  includes a plurality of capture features  3222 , and each needle includes an attachment feature  3220  which may be received in a capture feature. Unlike other embodiments herein, needles  3214  are straight. When deployed, the needles rotate approximately 90° and project straight into a center opening  3208  of the carriage  3216 . When retracted, the needles may point up. 
         [0149]      FIG. 58  shows a tissue fixation carriage  3416  with a tissue fixation member  3414  attached to the carriage by a plurality of attachment features  3420 . Tissue fixation member  3414  is expandable and may include an expandable mesh which encircles a central opening  3408 . Small teeth or barbs  3426  are formed on the edges of the fixation member  3414 . When carriage  3416  is rotated in a first direction, fixation member  3414  expands and tissue may be positioned in the central opening  3408 . When the carriage  3416  is rotated in a second direction, fixation member  3414  contracts and the tissue is captured in the opening  3408 . The barbs  3426  help prevent withdrawal of the tissue. 
         [0150]      FIGS. 59A and 59B  are views of a tissue fixation device  3700  including housing  3712 , cap  3715 , and two needles  3714  captured in needle carriage  3716 . Instead of deploying circumferentially inward, when deployed the needles drop down into the center opening  3008  of the device, capturing tissue positioned therein. 
         [0151]      FIG. 60  shows a tissue fixation device  3800  including housing  3812 , and several needles  3814  captured in needle carriage  3816 . Each needle  3814  is compoundly curved, having at least one convex portion and one concave portion. When deployed, needles  3814  trap tissue between the needle  3814  and the carriage  3816 . 
         [0152]    It should be understood that the present apparatuses and methods are not intended to be limited to the particular forms disclosed. Rather, they are intended to include all modifications, equivalents, and alternatives falling within the scope of the claims. They are further intended to include embodiments which may be formed by combining features from the disclosed embodiments, and variants thereof. 
         [0153]    The claims are not to be interpreted as including means-plus- or step-plus-function limitations, unless such a limitation is explicitly recited in a given claim using the phrase(s) “means for” or “step for,” respectively. 
         [0154]    The term “coupled” is defined as connected, although not necessarily directly, and not necessarily mechanically. 
         [0155]    The use of the word “a” or “an” when used in conjunction with the term “comprising” in the claims and/or the specification may mean “one,” but it is also consistent with the meaning of “one or more” or “at least one.” The term “about” means, in general, the stated value plus or minus 5%. The use of the term “or” in the claims is used to mean “and/or” unless explicitly indicated to refer to alternatives only or the alternative are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and “and/or.” 
         [0156]    The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”) and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes” or “contains” one or more steps or elements, possesses those one or more steps or elements, but is not limited to possessing only those one or more elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes” or “contains” one or more features, possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
         [0157]    The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. It is appreciated that various features of the above-described examples can be mixed and matched to form a variety of other alternatives. For example, fixation members, needles, hooks or barbs may be interchangeable in any of the embodiments set forth herein, as may the actuation means for deployment. As such, the described embodiments are to be considered in all respects only as illustrative and not restrictive. Similarly, manufacturing, assembly methods, and materials described for one device may be used in the manufacture or assembly of another device. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.