Abstract:
A method of placing a suture through tissue includes placing a band on a finger of a user, where the band is attached to a head of a suturing device, and employing the finger and the device in identifying an intracorporeal tissue landmark and placing the head of the suturing device at the intracorporeal tissue landmark. The method additionally includes engaging a throat of the head of the suturing device with the intracorporeal tissue landmark, and ejecting a needle out of a needle exit port and through the tissue. The needle exit port is located on a proximal portion of the head of the suturing device.

Description:
BACKGROUND 
       [0001]    Intracorporeal suturing of tissue during surgery presents challenges to the surgeon in that the surgeon is called upon to manipulate one or more suturing instruments within the confines of an incision formed in the patient&#39;s body. In some cases, the surgeon will use his/her finger(s) to dissect tissue or separate tissue along tissue planes to form a space within the tissue that allows the surgeon to palpate and identify a desired target location for placement of a suture. Often, the space formed in the dissected tissue is opened until it is large enough to receive both the surgeon&#39;s finger(s) and the suturing instrument(s). The space provides access to the identified target location where it is desired to place the suture. However, the target location is often disposed inside the patient&#39;s body at an angle that is difficult to reach and can have a depth that precludes visualization of the target location. Delivering surgical instruments to the target location is challenging when the target location cannot be visualized by the surgeon. 
       SUMMARY 
       [0002]    One aspect provides a suture fixation system including a suture assembly having an anchor, an introducer, and a delivery device. The introducer is attachable to a finger of a person and includes a platform attached to an exterior of the introducer and a zip line attached to the platform. The delivery device is movable along the zip line and configured to removably retain the anchor. The introducer allows the finger to identify a target landmark within a patient and the delivery device positions the anchor for insertion to the target landmark. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0003]    The accompanying drawings are included to provide a further understanding of embodiments and are incorporated in and constitute a part of this specification. The drawings illustrate embodiments and together with the description serve to explain principles of embodiments. Other embodiments and many of the intended advantages of embodiments will be readily appreciated as they become better understood by reference to the following detailed description. The elements of the drawings are not necessarily to scale relative to each other. Like reference numerals designate corresponding similar parts. 
           [0004]      FIG. 1  is an exploded schematic view of one embodiment of a digital suture fixation system including an introducer and an anchor delivery device. 
           [0005]      FIG. 2  is a bottom view of the introducer illustrated in  FIG. 1 . 
           [0006]      FIG. 3  is a top view of the delivery device illustrated in  FIG. 1 . 
           [0007]      FIG. 4  is a cross-sectional view of the delivery device illustrated in  FIG. 3 . 
           [0008]      FIG. 5  is an end of view of the delivery device illustrated in  FIG. 3 . 
           [0009]      FIG. 6A  is a side view of a finger wearing the introducer illustrated in  FIG. 1 . 
           [0010]      FIG. 6B  is a side view of the delivery device illustrated in  FIG. 3  shuttled along a zip line to the introducer illustrated in  FIGS. 1 and 2 . 
           [0011]      FIG. 6C  is a side view of the system illustrated in  FIG. 1  employed to deliver an anchor to tissue of a patient according to one embodiment. 
           [0012]      FIG. 6D  is a schematic view of a suture line trailing away from the anchor that has been fixed into the tissue of the patient. 
           [0013]      FIG. 7  is an exploded perspective view of a digital suture fixation system including an introducer and an anchor delivery device according to one embodiment. 
           [0014]      FIG. 8A  is an exploded side view of the system illustrated in  FIG. 7 . 
           [0015]      FIG. 8B  is a schematic exploded view of a cable engaging with an anchor assembly of the system illustrated in  FIG. 8A  according to one embodiment. 
           [0016]      FIG. 9A  is a side view of a finger wearing the system illustrated in  FIG. 7 . 
           [0017]      FIG. 9B  is a side view of the delivery device illustrated in  FIG. 7  delivered to a landmark inside of the patient&#39;s body. 
           [0018]      FIG. 9C  is a side view of the system illustrated in  FIG. 7  employed to deliver an anchor to the landmark inside of the patient&#39;s body. 
           [0019]      FIG. 9D  is a side schematic view of a telescoping anchor housing. 
           [0020]      FIG. 10  is a perspective view of an optional position marker configured to be employed with the system illustrated in  FIG. 7  according to one embodiment. 
           [0021]      FIG. 11  is a side plan view of a digital suture fixation system including a delivery device attached to an introducer band according to one embodiment. 
           [0022]      FIGS. 12A-12C  are schematic cross-sectional views of the digital suture fixation system illustrated in  FIG. 11  employed to throw a needle through tissue according to one embodiment. 
           [0023]      FIG. 13  is a perspective view of the introducer band illustrated in  FIG. 11 . 
           [0024]      FIG. 14  is a perspective view of another embodiment of an introducer band. 
           [0025]      FIG. 15  is a perspective view of another embodiment of an introducer band attached to the delivery device illustrated in  FIG. 11 . 
           [0026]      FIG. 16  is a perspective view of another embodiment of an introducer band attached to the delivery device illustrated in  FIG. 11 . 
           [0027]      FIG. 17  is a perspective view of another embodiment of an introducer band attached to the delivery device illustrated in  FIG. 11 . 
       
    
    
     DETAILED DESCRIPTION 
       [0028]    In the following Detailed Description, reference is made to the accompanying drawings, which form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. In this regard, directional terminology, such as “top,” “bottom,” “front,” “back,” “leading,” “trailing,” etc., is used with reference to the orientation of the Figure(s) being described. Because components of embodiments can be positioned in a number of different orientations, the directional terminology is used for purposes of illustration and is in no way limiting. It is to be understood that other embodiments may be utilized and structural or logical changes may be made without departing from the scope of the present invention. The following detailed description, therefore, is not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims. 
         [0029]    It is to be understood that the features of the various exemplary embodiments described herein may be combined with each other, unless specifically noted otherwise. 
         [0030]    Tissue includes soft tissue, which includes dermal tissue, sub-dermal tissue, ligaments, tendons, or membranes. As employed in this specification, the term “tissue” does not include bone. 
         [0031]    A digital suture fixation system is a system that allows suture line to be thrown through tissue and/or allows the placement of an anchor into the tissue with a hand or one or more fingers on the hand. A digital suture fixation system allows for the “finger tack” fixation of suture line and/or anchors into the tissue. 
         [0032]    Embodiments provide a finger guided suture fixation system that includes an introducer that is configured to be donned over a finger of a surgeon to allow the finger to palpate and identify a landmark within the patient, and a delivery device configured to insert an anchor at the identified landmark. As an example, the introducer is provided with a zip line that is sized to trail proximally behind the finger to a location outside of the patient&#39;s body. The delivery device is movable along the zip line and attachable to the introducer. In this manner, the surgeon is able to locate a target site of interest with his/her finger and pass the delivery device along the zip line to the finger until it is placed at or near the target site to allow the precise placement of the anchor even without visually seeing the target site. 
         [0033]    In this specification, “zip line” means a conduit, such as a cable, that provides a pathway from a location exterior a patient&#39;s body to a location intracorporeal the patient&#39;s body. 
         [0034]      FIG. 1  is a side view of one embodiment of a digital suture fixation system  150 . System  150  includes an introducer  152  that is attachable to a finger F, a delivery device  154  that is attachable to introducer  152 , and an anchor  156  that is removably retained in the delivery device  154 . 
         [0035]    In one embodiment, introducer  152  includes a finger cot  160 , a platform  162  attached to an exterior surface of finger cot  160 , and a zip line  164  attached to platform  162 . In one embodiment, delivery device  154  includes a car  170  configured to couple with and move along the zip line  164  and a shaft  174  that is configured to eject anchor  156  from car  170 . The car  170  defines a port  172  sized to enclose anchor  156 . In one embodiment, anchor  156  includes a barb portion  180  configured to engage with tissue and a suture line  182  trailing from barb portion  180 . In one embodiment, the shaft  174  includes a distal end  190  that is attachable to the car  170 , a proximal end  192  including a plunger  194 , and a rod  196  that moves into and out of the shaft  174  in response to movement of the plunger  194 . 
         [0036]    System  150  is adapted to deliver anchor  156  to a landmark within the patient, where the landmark is not necessarily visible to the surgeon. For example, the finger cot  160  allows the finger F to identify the desired landmark, the car  170  is attachable to the platform  162  (which is located near a distal end of the finger F) to ensure that the anchor  156  is directed to the landmark identified by the finger F, and the shaft  174  is employed to selectively eject the anchor  156  into the landmark. Although the landmark in  FIG. 1  is illustrated as a ligament, system  150  is configured to allow the surgeon to palpate and identify any of a variety of intracorporeal landmarks. 
         [0037]    The systems disclosed in this specification are suited for the intracorporeal suturing of tissue during pelvic organ repair surgery, and in one embodiment are provided as sterile disposable surgical instruments that are discarded after the surgical procedure. To this end, the components of the systems are selected to be compatible with gas, steam, or radiation sterilization. 
         [0038]      FIG. 2  is a bottom view of introducer  152  showing zip line  164  trailing from a proximal end of introducer  152 . In one embodiment, introducer  152  includes a window  200  formed in the finger cot  160  between platform  162  and a distal end of the finger cot  160 . In one embodiment, the window  200  allows the finger F to directly contact tissue within a patient. In one embodiment, the window  200  allows a finger F inside of a glove (not shown) to identify a tissue landmark within a patient, where the glove is selected to provide the surgeon with a level of dexterity suited to sensing and discriminating different intracorporeal tissue landmarks. The platform  162  includes a retainer  204  that is configured to engage with the car  170  ( FIG. 1 ) to secure the car  170  to the introducer  152 . In one embodiment, the retainer  204  is provided as a pair of opposing substantially spherical recesses that are sized to receive spring-loaded ball bearings provided on the car  170 . 
         [0039]    Finger cot  160  is selected to be conformable to a distal end of the finger F, suitably elastic, and is suitably fabricated from plastic, metal, or combinations of plastic and metal (e.g., malleable metal thimbles covered with plastic as one example). Platform  162  is attached to finger cot  160  and is suitably formed from plastic, metal, or combinations of plastic and metal. Suitable suture line  182  materials include suture employed by surgeons in the treatment of pelvic organ prolapse, such as polypropylene suture, or the suture identified as Deklene, Deknatel brand suture, as available from Teleflex Medical, Mansfield, Mass., or suture available from Ethicon, a Johnson&amp;Johnson Company, located in Somerville, N.J. 
         [0040]    The zip line  164  is flexible and is suitably fabricated from a polymer strand, or a braided cable coated with plastic, as examples. 
         [0041]    In one embodiment, introducer  152  is integrated into a distal finger sleeve of a glove, which allows the introducer  152  to be more closely associated with the surgeon&#39;s hand. 
         [0042]      FIG. 3  is a top view of car  170 ,  FIG. 4  is a cross-sectional view of car  170 , and  FIG. 5  is a proximal end view of car  170 . In one embodiment, car  170  includes a proximal end  210  opposite a distal end  212 , a platform dock  214  formed adjacent to distal end  212 , a zip line channel  216  extending between end  210  and dock  214 , and a suture channel  218  extending between end  210  and port  172 . The platform dock  214  includes a lock  220  configured to couple with retainer  204  to secure car  170  to platform  162  ( FIG. 2 ). In one embodiment, the lock  220  includes spring-loaded ball bearings or another form of a biasing member configured to engage with recesses  204  formed on platform  162 . The car  170  is configured to slide along the zip line  164  until lock  220  engages with retainer  204  to secure the car  170  to the platform  162 . 
         [0043]    In one embodiment, threads  222  are formed within a proximal end of suture line channel  218  and are sized to receive a threaded distal end  190  of shaft  174  ( FIG. 1 ). In this manner, shaft  174  is configured to be removably attached to the car  170  such that rod  196  ( FIG. 1 ) is aligned with suture line channel  218  and the barb portion  180  of anchor  156 . 
         [0044]      FIG. 5  is a proximal end view of car  170 . In one embodiment, car  170  is substantially a circular cylinder, although other shapes and sizes that accommodate the intracorporeal delivery of the car  170  into the patient, as guided by the surgeon&#39;s preferences, are also acceptable. 
         [0045]      FIGS. 6A-6D  are side views of system  150  employed to insert an anchor into tissue according to one embodiment. 
         [0046]      FIG. 6A  is a side view of introducer  152  placed over the finger F such that the finger F is available to palpate tissue through the window  200 . 
         [0047]      FIG. 6B  is a side view of car  170  and shaft  174  of delivery device  154  moving along a zip line  164  for engagement with platform  162 . It is to be understood that shaft  174  could be suitably attached to car  170  before car  170  is engaged with the zip line  164  or after the car  170  is engaged with the zip line  164 . 
         [0048]      FIG. 6C  is a side view of the car  170  engaged with the platform  162  and the shaft  174  connected to the car  170 . In one embodiment, the barb portion  180  of the anchor  156  is retained within port  172  ( FIG. 1 ) and suture line  182  trails from the proximal end  210  of the car  170  ( FIG. 4 ). In this configuration, the shaft  174  is connected to the car  170 , and the car  170  is connected to the platform  162 , where the platform  162  and the car  170  are positioned adjacent to the window  200  and thus ready to deliver the barb portion  180  into the tissue (e.g., ligament) palpated by the finger F. In one embodiment, the surgeon uses the opposite hand (e.g., the hand to which introducer  152  is not attached) to activate the plunger  194 , which drives the rod  196  ( FIG. 1 ) axially from the shaft  174  to eject the barb portion  180  of the anchor  156  axially from the car  170  and into the ligament, as illustrated in  FIG. 6D . Although the plunger  194  is illustrated as a push-activated mechanical device in  FIG. 6C , other embodiments of the plunger  194  provide a plunger that operates pneumatically or electro-mechanically. Other suitable activation mechanisms for moving rod  196  to deliver anchor  156  include pull activation, twist activation, or squeeze activation of shaft  174  to activate movement of rod  196 . 
         [0049]    The anchor  156  is configured to penetrate tissue, including tough ligament tissue, and engage with the tissue after penetration. In one embodiment, the barb portion  180  is selectively deployed to expand from the anchor  156  only after the anchor penetrates into the tissue. In one embodiment, the barb portion  180  extends laterally from the anchor  156  and engages with the tissue as soon and the anchor penetrates into the tissue. 
         [0050]      FIG. 7  is a perspective view of another embodiment of a digital suture fixation system  250 . In one embodiment, system  250  includes an introducer  252  that is attachable to a finger, a delivery device  254  attached to introducer  252 , and an anchor (not shown) that is removably attachable to delivery device  254 . In one embodiment, the introducer  252  is a band  252  that is attachable to the finger and the delivery device  254  and includes an anchor housing  256  attached to an exterior surface of the band  252 . The delivery device  254  includes a shaft  258  having a distal end  260  that is configured to thread into a proximal end of the anchor housing  256 . The anchor housing  256  is sized to retain an anchor (or an anchor and a suture line) and the shaft  258  is configured to deploy the anchor from the anchor housing  256 . 
         [0051]      FIG. 8A  is a side view of system  250 . The anchor housing  256  includes a channel  270  that is sized to receive anchor  156  and suture line  182 . In one embodiment, anchor housing  256  has a longitudinal length between about 0.75-1.5 inches, and band  252  is configured to allow housing  256  to slide/move longitudinally (laterally left and right in the orientation of  FIG. 8A ). In this manner, the anchor housing  256  is sized to be positioned at a base segment of the finger (behind the distal-most joint of the finger) to allow the distal end of the finger freedom of movement. The anchor housing  256  is configured to move relative to the band  252  to a position adjacent to the distal end of the finger F to bring the anchor  156  near the desired landmark previously identified by the surgeon&#39;s finger F. 
         [0052]    In one embodiment, the band  252  is provided as adjustable band including a buckle or other adjustable form of attachment. Suitable materials for fabrication of the band  252  include plastics, metals, or combinations of plastics and metals. In one embodiment, the anchor housing  256  is molded from plastic attached to the band  252 . In one embodiment, shaft  258  is similar to shaft  174  ( FIG. 1 ). 
         [0053]      FIG. 8B  is an exploded schematic view of shaft  258  moved distally forward and ready for engagement with anchor  156 . In one embodiment, shaft  258  includes an extensible post  272  that is configured to extend out of a distal end  260  of shaft  258  to engage with a bore  274  formed in anchor  156 . In this manner, the post  272  is configured to drive the anchor  156  axially out of the channel  270  and into the tissue of the patient. 
         [0054]      FIGS. 9A-9C  provides schematic views of system  250  employed to deliver an anchor into tissue. 
         [0055]      FIG. 9A  is a schematic view of the band  252  attached to the finger F in a manner that locates the anchor housing  256  at the base of the finger F near the web of the thumb. The distal end of the finger F is unimpeded by the anchor housing  256  and is thus free to palpate the tissue. The shaft  258  trails behind the anchor housing  256  out of the patient&#39;s body for access by the other hand (e.g., the right hand in this example). 
         [0056]    The finger F is fully mobile (even if protected by a surgical glove) and able to palpate a desired tissue location for deployment of anchor  156 . As illustrated in  FIG. 9B , the anchor housing  256  is movable relative to the band  252  to position the distal end of the anchor housing  256  (retaining the anchor  156 ) next to the tissue landmark. In one embodiment, the shaft  258  is pushed in a proximal direction to displace the housing  256  proximally forward toward the tissue. 
         [0057]    The anchor housing  256  is not drawn to scale. In one embodiment, it is desirable to provide the anchor housing  256  in a low-profile format (e.g. a flat elliptical shape) that is configured to lay flat against the palm of a user&#39;s hand. For example, in one embodiment the anchor housing  256  has a lateral cross-sectional size that is similar to the size of the diameter of the shaft  258  such that the shaft  258  and the housing  256  appear as a single cable. 
         [0058]      FIG. 9C  illustrates anchor  156  driven into the tissue by the post  272  ( FIG. 8B ) of the shaft  258 . The suture line  182  is optional, and if provided, trails behind the anchor  156  through the anchor housing  256  and behind the hand of the surgeon. In one embodiment, the shaft  258  is rotated counterclockwise (one-quarter to one-half of a turn) to disengage the shaft  258  from the anchor  156 . Thereafter, the surgeon retracts the finger F and the system  250  from the patient leaving the anchor  156  inserted into tissue and the suture line  182  trailing away from the anchor and out of the patient. The suture line  182  is tied off to reinforce or suture the pelvic floor of the patient. Alternatively, the suture line  182  serves as a conduit into the patient&#39;s body for delivery of support mesh intracorporeally to the inserted anchor  156 . 
         [0059]      FIG. 9D  is a side schematic view of a telescoping anchor housing  256 ′. The telescoping anchor housing  256 ′ has a proximal end  280  that nestles against a web of the hand and a distal end  282  that moves forward toward the distal end of the finger F when the shaft  258  is pressed into the proximal end  280  of the anchor housing  256 ′. The proximal end  280  contacts the webbing of the hand to allow the hand to drive the distal end  282  forcefully into the tissue to ensure that the anchor  156  penetrates tough tissue. Consistent with the above description, activation of the shaft  258  moves the post  272  in the axial forward direction to eject the anchor  156 . In one embodiment, shaft  258  is attached to the proximal end  280  of the delivery device  256 ′, the shaft  258  is pushed distally, and separating segments of the telescoping delivery device  256 ′ axially expand to drive anchor  180  into the tissue. 
         [0060]      FIG. 10  is a perspective view of an optional position marker  290  configured for use with system  250 . In one embodiment, position marker  290  includes a distal surface  292 , a proximal surface  294 , a slot  296  formed between the surfaces  292 ,  294 , and a hole  298  formed in the proximal surface  294 . In one embodiment, position marker  290  is provided as a stroke-length control and twist-release locator that is configured to be tacked into position by the anchor  156 . For example, in one embodiment the hole  298  is sized to receive the distal end of anchor housing  256  ( FIG. 8A ) to allow accurate placement of the anchor  156  into the tissue. The position marker  290  functions to prevent inserting the anchor  156  too deeply into the tissue. The position marker  290  also functions to prevent twisting of the anchor  156  after placement of the anchor  156  to tissue. In one embodiment, position marker  290  includes another suture line  300  that is configured to trail out of the patient&#39;s body to a location that can be accessed by the surgeon for the subsequent delivery of support mesh into the patient to the location at which position marker  290  has been affixed. 
         [0061]    Suitable materials for fabrication of position marker  290  include plastic or radio-opaque material. 
         [0062]      FIG. 11  is a side plan view of a digital suture fixation system  350  including an introducer band  352  that allows the surgeon to use a finger to precisely place a delivery device  354  next to a tissue landmark. The introducer band  352  is attachable to the finger F and a suture assembly  356  is retained by a head  364  of the delivery device  354 . This configuration allows the finger F to guide the head  364  of the delivery device  354  directly and precisely to an intracorporeal tissue landmark (i.e., a target) identified by the finger F. The surgeon inserts his/her finger into the band  352  to guide the delivery device  354  through the dissected tissue precisely to the landmark previously identified by the finger, which positions the head  364  for delivery of the suture assembly  356  to the tissue landmark. 
         [0063]    Delivery device  354  includes a shaft  360  coupled between a handle  362  and the delivery head  364 . The introducer band  352  is attachable to the head  364 . Handle  362  thus defines a proximal end of system  350  nearest a user of the system  350 . 
         [0064]    With reference to  FIGS. 11 and 12A , the needle  374  is stored within a proximal end portion  376  of the head  364  and the suture assembly  356  is stored within a distal end portion  378  of the head  364 . The open space between the proximal end portion  376  of the head  364  and the distal end portion  378  of the head  364  is referred to as a throat. In one embodiment, the suture assembly  356  includes a suture line  380  connected to a capsule  382 , and the capsule  382  is retained within distal end  378  of head  364 . The needle  374  is adapted to move across the throat from the proximal end portion  376  of the head  364  to the distal end portion  378  of the head  364 . The needle  374  is shaped to frictionally engage and mate with the capsule  382 , remove the capsule  382  from distal end  378 , and retract the capsule  382  into the proximal end portion  376  of head  364 . In this manner, the suture line  380  is towed behind the capsule  382  and “thrown” through the tissue. 
         [0065]    For example, handle  362  includes an actuator  370  communicating with a rod  372  that is disposed within shaft  360 . The throat formed in the head  364  is configured to be engaged over a mass of tissue. When actuator  370  is activated (for example with the surgeon&#39;s free hand exterior to the patient), the rod  372  moves through shaft  360  to extend the needle  374  stored within the proximal end portion  376  of head  364  axially outward through tissue and toward the distal end  378  of head  364 . Thus, the needle  374  moves away from the user (who is holding handle  362  at the proximal end of system  350 ) and is thrust through the tissue toward distal end  378  of system  350 . The needle  374  ultimately grasps the capsule  382 , and the needle  374  and the capsule  382  are pulled back through the channel formed in the tissue by the needle  374 . Retraction of the needle  374  pulls the suture line  380  through the tissue, to “throw” the suture line through the tissue. 
         [0066]      FIGS. 12A-12C  are schematic cross-sectional views of digital suture fixation system  350  employed to throw needle  374  and capsule  382 /suture  380  through tissue. 
         [0067]      FIG. 12A  is a schematic cross-sectional view of needle  374  partially extending from the proximal end portion  376  of head  364  after activation of actuator  370  ( FIG. 11 ). Capsule  382  is seated in a cavity formed in the distal end  378  of head  364 . It is recommended that the surgeon direct a trailing end of suture  380  over distal end  378  of head  364  and back toward a proximal end of shaft  360  ( FIG. 11 ) for ease of managing the suture assembly during the procedure. To this end, in one embodiment the handle  362  is provided with a reel configured to receive the suture  380 . For example, in one embodiment the suture  380  is retained on a suture cartridge, and the handle  362  is provided with a spindle configured to receive and retain the suture cartridge. 
         [0068]      FIG. 12B  is a schematic cross-sectional view of head  364  illustrating the needle  374  moved across the throat of head  364  and engaged with capsule  382 . It is to be understood that the throat would typically be placed over a mass of tissue that the surgeon desires to suture. The needle  374  is reversible and configured to retract capsule  382  back in a proximal direction into the needle exit port of the proximal end portion  376  of head  364 . 
         [0069]      FIG. 12C  is a schematic view of needle  374  and the capsule  382  partially retracted into the proximal end portion  376  of head  364 . The needle  374  is retracted until the capsule  382  is parked inside the needle exit port of the proximal end portion  376  of head  364  and the suture  380  extends across the throat of head  364 . 
         [0070]    System  350  is suited for the intracorporeal suturing of tissue during pelvic organ repair surgery, and in one embodiment is provided as a sterile disposable surgical instrument that is discarded after the surgical procedure. To this end, the components of system  350  are selected to be compatible with gas, steam, or radiation sterilization. 
         [0071]      FIG. 13  is a perspective view of the introducer band  352 . In one embodiment, the introducer band  352  is a discontinuous band defined by a first ring segment  390  separated from a second ring segment  392  by a space  394  and includes a flange  396  that is configured to be removably attached to the head  364  of delivery device  354  ( FIG. 11 ). In one embodiment, the first and second ring segments  390 ,  392  are curved to define a substantially circular band sized to flexibly fit around a finger of a surgeon. The space  394  permits the ring segments  390 ,  392  to flex and adjust around differently sized fingers. The introducer band  352  is adapted to be placed over a finger of the surgeon to direct the head  364  of the delivery device  354  to a tissue landmark. The distal end of the finger of the surgeon is unencumbered and free to palpate tissue of the patient while the band  352  holds the delivery device  354  at the ready for placement of suture  380  and capsule  382 . 
         [0072]    In one embodiment, the introducer band  352  is molded from plastic. In one embodiment, the introducer band  352  includes a metal core (such as aluminum) having a plastic (such as silicone) molded over the metal core. 
         [0073]      FIG. 14  is a perspective view of another embodiment of an introducer band  402 .  FIG. 14  is oriented such that the view is directed to the pad P of the finger F, and an outside surface of the index finger F is oriented in the up direction. That is to say,  FIG. 14  is a depiction of a pad of a left hand index finger. 
         [0074]    In one embodiment, the introducer band  402  includes a base  404 , a first pair of arms  406  that are configured to wrap a portion of the way around the finger F, a single arm  408  that is configured to wrap a portion of the way around the finger F in a direction opposite the first pair of arms  406 , and a metal interface  410  attached to the base  404 . In one embodiment, the metal interface  410  is a ferrous metal that is configured to magnetically couple with a magnet that is provided inside of the head  364  of the delivery device  354  ( FIG. 11 ). 
         [0075]    The introducer band  402  is malleable and configured to conform around a finger of the surgeon. In one example, the introducer band  402  is fabricated from a malleable sheet of metal that is over molded with a plastic coating, such as a core of 3003 series aluminum that is over molded with silicone. 
         [0076]    When the introducer band  402  is donned, the pad P of the finger F is exposed and available for palpating tissue to locate a desired landmark within a patient. Thereafter, the surgeon magnetically attaches the head  364  of the delivery device  354  ( FIG. 11 ) to the metal interface  410  of the introducer band  402 , and using the finger F, digitally delivers the head  364  to the landmark. 
         [0077]      FIG. 15  is a perspective view of another embodiment of an introducer band  422  attached to the head  364  of the delivery device  354  ( FIG. 11 ). In one embodiment, the introducer band  422  includes a belt  424  having a buckle end  426 , a free end  428 , and a buckle  430  configured to selectively engage the free end  428  of the belt  424 . In one embodiment, an exterior surface  432  of the belt  424  includes engagement recesses  434  that allow the buckle  430  to adjustably engage the belt  424  around a finger of the user. In one embodiment, the belt  424  is fabricated from plastic and the buckle  430  moves about a pin  436 . 
         [0078]    During use, the surgeon will use a finger to palpate a desired landmark within a patient prior to donning the introducer band  422 . Thereafter, the band  422  is attached to the finger to allow the finger to guide the head  364  of the delivery device  354  ( FIG. 11 ) directly to the identified landmark. In one embodiment, the introducer band  422  is attached to the surgeon&#39;s finger and the surgeon subsequently uses the finger to palpate a desired landmark within a patient. 
         [0079]      FIG. 16  is a perspective view of another embodiment of an introducer band  442  attached to the head  364  of the delivery device  354  ( FIG. 11 ). In one embodiment, the introducer band  442  includes a shell  444  that is sized to receive the head  364  and a belt  446  that slides between two opposed flanges  448 ,  450  to form a finger slot  451 . In one embodiment, a belt stop  452  is provided that includes a post  454  that slides within an angled slot  456  to allow the selective adjustment of the belt  446  around the finger F. The belt stop  452  is configured to prevent the band  446  from sliding through the flange  450 , which would undesirably result in the finger slot  451  expanding after it is had been sized to fit around the finger of the surgeon. 
         [0080]      FIG. 17  is a perspective view of another embodiment of an introducer band  462  attached to the head  364  of the delivery device  354  ( FIG. 11 ). In one embodiment, the introducer band  462  is integral with the head  364 . An adjustable finger slot  463  is provided by a belt  464  that is formed to extend from a base of the delivery head  364  and terminate at an adjustable engagement slide  466 . In one embodiment, the belt  464  includes a pressure platform  468  that allows the belt  464  to be adjusted by movement of one end  470  of the belt  464  relative to the engagement slide  466 . In one embodiment, the engagement slide  466  is provided with a saw tooth pattern that is configured to mesh with saw teeth provided on the end  470  of the belt  464  to provide an adjustable and removable locking mechanism. Alternatively, the engagement slide  466  is provided with a hook-and-loop form of adjustable attachment. In one embodiment, the introducer band  462  is integrally formed as a complement of the delivery head  364 . 
         [0081]    Embodiments of digital suture fixation systems have been described that include a digital introducer that is attachable to a finger to guide an anchor delivery device intracorporeally to a patient. The introducer is attachable to the finger in one of a variety of approaches, include attachment bands, magnetic attachment mechanisms, finger cots, attachment strands such as zip tie style strands, etc. The introducer is configured to allow the finger to palpate and identify a landmark within a patient and the delivery device is configured to insert an anchor or a suture attached to an anchor or capsule into the landmark. Thus, accurate placement of the anchor/suture is provided even if the landmark is not visible to the surgeon. 
         [0082]    Although specific embodiments have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that a variety of alternate and/or equivalent implementations may be substituted for the specific embodiments shown and described without departing from the scope of the present invention. This application is intended to cover any adaptations or variations of medical devices as discussed herein. Therefore, it is intended that this invention be limited only by the claims and the equivalents thereof. 
       EMBODIMENTS 
       [0083]    1. A suture fixation system comprising:
       a suture assembly comprising an anchor;   an introducer that is attachable to a finger of a person, the introducer comprising a platform attached to an exterior of the introducer and a zip line attached to the platform; and   a delivery device movable along the zip line and configured to removably retain the anchor;   wherein the introducer allows the finger to identify a target landmark within a patient and the delivery device is movable along the zip line and attachable to the platform to position the anchor for insertion to the target landmark.       
 
         [0088]    2. The suture fixation system of embodiment 1, wherein the anchor is a tissue penetrating anchor comprising a tissue penetrating barb extending from a flange and the suture assembly comprises a suture line connected to the flange. 
         [0089]    3. The suture fixation system of embodiment 1, wherein the target landmark is an intracorporeal landmark and the zip line extends from the intracorporeal landmark to a location outside of the patient. 
         [0090]    4. The suture fixation system of embodiment 1, wherein the delivery device comprises a car defining a channel that is configured to couple to the zip line. 
         [0091]    5. The suture fixation system of embodiment 4, wherein the car defines a port sized to enclose the anchor. 
         [0092]    6. The suture fixation system of embodiment 5, wherein the delivery device comprises a cable having a distal end attachable to the car and a rod disposed in the cable. 
         [0093]    7. The suture fixation system of embodiment 6, wherein the rod is movable within the cable to axially eject the anchor from the port. 
         [0094]    8. The suture fixation system of embodiment 1, wherein the introducer comprises a finger cot attachable to a distal tip of the finger, the platform attached to an exterior of the finger cot. 
         [0095]    9. The suture fixation system of embodiment 8, wherein the finger cot defines a window sized to allow the distal tip of the finger to touch the target landmark, the platform located proximal the window. 
         [0096]    10. A digital suture fixation system comprising:
       a suture assembly comprising an anchor;   an introducer that is attachable to a finger of a person and configured to allow a distal tip of the finger to identify an intracorporeal landmark within a patient;   a delivery device separable from the introducer that is configured to retain the anchor;   means for guiding the delivery device from a location exterior the patient to the introducer disposed at the intracorporeal landmark; and   means for securing the delivery device to the introducer disposed at the intracorporeal landmark.       
 
         [0102]    11. The digital suture fixation system of embodiment 10, wherein the introducer comprises a zip line that is configured to trail from the introducer placed at the intracorporeal landmark to the location exterior the patient. 
         [0103]    12. The digital suture fixation system of embodiment 11, wherein the delivery device is a car that is movable along the zip line from the location exterior the patient to a platform attached to the introducer. 
         [0104]    13. The digital suture fixation system of embodiment 10, further comprising:
       means for ejecting the anchor from the delivery device.       
 
         [0106]    14. A digital suture fixation system comprising:
       a suture line coupled to an anchor;   an introducer comprising a band attachable around a finger;   a delivery device comprising an anchor housing attached to an exterior of the band such that a distal tip of the finger is exposed, the housing configured to enclose the anchor; and   a cable having a distal end that is insertable into the anchor housing, a rod disposed in the cable and attachable to the anchor, and a proximal end having a trigger that communicates with the rod;   wherein the delivery device is movable relative to the band and the rod is movable to eject the anchor from the anchor housing.       
 
         [0112]    15. The digital suture fixation system of embodiment 14, further comprising:
       a position marker comprising a distal surface opposite a proximal surface, a slot formed in a side of the position marker between the distal surface and the proximal surface, and an access hole formed in the proximal surface;   wherein the slot is configured to be engaged with a ligament of the patient and the access hole is configured to receive an anchor exit port of the anchor housing to align placement of the anchor with the landmark.       
 
         [0115]    16. The digital suture fixation system of embodiment 14, wherein the distal end of the cable is configured to be rotated in a first direction into engagement with the anchor and rotated in a second direction different than the first direction out of engagement with the anchor. 
         [0116]    17. The digital suture fixation system of embodiment 14, wherein the band is a stationary band attached around a proximal portion of the finger and the delivery device is movable in a distal direction toward the distal tip of the finger. 
         [0117]    18. A digital suture fixation system comprising:
       a suture line coupled to a capsule;   a delivery device comprising a handle having an actuator, a shaft coupled to the handle, and a head coupled to the shaft; and   a band attached to the head, the band attachable to a finger to allow the finger to direct the head to an intracorporeal landmark;   wherein the head comprises a proximal portion housing a needle and a distal end spaced apart from the proximal portion by a throat, the distal end defining a cavity sized to maintain the capsule, the actuator configured to move the needle across the throat to engage the capsule disposed in the cavity.       
 
         [0122]    19. The digital suture fixation system of embodiment 18, wherein the band comprises a metal interface and the head comprises a magnet configured to couple the band to the head. 
         [0123]    20. The digital suture fixation system of embodiment 18, wherein the band is length-adjustable to fit around the finger. 
         [0124]    21. The digital suture fixation system of embodiment 20, wherein the band comprises a buckle and an exterior surface of the band includes engagement recesses that allow the buckle to selectively engage the band for adjustment of the band around the finger.