Abstract:
The present invention relates generally to continue driver device with changeable parameters, more specifically, continues driver with changeable parameters used in surgical procedure such as suturing, wherein said continues driver device is employed in as continuous suture rotational needle driver which enhances the tissue suturing procedure, particularly the one performed on restricted, deep and less accessible locations. The device incorporates a plurality of interactive portion comprising several extended member wherein in said extended members are provided with rotational needle driving points at a distal end into a single device and is operated by the twist of a single knob. The use of the mechanism prevents problems associated with loss of needle control during the suturing procedure as well as the ones associated with the handedness of existing needle drivers.

Description:
RELATED APPLICATIONS 
       [0001]    N/A 
       BACKGROUND OF INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present invention relates generally to a continuous driver device with changeable parameters, more specifically, to a continuous driver with changeable parameters to be used in surgical procedure such as suturing, wherein said continuous driver device is employed in a continuous suture rotational needle driver which enhances the tissue suturing procedure. The device incorporates a plurality of interactive portions into a single device, each portion comprising several extended members wherein in said extended members are provided with rotational needle driving points at a distal end, and is wherein the device is operated by a actuator mechanism. The use of the mechanism prevents problems associated with loss of needle control during the suturing procedure as well as the ones associated with the handedness of existing needle drivers. It also enhances the control a surgeon has over the suturing needle by positioning a plurality of needle driving points at premeditated locations such that the needle will be driven by the device in a circular movement about the wound thus simplifying the steps to complete the suturing cycle. The needle driving system greatly simplifies the suturing procedure by combining the steps of the suturing procedure into a continuous cycle. 
         [0004]    2. BACKGROUND OF THE INVENTION 
         [0005]    Surgical procedures have proliferated among the medical practice as new treatments are developed to effectively treat common and extraordinary conditions. The spectrum of invasiveness goes from simple tissue suturing of small open wounds to complicated procedures as those performed in vascular or neurological surgeries. It is undoubted that each and every step on any surgical procedure is of great importance and could cause negative consequences for the patient if it is inadequately performed. The suturing procedure, in particular, could end in serious consequences for the patient if negligently conducted, causing damages to adjacent tissues or even organs. 
         [0006]    It is known that the suturing procedure consumes a considerable amount of time of the surgical treatment. Simplification of the suturing procedure by developing more effective suturing devices will reduce the time spent on that task and at the same time will reduce the risk of negative consequences arising from damages caused to adjacent tissues or organs. 
         [0007]    With the increasing cost of healthcare, a new device and procedure are needed to simplify the suturing procedure and reduce the time required for the process, without sacrificing the quality and precision required for delicate sutures. There is also the need to reduce time and costs to create sutures when a large amount of patients need treatment. In times of war, natural disasters, or large-scale accidents, among others, there is a need to increase the speed of the suture procedure. In these cases, complications arise due to the amount of time the patient has to wait for treatment with an open wound. Open wounds are susceptible to infection and could result in serious blood loss. Decreasing the time a patient has to wait with an open wound could save lives in these cases. 
         [0008]    Generally, the instruments used in suturing procedures are the suturing material, the suturing needle and the needle driver. Efforts have been made to reduce the suturing time and to enhance the suturing procedures&#39; safety, but they have been focused on performing modifications to existing needle drivers. 
         [0009]    One of the generally unattended deficiencies of the available needle drivers is the handedness of its designs. Ordinarily, needle drivers are designed to fit right handed users. The locking mechanisms and the direction of the curves at the end of the needle drivers are not designed for use by left-handed users. Thus, left handed users have difficulties performing the suturing procedure. Although some needle drivers are available in left-handed configurations, these have to be purchased separately. The additional purchases, the additional inventory, and the maintenance of the additional inventory further increases the cost involved with surgical and suturing procedures. 
         [0010]    The difficulties encountered by left-handed doctors and hospital personnel increases the risks of negative outcomes for patients from wrong needle driver maneuverings. The latest improvements to suturing devices often fail at their intention of easing the handling of the device for this reason. 
         [0011]    Therefore, it can be appreciated that there exists a prevalent necessity for new and improved suturing devices to perform safer and simplified suturing procedures. In this regard, the present invention substantially fulfills this need. 
         [0012]    The suturing process executed with the needle drivers widely available today consists of a number of steps. These steps include, but are not limited to, grasping the needle with the needle driver, inserting the needle into the tissue, pushing the needle until it reaches the other side of the wound, letting go of the needle, and grasping the needle at the other side. The steps are repeated a number of times, depending on the size of the wound. Each step is susceptible to human error. Completing the cycle is a time-consuming process. There is a need for a procedure that will simplify the steps and shorten the time needed to complete the suturing cycle. 
         [0013]    None of the prior art considered for this invention, taken either simply or in combination teaches the use of multiple needle driving points coupled to a geared mechanism as described above. In light of the foregoing, it will be appreciated that what is needed in the art is a suturing device capable of completing the suturing procedure in a simplified manner without the need of multiple devices. 
       SUMMARY OF THE INVENTION 
       [0014]    The present invention overcomes the disadvantages of existing suture devices mentioned above by providing a device comprising interactive portions, a circumference adjuster, a locking mechanism, a rotational system, a linear motion system and a sequence control system. 
         [0015]    Each interactive portion comprises several extended bodies, wherein each extended body comprises a distal end a proximal end and a main body, wherein said main body is located between said distal and proximal ends as one completed structure. Said interactive portion comprises action means to perform suturing, grasping, cutting, pushing and other motions wherein said action means comprises the distal end of a first extended body in combination with the distal end of a second extended body to perform an action over several materials including but not limited to, tissues, textiles and/or wires. 
         [0016]    In the present invention the interactive portion is capable of shifting in more than one direction and/or performing several movements. For example, at least one extended body of the interactive portion rotates upon itself or/and move linearly to perform a task such as grasping or cutting and/or transfer for one position to another in order to modify distance between the interactive portions. 
         [0017]    In order to achieve the movement of said interactive portions each interactive portion is coupled and mechanically connected to a system that provides at least one of the desired motions. In the instance case the circumference adjuster, rotational system and linear motion systems are mechanically connected to interactive portion. 
         [0018]    The circumference adjuster comprises circumference changing means to change the distance between the interactive portions by angular displacement and/or linear motion of the interactive portions, wherein said circumference changing means comprises gears, bearings and circumference change actuators. Further, the device comprises a locking mechanism in order to lock or hold the interactive portions at a preferred circumference. 
         [0019]    The rotational system comprises rotational motion means to rotate at least one extended body of the interactive portion upon itself, wherein said rotational motion means comprises a rotational motion actuator mechanically connected to several gears with different ratios in order to achieve a desired rotation at said interactive portion. 
         [0020]    The linear motion system comprises linear motion means to provide a desired linear motion at least one of the distal ends of each interactive portion to, open close or compress said interactive portion. Said linear motion means comprises a linear motion actuator connected to several elements, including but not limited to, gears with a particular ratio and resilient material. The linear motion system is preferred to execute the linear motion for a specific time at each interactive portion. Therefore the linear motion system is designed to comprise a linear movement sequence control, wherein linear movement sequence control uses part of the linear motion means elements. 
         [0021]    The present invention achieves the combination of several systems in a single apparatus wherein several interactive portions are provided with changeable circumference properties wherein at the same time the apparatus provides distal ends with linear sequence control movement and/or a rotational movement in order to facilitate and efficiently speed up several procedures such as suturing, grasping, cutting, wiring and other procedures that interact with a material such as but not limit to tissues, textile, wires and others. 
         [0022]    As an example, the present embodiments make use of the present invention to provide an effective suturing device that enhances the maneuvering and safety of suturing procedures, as well as decreasing the time required to complete a suturing procedure. 
         [0023]    The disclosed embodiments consist of a suturing device that comprises a plurality of interactive portion comprising extended members wherein each extended member includes a distal end include action means, such as needle driving points at a distal end of the of the extended members, wherein each extended member is adequately placed such that the needle&#39;s movement through the driving points completes one cycle of the suturing procedure. Each interactive portion comprises two rods as extended member that will rotate in opposite directions. The needle will be held between the rods and will be driven by the rotation of the rods. Prior to the release from the starting needle driving point, the needle will be inserted between the next needle driving point in the cycle. As the motion continues, the needle is released from the starting point and movement is driven by the next point. Further before release from the next point, the needle will be grasped by the following point, and so forth as part of the sequence control. 
         [0024]    The needle driving points are located around a circumference that can be adapted to fit the curvature of a particular needle. With this feature, a single device can be used for a wide range of wound types and sizes, from small wounds resulting from endoscopic procedures to large wounds resulting from accidents or invasive surgery. 
         [0025]    The device is driven by several elements such as geared mechanism that will rotate the rods and move the needle across the cycle. The mechanism includes but is not limited to a linear motion system comprising a cam system that will increase or decrease the pressure between the rods at different points within the cycle, such that the rods tighten or release the needle as required as part of the sequence control. 
         [0026]    The use of several elements, such as a geared mechanism, provides the desired motion at the interactive portions and at the same time the present arrangement simplifies the use of the device. The device comprises several actuators to transfer a rotational, turning or spinning motion into a desired change in the apparatus parameter. For example a knob turned by the user is coupled to a main gear which controls the rotation of the driven rods. The slave rods are controlled by the rotation of the driven rods. The rotation of the needle is controlled by the rotation of the driven and slave rods. The cam system is also controlled by the rotation of the knob. In conclusion, the functionality of the entire system is controlled by the rotation of a single knob. The suturing procedure is in turn greatly simplified. 
         [0027]    By achieving a simplified design that will complete the steps of a suturing cycle with the twist of single knob, the invention provides a number of possibilities for further development. The advances in medical technology are moving towards machine-powered automatic devices which increase the precision and decrease the risk of human error. The simplicity of the proposed invention can easily be coupled with machines of this kind. 
         [0028]    Additional applications associated with the proposed invention, such as sewing, crafts and electronics, also benefit from the simplicity of the device and its capability to be coupled with automatic machines. 
         [0029]    The device has been designed for convenient use of right and left-handed users. The need for a reduced number of suturing devices and the increased speed of the suturing procedure will no doubt have a positive impact in the cost of surgical and emergency room procedures. 
         [0030]    Therefore one of objects of the present invention is to provide a continuous driver with changeable parameters to be used in surgical procedure such as suturing, wherein said continuous driver device is employed in a continuous suture rotational needle driver which enhances the tissue suturing procedures. 
         [0031]    Another object of the present invention is to provide a surgical suturing device that eases the suturing procedure. 
         [0032]    Another object of the present invention is to provide a surgical suturing device that reduces cost of surgical and emergency room procedures. 
         [0033]    Another object of the invention is to provide a device that will complete an entire suturing cycle with one simple motion without the need to reposition the needle. 
         [0034]    Another object of the present invention is to provide a device designed for convenient use of right and left-handed users. 
         [0035]    Yet another object of the present invention is to provide a device wherein the change in parameters is controlled by at least one actuator located at a comfortable position for the hand and/or thumb for a simple driven action. 
         [0036]    Furthermore, the present invention overcomes the inability of the prior art to foresee the need of an ergonomic suturing needle driver that permits left and right handed users to performed safe suturing procedures. The present apparatus is intended to provide an ergonomic suturing device comprising: (i) a plurality of needle driving points located in premeditated positions such that movement of the needle through the points completes one cycle of the suturing procedure; and (ii) a geared mechanism that allows the suturing procedure to be executed with the rotation of a single knob. 
         [0037]    The system of the invention itself, both as to its configuration and its mode of operation will be best understood, and additional objects and advantages thereof will become apparent, by the following detailed description of a preferred embodiment taken in conjunction with the accompanying drawing. 
         [0038]    When the word “invention” is used in this specification, the word “invention” includes “inventions”, that is, the plural of “invention”. By stating “invention”, the Applicant does not in any way admit that the present application does not include more the one patentable and non-obviously distinct invention and Applicant maintains that the present application may include more than one patentable and non-obviously distinct invention. The Applicant hereby asserts, that the disclosure of the present application may include more than one invention, and, in the event that there is more than one invention, that these inventions may be patentable and non-obvious one with respect to the other. 
         [0039]    Further, the purpose of the accompanying abstract is to enable the U.S. Patent and Trademark Office and the public generally, and especially the scientists, engineers, and practitioners in the art who are not familiar with patent or legal terms or phraseology, to determine quickly from a cursory inspection the nature and essence of the technical disclosure of the application. The abstract is neither intended to define the invention of the application, which is measured by the claims, nor is it intended to be limiting as to the scope of the invention in any way. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0040]      FIG. 1  shows a first embodiment employing a continuous driver device with changeable parameters. 
           [0041]      FIGS. 2A-2D  shows the first embodiment circumference adjuster components. 
           [0042]      FIGS. 3A-3F  shows first embodiment rotational system components 
           [0043]      FIG. 4  shows the first embodiment&#39;s locking system components 
           [0044]      FIGS. 5A-5B  shows the first embodiment&#39;s frame 
           [0045]      FIGS. 6A-6C  shows the first embodiment&#39;s interactive portion attached to a frame and first distal end components. 
           [0046]      FIG. 7  shows part of the first embodiment&#39;s linear motion system 
           [0047]      FIG. 8  shows part of the first embodiment&#39;s linear motion system with contact distal end adjustment mechanism. 
           [0048]      FIGS. 9A-9C  shows the first embodiment&#39;s sequence control mechanism. 
           [0049]      FIG. 10  shows a second embodiment employing a continuous driver device with changeable parameters. 
           [0050]      FIG. 11  shows part of the second embodiment circumference adjuster components. 
           [0051]      FIG. 12  shows a top view of the second embodiment circumference adjuster components. 
           [0052]      FIG. 13  shows part of the second embodiment&#39;s rotational system components 
           [0053]      FIG. 14  shows a top view of the second embodiment&#39;s rotational system components 
           [0054]      FIG. 15  shows a side view of the second embodiment&#39;s rotational system components 
           [0055]      FIG. 16  shows part of the second embodiment single way circumference adjuster components in combination with elements of the second embodiment&#39;s rotational system components. 
           [0056]      FIGS. 17A-17C  shows part of the second embodiment two way circumference adjuster components 
           [0057]      FIGS. 18A-18C  shows the second embodiment extended member housing 
           [0058]      FIGS. 19A-19F  shows the second embodiment&#39;s linear motion system. 
           [0059]      FIGS. 20A-20C  shows parts of the second embodiment&#39;s linear motion system with a first contact distal end adjustment mechanism. 
           [0060]      FIGS. 21A-21B  shows parts of the second embodiment&#39;s linear motion system with a second contact distal end adjustment mechanism. 
           [0061]      FIG. 22  shows parts of the second embodiment&#39;s linear motion system with a rearrangement of distal end for second contact distal end adjustment mechanism. 
           [0062]      FIGS. 23A-23B  shows a third embodiment employing a continuous driver device with changeable parameters. 
           [0063]      FIGS. 24A-24F  shows the third embodiment interchangeable box with several elements from different sub systems. 
           [0064]      FIGS. 25A-25C  shows the third embodiment interchangeable box with several elements from different sub systems coupled to the rotational system main gear. 
           [0065]      FIGS. 26A-26B  shows the third embodiment actuator rearrangement in combination with the interchangeable boxes. 
           [0066]      FIGS. 27A-27C  shows the third embodiment housing top view and several resilient material arrangements. 
           [0067]      FIGS. 28A-28B  shows part of the third embodiment linear motion system with a contact distal end adjustment mechanism. 
           [0068]      FIGS. 29A-29B  shows part of the third embodiment rotational system in combination with the linear motion system. 
           [0069]      FIG. 30  shows part of the third embodiment circumference adjuster components. 
           [0070]      FIG. 31  shows a continuous driver device with changeable parameters in housing. 
           [0071]      FIG. 32  shows a continuous driver device with changeable parameters coupled to a non-human motion control system with a control unit. 
           [0072]      FIGS. 33A-33B  shows a fourth embodiment employing a continuous driver device with changeable parameters comprising electric motors. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0073]      FIG. 1  shows a first embodiment employing a continuous driver device  1  with changeable parameters as suturing device wherein said continuous driver device comprises a interactive portions  2 , a circumference adjuster system  4 , locking mechanism  6 , a rotational system  5 , at least a linear motion system  7 , a sequence control system comprising several linear motion systems  7  mechanically connected, and a housing H 1  comprising a frame  3 . All element or part are made by different material wherein said material are selected depending on the field the device is going to be employed. 
         [0074]    For example, employing the continuous driver  1  as a suturing device requires at least a needle grasping action combined rotational motion in order to produce a continuous circumferential motion of the needle during the suturing procedure. The translation of the needle  11  during continuous circumferential motion is limited to a particular radius, wherein said particular or preferred radius depend most of the time of the wound to be sutured. The first embodiment, as mentioned before, comprises a circumference adjuster  4 , as shown in  FIGS. 2A-2D , wherein said circumference adjuster fulfill the purpose providing a desired radius subject to a radius displacement of the needle  11 . 
         [0075]    The circumference adjuster system for the first embodiment, as shown in  FIG. 2A-FIG .  2 D, comprises a shaft, such as central rod  4   b,  wherein said central rod  4   b  comprises two distal ends, wherein the first distal end comprises an expandable member or pivoting legs  4   a  and at the second distal end comprises locking means  6 . Each pivoting leg, as shown in  FIG. 1 , contacts said interactive portion  2  maintaining a constant distance between said interactive portions  2 . The connection between the interactive portion  2  and the pivoting leg  4   a  is accomplished by a rotational holder  2   c.  Each rotational holder  2   c  comprises a bearing means, such that the part of the interactive portion  2  can rotate within it. The second distal end of the central rod  4   b,  comprises locking means  6  as mentioned before wherein said locking means  6  comprises a platform  6   b.  The locking means  6  also serves as the circumference adjuster actuator wherein said device circumference is increased by pushing said platform  6   b  forward. In other words pushing the central rod  4   b  forward causes the pivoting legs to push the interactive portions  2  outward. In order to control the displacement and/or to fix the circumference at a desired radius the platform  6   b  comprises extended pieces having hooks shapes  6   a  that interact with another portion of the locking system located at the static structure or frame  3 . 
         [0076]    Further the central rod  4   b  is assembled to be slipped along the center axis of the device, within the hollow central shaft  5   b  of the rotational system which is discussed below. It is important to understand that the circumference adjuster is provided, as mentioned before, to increase or decrease the needle  11  radial circumferential motion in order to make available changes in the needle and/or the wound to be sutured. 
         [0077]    The circumferential motion of the interactive portions is achieved while providing rotational motion at the interactive portions  2 . The first embodiment makes use of a rotational system to perform said rotational motion wanted at the interactive portion  2 . The rotational system for the first embodiment comprises a main gear  5   a  driven by a central shaft  5   b.  The central shaft  5   b  comprises a hollow cylinder positioned about the central axis of the device. The central shaft is  5   b  positioned within the frame  3  and include a portion of the locking systems at a distal end. It is important to understand that the central shaft  5   b  is mechanically connected to the supporting plate  6   c  of the locking system  6  by means of a bearing, wherein said central shaft  5   b  rotates free about its axis without transferring the rotation to the frame. In addition the central shaft  5   b  is equipped with a rotational actuator such as a turning knob  5   c  comprising a rugged outer layer on the central shaft  5   b.  The turning knob  5   c  allows the user to apply a rotational motion to the device  1  with his or her fingers. The supporting plate  6   c  further comprises engaging protrusions  6   f  extended away from the rotational system  5  and two structural bars  3   b  attaching said plate  6   c  to the frame  3 . 
         [0078]      FIG. 4  clearly discloses the locking system  6  wherein the platform  6   b  engage the supporting plate  6   c  by means of the protrusions  6   a  and said engaging protrusions  6   f,  wherein said extended pieces having hooks shapes  6   a  mechanically connects and fixes the circumference system  4  to the central shaft  5   b.    
         [0079]    The frame, as shown in  FIGS. 5A-5B , comprise the central plate  3   a,  a supporting plate  6   c,  and two structural bars  3   b  attaching said plates. The central plate  3   a,  as shown in  FIG. 5   a , is shaped to be a flat cylindrical portion with a concentric hole. The plate  3   a  serves as a support for the interactive portions  2 , wherein said central plates comprises pivoting ends  30  for the rods  20 , 21  movement in the event a change in the circumference is desired. It has to be understood that the pivoting end  30  works in combination with the circumference adjuster  3  to provide the desired circumference or distance between the interactive portions  2 . The supporting plate  6   c  is rigidly connected to the central plate  3   a  by means of the two structural bars  3   b.    
         [0080]      FIGS. 6A-6C  discloses the interactive portion  2 , wherein said interactive portion  2  comprises extended members, such as rods  20 ,  21  wherein each rod has a main body with a first distal end  2   a  at one extreme of said rods  20 ,  21  and a second distal end at the other extreme of said rods  20 ,  21 . The first embodiment comprises a first extended member  20  and a second extended member  21 , wherein the first extended member  20  works as a driven rod and the second extended member  21  works as a slave rod. The first extended member  20  transfers the rotational motion from the rotational system  5  toward the distal end  2   a.  The first extended end achieves the transferring of rotational motion by comprising a first distal end, a second distal end and a main body, wherein the main body in shaped to have linkages (“teeth” or “cogs”) that mesh with other gear teeth, such as the main gear  5   a,  allowing the rotational force from said main gear  5   a  be transferred to the first distal end. In the instance case the main body has different ratio at the same main body, as shown in  FIG. 5   b , in order to vary revolutions. As mentioned before a rotation holder  2   c  is connected to the rod  20 . 
         [0081]      FIGS. 6A-6B  is more directed to the grasping needle action at the first embodiment distal end structure. The first embodiment, as mentioned, applies the grasping action at the interactive portion, more specifically at a distal end  2   a  of the interactive portion  2 . Each contact distal end  2   a  comprises a driven rod  20 , a slave rod  21 , and a linear motion mechanism  23  to open or close each end as needed. The driven rod  20  and slave rods  21  are obliquely positioned coming into contact at their respective distal ends having fluted surface creating a needle-grasping portion or contact distal end  28 , around each rod surface for better positioning of the needle  11 . It is important to understand that the use of obliquely positioned rods provide a better control of the portion to be press contrary to parallel rods, wherein the area where the force is applied is bigger and therefore the contacting point of force is transmitted or distributed over the whole contacting surface. 
         [0082]    The distance between the axis of the device and each end of the driven rods  20  is identical. That is, all the driven rods  20  lie on a common circumference. Each slave rod  21  is positioned on the same radial line as the driven rod  20 , forming a separate circumference outside the first. The needle  11  is moved by the force created by the rotation of the driven and slave rods  20 ,  21  against each other. The needle  11  will follow a line tangent to the outer edge of the driven rod  20  and the inner edge of the slave rod  21 . With the driven rods  20  forming a circumference within the circumference of the slave rods  21 , the trajectory of the needle  11  follows the circumference created by the points between the driven rod  20  and slave rod  21 . 
         [0083]    The linear motion mechanism  23 , as shown in  FIGS. 6A-6C , is located at the interactive portion distal end  2   a.  The linear motion mechanism, as shown in  FIGS. 7-8 , controls the grasping force exerted over the needle  11  and the linear motion at the contact distal end  28 . The linear motion mechanism  23  comprises a torsion spring  25  that maintains the contact distal end  2   a  in a normally closed position. On the other hand the cam  22  is designed to open the contact distal end  2   a  at a particular distance for a particular length of a cycle. The driven rod  20 , as mentioned before, transfers the rotating motion to a first gear  26 . The first gear  26  consequently transfers the rotation to a second gear  27 , which is coupled to the cam  22 . As the cam  22  rotates, the driven rod  20  and slave rods comes into contact with a cam  22 . During the cam  22  rotations the slave rod  21  will be pushed outward by the cam  22  opening the contact distal end  2   a,  or pushed inward by the torsion in the spring  25  creating a linear motion of the distal end  2   a.    
         [0084]    The cam  22  is designed to open the contact distal end  2   a  a particular distance for a particular length of the cycle. The spring  25  comprises a torsion spring that will maintain the contact distal end  2   a  in a normally closed position. The driven rod  20  will rotate, transferring the rotating motion to a first gear  26 . The first gear  26  will transfer the rotation to a second gear  27 , which is in turn coupled to the cam  22 . As the cam  22  rotates, the slave rod  21  will be pushed outward by the cam  22  opening the contact distal end  2   a,  or pushed inward by the torsion in the spring  25 . 
         [0085]      FIGS. 9A-9C  shows the first embodiment comprising a sequence control system wherein said sequence control system comprises several linear motion mechanisms  23  located at all the interactive portions distal end  2   a.  The cam  22  of each contact distal end  2   a  is out of phase with one another in order to provide an opening sequence at the distal end  2   a.    FIG. 9C  shows an example of a possible positioning scheme for a device comprising three contact distal ends  2   a.  The contact distal end  2   a  will be at the tightest position when said end is holding a needle  11 , as shown in  FIG. 9B . The end located in the next point in the needle&#39;s trajectory will open slightly to allow the needle  11  to comfortably enter the gap between the slave and driven rods  20 ,  21 . As the needle  11  moves through the cycle, the contact distal ends  2   a  open or close as required. 
         [0086]    It has to be understood that the length of the device may vary depending on the use. For example, a shorter device may be used by a healthcare professional suturing an open wound while longer bars could be used for devices used in laparoscopic surgeries or other uses where the wound is hard to reach. The first embodiment shows a cross-section of the central plate  3   a  wherein the structural bars  3   b  are shown having a rectangular cross-section. However, that any shape, number or variation of the structural bars here described is not beyond the scope of the invention. Further the gear ratio in the device may vary depending on the desired velocity needed, control of the needle and purpose. However, independently of gear ratio the rotation of the needle  11  around the circumference creates a suture. 
         [0087]      FIG. 10  shows a second embodiment employing a continuous driver device  1 ″ with changeable parameters as suturing device wherein said continuous driver device comprises a interactive portions  2 ″, a circumference adjustment mechanism  3 ′ which includes a locking mechanism, a rotational system  5 ′, at least a linear motion system  7 , a sequence control system mechanically connected rotational system  5 ′, and a housing H 2  enclosing several part of the second embodiment. 
         [0088]    Similarly to the first embodiment 1, the device of the second embodiment 1′ comprises a plurality of interactive parts  2 ″, wherein said interactive portion comprises several extended members each with a contact distal end  2   a ′. Also the suture is created by rotating a needle  11  about a circumference by a number of interactive parts  2 ′, each comprising a driven rod  200 , a slave rod  210 , and a contact distal end  2   a ′. A unified gear mechanism will provide rotation to the driven and slave rods  200 ,  210  and therefore to the needle  11 . 
         [0089]    The circumference adjustment mechanism  3 ′, as shown in  FIGS. 11-17  comprises a circumference change actuator  300   a  comprising a quasi-circular platform, several pivoting leg  300   b  connected to each of the interactive actuators  2 ′, more particularly to each interactive portion housing  2000 , an circumference actuator  31   a,  and a locking mechanism presented more in detail in  FIGS. 13-17 . 
         [0090]      FIG. 12  shows a top view of the circumference change actuator  300   a  comprising the quasi-circular platform  300   a  with three pivoting legs  300   b,  wherein said pivoting legs are attached to the platform  300   a  by pivoting means  300   c  inside a platform groove  300   c.  The platform groove  300   c  of the quasi-circular platform  300   a  is removed at the base of each pivoting leg  30   b  to allow the leg  30   b  to pivot from a radial position to a position parallel to the tangent of the circle. The circumference will be largest when the legs  300   b  are positioned in the radial position and smallest when the legs are positioned in a tangential position. The handle  31   a  is rigidly fastened by connection means  31   b,  such as a rod to the quasi-circular platform  300   a.    
         [0091]    The pivoting legs  300   b  of the circumference change actuator  300   a  are attached to the rod housing  2000 . Therefore as the circumference change actuator  300   a  rotates counterclockwise the circumference decreases and the rod housing  2000  is pulled inward. 
         [0092]      FIGS. 13-17  shows the circumference adjustment mechanism  3 ′ including a locking mechanism in order to maintain the desired circumference for the device  1 ′.  FIG. 13  shows a second embodiment wherein the interactive housing  2000  is mechanically coupled to single way circumference adjuster including a locking mechanism and to the rotational system by means of the main gear  5   a.    FIG. 14  shows the rotational system  5 ″ couple to the circumference adjuster  8  including a locking mechanism by means of the main gear  5   a.    FIG. 15  is directed to show the non-rotational plate  5   e  which is connected to the frame or housing H 2  to support part circumference adjustment mechanism gears  8 . The rotational system extension  5   b ′ passes through said non-rotational plate  5   e  in order to contact the main gear  5   a.    
         [0093]      FIG. 16  shows the circumference adjustment mechanism gears  8  comprising a secondary gears  8   a,  a third gear  8   b  coupled to a rotation distal end gear  8   e,  a movable body  8   c  and a movable attachment  2005 . The second gear  8   a  comprises a hollow body, wherein said hollow body comprises inner hooks  80  at the inner surface of the hollow body and a resilient material  8   d  placed inside said hollow body. The movable body  8   c  comprises at least two distal ends and a movable main body. One of the distal end is attached to the movable attachment  2005  in such way that the movable attachment  2005  controls the moveable body displacement in the direction parallel to the interactive housing  2000  but said moveable body  8   c  rotates freely on it one axis. The third gear  8   b  is attached to the movable main body in such way that the movable main body controls the rotation of said third gear  8   b.  The other movable body  8   c  distal end comprises hooks  81  that are combined with hollow body inner hooks  80  to lock the interactive portions  2 ″ at a desired circumference. 
         [0094]    During the process to adjust the second embodiment circumference the circumference actuator  31   a  is rotated counterclockwise. The turning action of the circumference actuator  31   a  is transferred to the circumference change actuator  300   a  resulting in the inward pulling action on the interactive housing  2000 . Due to the arrangement between the hooks  81  and hollow body inner hooks  80  the no force is exerted on the second gear  8   a  resulting in a mere displacement of the housing and a difference in housing  2000  radius with respect to the center of the device  1 ′. It has to be understood that the resilient material, which may be attached to the moveable body  8   c,  keeps the hooks  81  and hollow body inner hooks  80  aligned. However if the movable attachment  2005  is pushed toward the second gear  8   a,  for example as the result of a force applied at the circumference change actuator  300   a,  no contact is exerted between the second gear and the moveable body. Without contacting each other there is no restraining force between the second gear  8   a  and the moveable body  8   c  and consequently the resilient material pulls the interactive housing  2000  to its starting point. 
         [0095]      FIGS. 17A-17C  discloses the circumference adjustment mechanism gears  8  comprising a circumferential controlled system for increasing or decreasing the interactive housing radius with respect to the device center  1 ′. The increment or decrement in the interactive housing radius is due to the vertical displacement of the movable attachment  2005  (pushing or pulling toward the second gear  8   a ) as the result of a force applied at the circumference change actuator  300   a.  The vertical movement or vertical displacement of the moveable attachment  2005  engages one distal end inner hooks  80  of the moveable body  8   c ′ with a surface comprising hooks  81  instead of releasing the moveable body from a restraining force. Therefore the elastic force provided by the resilient material  8   d,    8   d ′ is limited in both directions. The second embodiment shows circumference adjustment mechanism gears  8 , wherein a pulling action at the circumference change actuator permits one direction movement of the interactive portion housing  2000  and the pushing action permits one direction movement opposed to the pulling action movement of the interactive portion housing  2000 . In other words  FIGS. 17A-17C  discloses a two way displacement gear  8 . In normal condition, wherein normal conditions is defined as no pulling or pushing force applied at the moveable attachment  2005  the interactive housing can only rotates in one direction.  FIG. 17C  shows a moveable body with a groove to attach the moveable attachment  2005 , wherein said moveable attachment permits the moveable body to rotate freely but controls the vertical displacement, as mentioned in  FIG. 16 . Further a cylindrical hollow second body  8   a ′ is fixed to the housing H 2  frame without affecting the circumference movement of the interactive portion housing  2000 . 
         [0096]      FIG. 18  shows in more details the interactive housing  2000 , wherein said housing comprises two extended hollow cylinders having open ends, wherein a first extended cylinder  2002  serves as housing for the slave rod  210  and a second extended cylinder  2001  serves as housing for a driven rod  200 . The first extended cylinder  2002  and the second extended cylinder  2001  are connected by a connecting housing body  2003 , wherein said connecting housing body  2003  maintains a constant distance between the two extended hollow cylinders. The first extended hollow cylinder  2002  comprises several protrusions  2004  and a first resilient material S 1 , wherein said protrusions  2004  are combined with a first resilient material S 1  to assist positioning substantially firmly the slave rod inside said first extended hollow cylinder  2002 . Further the slave rod  210  comprises a proximal ends  211  that assists with the linear displacement of said slave rod  210  which results in the grasping force exerted over the needle  11 . 
         [0097]      FIGS. 19A-19F  shows the second embodiment linear motion system or mechanism, wherein said system provides a platform  7 , wherein the proximal ends  211  of the slave rods  210  comes into contact in order to provide a controls for the grasping force exerted over the needle  11  at the contact distal end. The platform  7  comprises an uneven surface facing the slave rods proximal ends  211 . As mentioned before, the spring S 1  assists to position the slave rod  210  in a particular position, more particularly the position of the slave at the contact distal end  2   a ′. During the assembling of the slave rod  210  and the spring S 1  the user select if the normal position of the contact distal ends  2   a ′ will be open or close. Depending on the selection user combines the assembling with the uneven platform  7  for the linear motion which results in the grasping force exerted over the needle  11 . 
         [0098]    The uneven platform  7  comprises a plurality of bumps  7   a  or grooves  7   b  along its surface in order to interact with the slave rod potion in the first extended hollow cylinder  2002 . For example, when the proximal end  211  of the slave rod  210  comes into contact with the bump  7   a  the slave rod  210  said slave rod  210  is pushed forward tightening the contact distal end  2   a ′. When the proximal end  211  of the slave rod  210  comes into contact with the groove  7   b  the slave rod  210  will be pulled backward releasing the contact distal end  2   a ′. The bumps  7   a  or grooves  7   b  on the uneven platform  7  can be designed to open and close the contact distal ends  2   a ′ sequentially. The tightness of the contact distal ends  2   a ′ and the duration of the opening or closing can all be controlled with the design of the uneven platform  7 .  FIGS. 19C and 19E  show the front views of the bump  7   a  and groove  7   b  on the uneven platform  7 , respectively.  FIGS. 19D and 19F  show the cross-sectional areas of the bump  7   a  and groove  7   b,  respectively. The arrangement of the linear mechanism, more particular the bumps or groves assists with the open and close action at the contact distal end  28  in different points of the suture cycle. The driven rod  200  is not affected by the platform  7  and remains in a fixed position. The slave rods  210  can slide forward or backward with respect to the longitudinal axis of the device  1 ′. As mentioned before, the contact distal end  2   a ′ will tighten when the slave rod  210  is pushed forward. 
         [0099]      FIGS. 20-21  are directed to the distal end arrangement of the slave rod  210  and driven rod  211 .  FIG. 20  shows the driven and slave rods  200 ,  210  are positioned in parallel to the longitudinal axis of the device  1 ′. The slave rod  210  is pivoted near at the contact distal end  2   a ′, such that the ends of slave rods  210  are positioned obliquely with respect to the driven rods  200 .  FIG. 20A  shows the first extended hollow cylinder  2002  comprising a protrusion  2104  extended perpendicular to the slave rod  210  and positioned at the inner surface of said hollow cylinder  2002 . The main purpose of the protrusion is to be combined with the linear movement of the slave rod  210  and increase the grasping force at the contact distal end  28 . A distal end resilient material  2103  is located at the inner surface of said hollow cylinder  2002  substantially facing or at least providing some resistance to the force exerted by the protrusion  2104  over the slave rod  210  when the slave rod is pushed to tightly contact the driven rod at the contact distal end  28 . The third embodiment shows an arrangement that increases the force at the contact distal end when slave rod  210  is pushed toward said contact distal end  28 . The slave rods  200 ,  210  are encased in a rigid housing  2000 , and will remain parallel to the axis at all times. This feature will improve the handling of the needle  11 . 
         [0100]    Further the distal ends  210   a,    200   a  comprises a gear mechanism  9   a,   9   b  that regulates the rotational movement between the slave distal end  210   a  and the driven distal end  200   a  as shown in  FIG. 20B .  FIGS. 20C  shows the assembling of the slave distal end  210   a,  wherein said distal end  210   a  rotates freely on distal end holder  2106 . The inner wall of the slave distal end  210   a  is provided with distal end protrusion  2109  which restrains the non-rotational displacement of the slave distal end  210   a.  The slave distal end  210   a  and the driven distal end  200   a  are detachable and disposable. Using a device with detachable and/or disposable distal ends or interactive portions offers several benefits to the user and the device. For example, if the users need to change the distal end due to changes in needle size a simple change of distal end and/or interactive portion would be enough to continue performing the suturing process without the need of an extra device. 
         [0101]    Similarly to  FIGS. 20A-20C ,  FIGS. 21A-21B  shows a mechanism that increases the grasping force at the contact distal end  28 .  FIG. 21A  shows a grasping mechanism wherein the grasping force at the slave contact distal end  210   a ′ and the driven contact distal end  200   a ′ is enhanced by the slave contact distal end  210   a ′ inner wall R, wherein said inner wall is shaped to move away the slave contact distal end  210   a ′ from the driven contact distal end  200   a ′ when the linear motion at the slave rod is away from the driven contact distal end  200   a ′, as shown in  FIG. 21   b.    
         [0102]      FIG. 22  shows a interactive portion distal end  2   a  wherein the inner wall, as shown in  FIG. 21  is combined with a shaped external structure in order to assist the distal end grasping force. The slave distal end rod  210   a ″ comprises a distal end gear  9   a  at a distal end  210 ″ and a slave circumferential distal end extended body T, wherein said circumferential distal end extended body in combination with a driven circumferential distal end recess D assists the increases the grasping force at the contact distal end  28 . 
         [0103]    The distal ends are made of any selected material capable to perform at least the functions herein mentioned. The selection of the material depends on the field the device is going to be employed. Also the contact distal end  28  is preferred to have a surface that assist the performed action. For example, while using the device in a suturing process is preferred to have a distal end or contact distal end surface cover with a material, such as but not limited to rubber, that provide some friction over the needle in order to keep a constant displacement of said needle. 
         [0104]      FIG. 23A  and  FIG. 23B  discloses a third embodiment for the present invention comprising interactive portions  2 ″, a circumference adjuster system  3 ″, locking mechanism  8 ″, a rotational system  5 ″ similar to the rotational system mentioned for the second embodiment, a linear motion system, a sequence control system and housing H 3 . The main difference between  FIG. 23A and 23B  is the position of the resilient material S 2 , S 3  which is part of the linear motion system. 
         [0105]    Inside said housing H 3  is located an interchangeable box  11  serving as internal housing for several elements from the interactive portion  2 ″ and said circumference adjuster, wherein said interchangeable box is part of the linear motion elements.  FIG. 24A-FIG .  24 F shows the a trapezoidal shaped interchangeable box  11 , as shown in  FIG. 24A  and  FIG. 24B , comprising a hollow body, as shown in  FIG. 24C , wherein said hollow body include several openings  11   a,    11   c  and groves  11   b  providing an angular shapes.  FIG. 25A-FIG .  25 C discloses part of the elements located inside said interchangeable box  11 .  FIG. 25A  discloses part of the interactive portion housing  2000  and therefore part of the extended bodies  200 , 210  inside the interchangeable box  11 . Further the interchangeable box  11 , as clearly shown in  FIGS. 25B-25C , includes several gears  8   a - 8   f  from the circumference adjuster and part of the locking mechanism  80 ,  8   c.  Opening  11   a  provided at one of the interchangeable box  11  allow the access of the main gear  5   a  which is coupled to a rotation movement actuator by mechanical means. The openings  11   c  at the top of the interchangeable box  11  permits the interactive portion  2 ″ to extend away from the interchangeable box  11  outer surface while provides a path for the angular movement of the interactive portion housing  2000 . The grooves  11   c  located at the inner wall of the interchangeable box  11  serve as a path for the angular movement of the interactive portion extended members  210 , 200 . It is important to understand that the interchangeable box may include scissor or grasping ends instead of means for suturing. In such case the interchangeable box is removed to perform an action such as cutting or grasping. 
         [0106]      FIGS. 26A-26B  and  FIGS. 27A-27C  show, is more directed to the combination of the housing, grooves and the linear motion system. It has to be understood the interactive portion are not show for illustration purposes. The housing H 3 , which works together with the linear motion system encloses the interchangeable box  11  which is compressed between a resilient material S 2 ,S 3  and a pressure adjusting system as shown in  FIGS. 26A-26B .  FIG. 27B-FIG .  27 C shows in more details how the resilient material S 2 ,S 3  is positioned inside the housing H 3  with respect to the interchangeable box  11 . It is important to understand that the resilient material has to contact the interchangeable box  11  in order to provide a better control of the linear motion of the interactive portion extended members  210 , 200 . 
         [0107]    The pressure adjusting system comprises a pressure actuator  12  coupled to a pressure adjusting plate  7 ″ having a cylindrical shape, wherein said pressure adjusting plate has a protrusion  70  having a designated shape as shown in  FIG. 28A-FIG .  28 B. In the present case the protrusion has a C shape extending on the adjusting plate surface for approximately 240 degrees. The shape of the protrusion  70  is related to the control of sequence at the linear motion of the interactive portion. Therefore the protrusion shapes vary depending on the number of interactive portion and/or desired sequence motion. 
         [0108]    The pressure adjusting system has a center hole that allows the connection of the rotational actuator  5 ″ with the main gear  5   a  by means of a hollow cylindrical body  50  which provides rotational motion to the interactive portions. As shown in  FIG. 29A  the hollow cylindrical body  50  comprises a threaded portion  51 . The pressure actuator  12  is mechanically attached to said threaded portion  51  wherein said threaded portion  51  assists the vertical displacement toward the main gear  5   a ″ of the pressure adjusting plate  7 ″ for compressing the interchangeable box  11  as shown in  FIG. 29B  assembling of said hollow cylindrical body  50  with said pressure actuator  12 . It has to be understood that the compressing action applied over the interchangeable box  11  has a direct effect over the interactive portions providing a more rigid compressing action at the interactive portions distal end  2   a.    
         [0109]    At the same side of the housing H 3 , as shown in  FIG. 26A  and  FIG. 26B , and in line with the pressure actuator and rotational actuator  5 ″ is located the circumference actuator  33   a.    FIG. 30  discloses the circumference actuator  33   a  mechanically coupled to the circumference adjuster center portion  3 ″ by an extended rod  33   b  that transmits the turning motion of the actuator to an angular displacement of the interactive portion. As explained before the turning motion of the circumference actuator  33   a  produces the displacement of the interactive portions by pulling said interactive portion housing toward the circumference adjuster center portion  3 ″ center by means of an angular manner and therefore changing the circumference at the extended members  210 ,  200 . The circumference adjuster center portion  3 ″ is connected to a rigid portion such as the housing H 3  to avoid unwanted movement, for example non-rotational movement of the circumference adjuster center portion  3 ″. 
         [0110]      FIG. 31  and  FIG. 32  is directed to the apparatus couple to a automatic system wherein a motor M is mechanically couple to the apparatus to provide the desired turning motion on any of the actuators in order to change any of the changeable parameter of the apparatus  1 , 1 ′, 1 ″ such as circumferential distance between interactive portions, linear motion, compressing force and rotational motion at the first distal end and said interactive portions. Further the apparatus can be applied to another instrument, such as laparoscopy instruments. 
         [0111]      FIG. 33A  and  FIG. 33B  shows a forth embodiment  1 ″″ for the present invention comprising interactive portions housing  2000 , a circumference adjuster system  1001 , a rotational system  1004 , a linear motion system  1003  and a housing H 4 . The current embodiment employs the use of rotational and/or linear motor to perform the same functions as explained above. 
         [0112]    The invention is not limited to the precise configuration described above. While the invention has been described as having a preferred design or use, it is understood that many changes, modifications, variations and other uses and applications of the subject invention will, however, become apparent to those skilled in the art without materially departing from the novel teachings and advantages of this invention after considering this specification together with the accompanying drawings. Accordingly, all such changes, modifications, variations and other uses and applications which do not depart from the spirit and scope of the invention are deemed to be covered by this invention as defined in the following claims and their legal equivalents. In the claims, means-plus-function clauses, if any, are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. 
         [0113]    All of the patents, patent applications, and publications recited herein, and in the Declaration attached hereto, if any, are hereby incorporated by reference as if set forth in their entirety herein. All, or substantially all, the components disclosed in such patents may be used in the embodiments of the present invention, as well as equivalents thereof. The details in the patents, patent applications, and publications incorporated by reference herein may be considered to be incorporable at applicant&#39;s option, into the claims during prosecution as further limitations in the claims to patentable distinguish any amended claims from any applied prior art.