Abstract:
A cycling, suturing and knot-tying device is characterized by an arcuate fixed, grooved or recessed way provided in a correspondingly shaped support frame for accommodating a curved needle fitted with thread, and frictional needle-engaging devices provided in the way for selectively engaging the needle and driving the needle in one or both rotational directions to suture a wound with the thread. Selective articulation of the frame and the way and driving of the needle in the way by positioning the frictional needle-engaging devices with respect to the needle are typically effected by manipulation of a pistol-grip operating apparatus having a transmission tube that mounts the frame and the way in articulating relationship and rotates and articulates with respect to the pistol grip and carries various operating elements that interface with the frictional needle-engaging devices in the way. In at least one embodiment needle, direction-adjusting elements are provided in the frame in cooperation with selected devices in the way for determining the direction of needle rotation responsive to manipulation of an interfacing operating element located on the operating apparatus. Auxiliary thread-handling or incrementing and knot-tying devices are also disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This is a Continuation-In-Part of co-pending application Ser. No. 12/012,816 filed Feb. 5, 2008, which is a Continuation-In-Part of Ser. No. 11/223,737 filed Sep. 9, 2005, now U.S. Pat. No. 7,338,504 which is a Continuation-In-Part of Ser. No. 10/263,902 filed Oct. 3, 2002, now U.S. Pat. No. 7,004,951 issued Feb. 28, 2006. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not Applicable 
       INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISC 
       [0003]    Not Applicable 
       BACKGROUND OF THE INVENTION 
     Field of the Invention 
       [0004]    This invention relates to the suturing of surgical incisions, wounds and any other joining or fixing of tissue in general surgical procedures and, in particular, the suturing, joining or binding of tissue in surgical procedures involving very small, cramped or otherwise inaccessible fields of operation, such as, in general, laparoscopic and neurological brain surgery. One of the problems which is inherent in many surgical procedures is that of limited access of the surgeon&#39;s hands, as well as the needle and suturing implements, into the incision or wound. This problem is amplified under circumstances where delicate surgery such as heart, brain, and spinal surgery, as well as surgery on infants and children is undertaken, since the surgical areas of interest involve minute features. Many surgical procedures that would otherwise be possible on adults and children are impossible due to the tiny operating fields, and many conditions that might otherwise be corrected by surgery are, therefore, considered to be inoperable. The same situation occurs under circumstances such as suturing within interior and normally inaccessible areas of the body where no known surgical techniques and/or instruments can access these areas and provide the necessary surgical relief. 
         [0005]    The micro-sized cyclical suturing and knot-tying device of this invention is designed to optimize surgical suturing and, in particular, to facilitate access to very small, normally, but not limited to, inaccessible areas of the body, including the heart, brain and spinal cord, as well as conventional procedures on infants, to allow surgical relief which has heretofore been unavailable by conventional surgical techniques. The device of this invention is characterized by an arcuate, fixed, grooved or recessed way provided in a correspondingly configured support frame capable of receiving a curved needle fitted with a length of thread. The curved or arcuate frame is constructed to support the needle from end to end when the needle is in the starting position. The arcuate, grooved or recessed support-way is shaped in such a manner as to provide the correspondingly shaped needle with adequate support while leaving the top of the groove or recess, located on the top of the disk of rotation, open to permit passage of the thread around the way circuit traversed by the needle without trapping the thread in any of the needle support and drive structure. Both the needle and the frame, as well as the way, have a corresponding gap to accommodate tissue to be sewn. Accordingly, when the needle is driven in a circular path by manipulation of the appropriate operating components or elements in the operating device, the needle passes through tissue which protrudes into the gap in the way. Furthermore, since the thread is attached to the needle, the thread is drawn behind the needle, around the open top of the way, across the gap and through the tissue as the needle traverses the tissue. Although the thread cannot be trapped within the way, it is entrapped within the tissue through which the needle and thread is passed. 
         [0006]    Various elements and components are provided in the operating device in cooperation with the way, the needle and the support frame for effecting rotation of the needle in response to manipulation of the operating device. 
         [0007]    The device also uniquely includes means that allows the suturing head to be controllably moved arcuately upwardly and downwardly relative to the hollow-barrel portion of the device to which it is connected. Additionally, means are provided for controllably rotating the hollow-barrel portion of the device relative to the hand grip portion of the device to which it is connected. 
       DESCRIPTION OF RELATED ART INCLUDING INFORMATION DISCLOSED UNDER 37 CFR 1.97 AND  1 . 98   
       [0008]    Not Applicable 
       BRIEF SUMMARY OF THE INVENTION 
       [0009]    The foregoing and other objects of the invention are provided in a suturing device which includes an arcuate frame having an open groove; an arcuate needle disposed within the frame and seated in the groove; engaging means disposed within the frame and selectively extending into the groove for releasably engaging the needle; and drive means engaging the engaging means for driving the needle in the groove. 
         [0010]    One object of one form of the invention is to provide a suturing device which comprises a uniquely configured articulating, suturing head that includes a plurality of strategically shaped, circumferentially spaced cavities, a generally semi-circular-shaped shuttle track along which a novel needle advancing shuttle is slidably movable and a generally semi-circular-shaped needle guide along which a novel suturing needle is sequentially advanced by movement of the needle advancing shuttle. 
         [0011]    Another object of one form of the invention is to provide a suturing device of the character described in the preceding paragraph which includes a suturing needle that has a novel rectangular cross section, a circumferentially extending, notched wall and a strategically angled, chamfered end that compensates for needle deformation in the suturing process. 
         [0012]    Another object of one form of the invention is to provide a suturing device of the aforementioned character, which includes a plurality of uniquely configured needle-engaging and advancing members that are disposed within the plurality of strategically shaped, circumferentially spaced cavities formed in the articulating, suturing head portion and are adapted for both transverse and pivotal movement within the cavities in response to movement of the needle advancing shuttle. 
         [0013]    Another object of one form of the invention is to provide a suturing device of the character described in the preceding paragraphs which comprises a dual-cable shuttle advancing subsystem that includes a cooperating biasing spring and trigger mechanism for smoothly and positively moving the needle advancing shuttle along the shuttle track of the suture head of the device. 
         [0014]    Another object of the invention is to provide means that allows the suturing head of the device to be controllably moved arcuately upwardly and downwardly relative to the hollow-barrel portion of the device to which it is connected. 
         [0015]    Another object of the invention is to provide means for controllably rotating the hollow-barrel portion of the device relative to the hand grip portion of the device to which it is connected. 
         [0016]    These and other objects of the invention will be achieved by the novel apparatus of the invention, the details of which are discussed in the paragraphs that follow. 
     
    
     
       BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS 
         [0017]      FIG. 1  is a generally perspective view of one form of the suturing device of the present invention. 
           [0018]      FIG. 2  is a generally perspective view of the suturing device shown in  FIG. 1  as viewed from one side of the device and broken-away to show internal construction. 
           [0019]      FIG. 3  is a greatly enlarged, generally perspective, fragmentary view of the area designated in  FIG. 2  as “ 3 ”. 
           [0020]      FIG. 4  is a generally perspective view, similar to  FIG. 2 , but showing the trigger in an actuated position. 
           [0021]      FIG. 5  is a greatly enlarged, generally perspective, fragmentary view of the area designated in  FIG. 4  as “ 5 ”. 
           [0022]      FIG. 6  is a generally perspective view of the suturing device shown in  FIG. 1  as viewed from the opposite side of the device and broken-away to show internal construction. 
           [0023]      FIG. 7  is a greatly enlarged, generally perspective, fragmentary view of the area designated in  FIG. 6  as “ 7 ”. 
           [0024]      FIG. 8  is a view similar to  FIG. 6 , but showing the trigger in an actuated position. 
           [0025]      FIG. 9  is a greatly enlarged, generally perspective, fragmentary view of the area designated in  FIG. 8  as “ 9 ”. 
           [0026]      FIG. 10  is a greatly enlarged, generally perspective, fragmentary view of the articulable head portion of the device and of the coupling sub-assembly for coupling the head portion to the barrel portion of the device. 
           [0027]      FIG. 11  is a top plan view of the articulable head portion of the device as it appears after the cover portions have been removed to reveal the internal construction thereof. 
           [0028]      FIG. 12  is a top plan view similar to  FIG. 11 , but showing the location of the suturing needle of the device after it has been moved from the position illustrated in  FIG. 11  to a first advanced position. 
           [0029]      FIG. 13  is a generally perspective, top view similar to  FIG. 12  further showing the location of the suturing needle of the device after it has been advanced in a clockwise direction. 
           [0030]      FIG. 14  is a generally perspective, exploded view showing more clearly the various operating components of the head portion of the suturing device. 
           [0031]      FIG. 15  is a greatly enlarged, generally perspective view of one form of the suturing needle of this latest form of the suturing device. 
           [0032]      FIG. 16  is a greatly enlarged, generally perspective view of one of the needle-engaging members of the invention that, during operation of the device, function to control movement of the suturing needle within a suturing needle guide-way formed in the body of the head portion of the device. 
           [0033]      FIG. 17  is a greatly enlarged, diagrammatic view of the needle-engaging members of the invention illustrating their interaction with the needle during advancement of the shuttle member. 
           [0034]      FIG. 18  is a greatly enlarged, diagrammatic view of the needle-engaging members of the invention illustrating their interaction with the needle during retraction of the shuttle member. 
           [0035]      FIG. 19  is a generally enlarged, diagrammatic view of the head portion of the apparatus broken-away to illustrate the cooperative interaction of the operating cables of the apparatus on the shuttle member. 
           [0036]      FIG. 20  is a generally perspective view of an alternate form of the suturing device of the present invention. 
           [0037]      FIG. 21  is a generally perspective view of the suturing device shown in  FIG. 20  as viewed from one side of the device and broken-away to show internal construction. 
           [0038]      FIG. 22  is a side-elevational view of the suturing device shown in  FIG. 20  as viewed from one side of the device and shown partly in cross section. 
           [0039]      FIG. 23  is a greatly enlarged, cross-sectional view of the area designated in  FIG. 22  as “ 23 ”. 
           [0040]      FIG. 24  is a greatly enlarged, cross-sectional view of the area designated in  FIG. 22  as “ 24 ”. 
           [0041]      FIG. 25  is a top plan view of the articulable head portion of this alternate form of the device as it appears after the cover portions have been removed to reveal the internal construction thereof. 
           [0042]      FIG. 26  is a greatly enlarged, generally perspective view of one form of the suturing needle of this latest form of the suturing device. 
           [0043]      FIG. 27  is a greatly enlarged, side-elevational view of the suturing needle of this latest form of the suturing device. 
           [0044]      FIG. 28  is a greatly enlarged, top plan view of the suturing needle of this latest form of the suturing device. 
           [0045]      FIG. 29  is a top plan view similar to  FIG. 25 , but showing the location of the suturing needle of the device after it has been moved from the position illustrated in  FIG. 25  to a first advanced position. 
           [0046]      FIG. 30  is a greatly enlarged view of the area designated in  FIG. 29  as “ 30 ”. 
           [0047]      FIG. 31  is a top plan view similar to  FIG. 29 , but showing the needle driving member in a release position. 
           [0048]      FIG. 32  is a greatly enlarged view of the area designated in  FIG. 31  as “ 32 ”. 
           [0049]      FIG. 33  is a top plan view of an alternate form of the articulable head portion of this alternate form of the device as it appears after the cover portions have been removed to reveal the internal construction thereof. 
           [0050]      FIG. 34  is a top plan view similar to  FIG. 33 , but showing the location of the operating cables of the device. 
           [0051]      FIG. 35  is a greatly enlarged view of the area designated in  FIG. 34  as “ 35 ”. 
           [0052]      FIG. 36  is a top plan view similar to  FIG. 34 , but showing the needle driving member of this latest form of the invention in a release position. 
           [0053]      FIG. 37  is a greatly enlarged view of the area designated in  FIG. 36  as “ 37 ”. 
           [0054]      FIG. 38  is a top plan view similar to  FIG. 36 , but showing the location of the suturing needle of the device after it has been moved from the position illustrated in  FIG. 36  to a second advanced position. 
           [0055]      FIG. 39  is a top plan view of still another alternate form of the articulable head portion of this alternate form of the device as it appears after the cover portions have been removed to reveal the internal construction thereof. 
           [0056]      FIG. 40  is a greatly enlarged view of the area designated in  FIG. 39  as “ 40 ”. 
           [0057]      FIG. 41  is a top plan view similar to  FIG. 39 , but showing the location of the suturing needle of the device after it has been moved from the position illustrated in  FIG. 39  to an advanced position. 
           [0058]      FIG. 42  is a greatly enlarged view of the area designated in  FIG. 41  as “ 42 ”. 
           [0059]      FIG. 43  is a greatly enlarged, side-elevational view of one form of the suturing head of the apparatus of the invention. 
           [0060]      FIG. 44  is a greatly enlarged view of the area designated in  FIG. 43  as “ 44 ”. 
           [0061]      FIG. 45  is a generally perspective view of the suturing device shown in  FIG. 20  as viewed from one side of the device and broken-away to show internal construction. 
           [0062]      FIG. 46  is a greatly enlarged view of the area designated in  FIG. 45  as “ 46 ”. 
           [0063]      FIG. 47  is a greatly enlarged view of the area designated in  FIG. 45  as “ 47 ”. 
           [0064]      FIG. 48  is a generally perspective view of the suturing device similar to  FIG. 45 , but showing the suture head moved angularly upward relative to the barrel. 
           [0065]      FIG. 49  is a greatly enlarged view of the area designated in  FIG. 48  as “ 49 ”. 
           [0066]      FIG. 50  is a greatly enlarged view of the area designated in  FIG. 48  as “ 50 ”. 
           [0067]      FIG. 51  is a generally perspective view of the suturing device also similar to  FIG. 45 , but showing the suture head moved angularly downward relative to the barrel. 
           [0068]      FIG. 52  is a greatly enlarged view of the area designated in  FIG. 51  as “ 52 ”. 
           [0069]      FIG. 53  is a greatly enlarged view of the area designated in  FIG. 51  as “ 53 ”. 
           [0070]      FIG. 54  is an enlarged, generally perspective view showing the suture head moved angularly upward relative to the barrel connector. 
           [0071]      FIG. 55  is an enlarged, generally perspective view showing the suture head moved angularly downward relative to the barrel connector. 
           [0072]      FIG. 56  is a generally perspective view of still another form of the suturing device of the invention that is somewhat similar to the form of the suturing device shown in  FIG. 45  and showing the suture head moved angularly upward relative to the barrel. 
           [0073]      FIG. 57  is a greatly enlarged view of the area designated in  FIG. 56  as “ 57 ”. 
           [0074]      FIG. 58  is a greatly enlarged view of the area designated in  FIG. 56  as “ 58 ”. 
           [0075]      FIG. 59  is a generally perspective view of the head portion of the form of the suturing device of the invention shown in  FIG. 56   
           [0076]      FIG. 60  is a top plan view of the embodiment shown in  FIG. 59 . 
           [0077]      FIG. 61  is a greatly enlarged view of the area designated in  FIG. 60  as “ 61 ”. 
           [0078]      FIG. 62  is a top plan view showing the shuttle of the device of  FIG. 59  in a retracted, starting position. 
           [0079]      FIG. 63  is a top plan view showing the shuttle moved to an advanced position. 
           [0080]      FIG. 64  is a generally perspective view of yet another form of the suturing device of the invention that is somewhat similar to the form of the suturing device shown in  FIG. 56  and showing the suture head moved angularly upward relative to the barrel. 
           [0081]      FIG. 65  is a greatly enlarged view of the area designated in  FIG. 64  as “ 65 ”. 
           [0082]      FIG. 66  is a greatly enlarged view of the area designated  FIG. 64  as “ 66 ”. 
           [0083]      FIG. 67  is a generally perspective view of the head portion of the form of the suturing device of the invention shown in  FIG. 64 . 
           [0084]      FIG. 68  is a top plan view of the embodiment shown in  FIG. 67 . 
           [0085]      FIG. 69  is a greatly enlarged view of the area designated in  FIG. 68  as “ 69 ”. 
           [0086]      FIG. 70  is a top plan view showing the shuttle of the device of  FIG. 59  in a retracted, starting position. 
           [0087]      FIG. 71  is a top plan view showing the shuttle moved to an advanced position. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0088]    Turning to  FIGS. 1 through 19  of the drawings, one form of the cycling suturing and knot-tying device of this invention is there illustrated and generally identified by the numeral  1400 . Referring particularly to  FIG. 1  of the drawings, device  1400  can be seen to comprise a gripping portion  1402  comprising a generally pistol-shaped handgrip  1404  and a trigger mechanism  1406  connected to the handgrip in the manner shown in  FIGS. 2 ,  4  and  6 . Trigger mechanism  1406  comprises a part of the novel operating means of the invention, the character of which will presently be described. 
         [0089]    Connected to gripping portion  1402  is an elongated, hollow-barrel portion  1408  and connected to the hollow-barrel portion is an articulating, suturing head portion generally designated by the numeral  1410 . Articulating-head portion  1410 , which comprises one of the improved features of this latest form of the invention, is of a novel design that includes a generally semi-circular-shaped body  1412  having a generally semi-circular-shaped shuttle track  1413  ( FIGS. 11 and 12 ). Operably associated with body  1412  is a generally semi-circular-shaped shuttle member  1414  that is slidably movable by the operating means of the invention along the shuttle track between a first position shown in  FIG. 11  and the advanced second position shown in  FIG. 12 . As best seen in  FIGS. 13 and 14 , shuttle member  1414 , which has a first end  1414   a  and a second end  1414   b , is provided with a generally semi-circular-shaped needle groove or guide  1416  that extends from the first end of the shuttle member to the second end thereof. Uniquely, shuttle member  1414  is also provided with a plurality of strategically shaped, circumferentially spaced cavities  1420  the purpose of which will be described in the paragraphs which follow. 
         [0090]    Carried within a needle guide  1416  that is formed in shuttle member  1414  is a highly novel, generally semi-circular-shaped suturing needle  1422 . Needle  1422 , which can be constructed from metal or plastic, is incrementally movable along the needle guide from a first position shown in  FIG. 11  to an advanced second position shown in  FIG. 12  and then to a third further advanced position. As best seen in  FIG. 15 , needle  1422 , which has first and second ends  1422   a  and  1422   b , is of a unique construction. Unlike most prior art suture needles, needle  1422 , rather than being circular in cross section, is generally rectangular in cross section and has upper and lower surfaces disposed within the generally parallel planes (See  FIG. 15 ). The first end of the suture needle is chamfered at a precisely selected angle, while the second end thereof is provided with a pair of spaced-apart apertures  1424  and  1426 . These apertures, which receive the suture “S”, extend generally perpendicular to the plane of the upper and lower surfaces of the needle. To counter the tendency of the needle to open up as it penetrates the tissue to be sutured, the point “S- 1 ” of the needle is off-center of the axis “A” of the arc of the needle (see  FIG. 15 ). 
         [0091]    As best seen in  FIGS. 12 and 13 , the first end  1412   a  of generally semi-circular-shaped body  1412  is provided with a generally conically shaped opening  1428  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1428  is strategically configured so as to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1416  formed in the shuttle member. 
         [0092]    Considering now in greater detail the previously mentioned operating means of this latest form of the invention. As will be understood from the discussion that follows, this novel operating means functions to controllably advance and retract the shuttle member  1414  along shuttle track  1413  between its first and second positions. This sequential movement of the shuttle member, in turn, uniquely causes the suturing needle  1422  to incrementally move smoothly along the needle guide from its first position to its second position and then onto further advanced positions within the shuttle head. In addition to the previously mentioned trigger mechanism  1406 , this important operating means also comprises first and second operating cables  1430  end  1432  which are strategically entrained through hollow-barrel portion  1408  in the manner illustrated in  FIGS. 2 ,  6  and  8 . As seen in the drawings, operating cable  1430  has a first end  1430   a  connected proximate the first end  1414   a  of shuttle  1414  and a second end  1430   b  connected to trigger mechanism  1406 . Similarly, second operating cable  1432  has a first end  1432   a  connected proximate second end  1414   b  of shuttle  1414  and a second end  1432   b  connected to trigger mechanism  1406 . 
         [0093]    With the construction described in the preceding paragraph, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track between the first and second positions in the manner illustrated in  FIGS. 11 and 12 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1430  will move the shuttle  1414  in a clockwise direction from the first position shown in  FIG. 11  to the second position shown in  FIG. 12 . As this occurs, a biasing means shown here as a compression spring  1406   c , which is connected to a reciprocally movable coupling mechanism that is carried by gripping portion  1402 , yieldably resists movement of the trigger, is extended as illustrated in  FIG. 8 . In its extended position the extension spring acts upon the second operating cable  1432  via the coupling mechanism in the manner such that when the trigger is released, the shuttle  1414  will be caused to move in a counterclockwise direction and return to its starting position. 
         [0094]    In a manner now to be described, movement of the shuttle  1414  along the shuttle track  1413  causes concomitant, controlled movement of the suture needle  1422  along needle guide  1416 . As previously mentioned, shuttle member  1414  is provided with a plurality of strategically shaped, circumferentially spaced cavities  1420 . Disposed within each of these cavities  1420  is a uniquely configured needle-engaging member  1440  (see  FIG. 16 ) that is adapted for both transverse and pivotal movement within the cavity in response to movement of the  1414  shuttle between its first and second positions. This novel movement of the members  1440  within the cavities  1420  is illustrated in  FIGS. 17 and 18  of the drawings. As shown in  FIG. 17 , also partially disposed within cavities  1420 , are biasing means shown here as compressible, expandable elastomeric springs  1442 , which act upon members  1440 . Springs  1442 , which are of a generally cylindrically shaped, plug-like configuration are carried within smaller cavities segments  1444  which communicate with larger cavities  1420  in the manner illustrated in  FIGS. 17 and 18 . 
         [0095]    Turning particularly to  FIG. 15 , it is to be noted that suturing needle  1422  is provided with a multiplicity of circumferentially spaced-apart notches  1445 , which are uniquely constructed and arranged to be engaged by the needle-engaging members as the needle-engaging members move within cavities  1420 . More particularly, as the shuttle member  1414  moves from the first position shown in  FIG. 11  toward the second position shown in  FIG. 12 , the needle-engaging drive members will engage the needle in the manner illustrated in  FIG. 17 , causing the needle  1422  to move along with the shuttle member and penetrate the tissue disposed within the head opening  1447  ( FIG. 10 ). Unlike the prior art circular cross section suturing needles, which provide only a point contact with a needle driving member, the novel rectangular cross section needle of the present invention presents a substantially flat, grooved wall that provides a superior line contact with the driving member that advances the needle. 
         [0096]    As indicated in  FIG. 17 , spring  1442  continuously urges the drive members into binding engagement with the needle. However, upon release of the trigger which permits the shuttle to return to its starting position due to the urging of the extension spring  1407   a  ( FIG. 9 ), the needle-engaging members  1440  will compress the elastomeric springs  1442  and will pivot and move transversely within cavities  1420  in the direction of the arrows to engage the needle in the manner shown in  FIG. 18  to allow the members  1440  to slide relative to the needle allowing the needle to remain in place when the trigger is again actuated, the shuttle member  1414  will once again move in a clockwise direction as illustrated in  FIG. 12  causing the needle-engaging members  1440  to once again grip the suturing needle  1422  due to the urging of the elastomeric springs  1442 . This gripping of the needle will once again cause it to advance in a clockwise direction along the needle guide  1416  toward its third advanced position (not shown). As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1416  so that the suturing can be controllably and efficiently completed. 
         [0097]    As illustrated in  FIGS. 11 ,  12  and  13 , body  1412  of the suturing head is also provided with a pair of strategically shaped, circumferentially spaced cavities  1420  within which needle-engaging members  1440  are housed. These members cooperate with and function in an identical manner as the needle-engaging members housed within the cavities formed in the shuttle  1414  to control the movement of the suturing needle within guide-way  1416  as the shuttle moves along the shuttle track  1413 . More particularly, as the shuttle member  1414  moves from the first position shown in  FIG. 11  toward the second position shown in  FIG. 12 , these needle-engaging members will engage the needle in the manner illustrated in  FIG. 17 , allowing the needle  1422  to move with the shuttle member. However, upon release of the trigger which permits the shuttle to return to its starting position due to the urging of the extension spring  1407   c , these needle-engaging drive members will move into the needle slip configuration shown in  FIG. 18 , permitting the needle to remain in its advanced position. 
         [0098]    In using the suturing device of the present invention, with the suturing head components in the position illustrated in  FIG. 11  and with the tissue to be sutured disposed within open  1447 , the suturing process is begun by actuating the trigger of the trigger mechanism. When the trigger is actuated, the first operating cable  1430  which is connected proximate the bottom of the first end of the shuttle  1414  (see  FIG. 19 ) will move the shuttle  1414  in a clockwise direction from the first position shown in  FIG. 11  to the second position shown in  FIG. 12 . As the shuttle moves in this clockwise direction, cable  1432  will be foreshortened in the direction of the arrow  1451  of  FIG. 19 , causing the extension spring  1407   c  to be extended by the reciprocally movable coupling mechanism in the manner shown in  FIG. 8 . 
         [0099]    During the clockwise movement of the shuttle, elastomeric springs  1442  will urge spring engaging members  1440  into binding engagement with the needle  1422  in the manner illustrated in  FIG. 17 , causing the needle along with the suture “S” to advance to the needle penetrating position shown in  FIG. 12 . When the needle and the shuttle reach this advanced position, the trigger is released thereby permitting the shuttle  1414  to move in a counterclockwise direction toward its starting position due to the urging of extension spring  1407   c . During this counterclockwise movement of the shuttle members, the needle-engaging members  1440  will move within cavities  1420  into the needle slip position illustrated in  FIG. 18 . This novel pivotal and transverse movement of the needle-engaging members within their respective cavities will compress elastomeric springs  1442  and will permit the needle  1422  to slip relative to the shuttle members and remain in the advanced position shown in  FIG. 12 . 
         [0100]    After the shuttle members return to their starting positions, actuation of the trigger member will once again cause clockwise movement of the shuttles along the shuttle track  1413 . As before, during this clockwise movement of the shuttle, elastomeric springs  1442  will urge spring engaging members  1440  into binding engagement with the needle  1422  in the manner illustrated in  FIG. 17  causing the needle and the suture “S” to advance to a third, further advanced position (not shown). It is to be appreciated that by the repeated actuation and release of the trigger member the suturing needle can be smoothly and controllably, incrementally advanced along the needle guide  1416  to efficiently complete the suturing operation. 
         [0101]    Turning to  FIGS. 20 through 32  of the drawings, an alternate form of the cycling, suturing and knot-tying device of this invention is there illustrated and generally identified by the numeral  1460 . This embodiment is similar in some respects to the embodiments described in U.S. Pat. No. 7,004,951, but includes several improvements the nature of which will be discussed in the paragraphs which will follow. Because of its pertinence, U.S. Pat. No. 7,004,951 is hereby incorporated by reference as though fully set forth herein. This latest embodiment of the invention is also similar in some respects to that shown in  FIGS. 1 through 19  of the present application and like numerals are used in  FIGS. 20 through 32  to identify like components. The primary differences between this embodiment and that of  FIGS. 1 through 19  reside in the somewhat differently configured suturing head  1462  and the provision of novel suturing head-positioning means that allows the suturing head to be controllably moved arcuately relative to hollow-barrel portion  1464  to which it is connected. 
         [0102]    Referring particularly to  FIG. 20  of the drawings, device  1460  can be seen to include a gripping portion  1402  that comprises a generally pistol-shaped handgrip  1404  and a trigger mechanism  1406  connected to the handgrip in the manner shown in  FIGS. 20 and 21 . Trigger mechanism  1406 , which is substantially identical in construction and operation to that previously described, comprises a part of the novel operating means of this latest form of the invention. Connected to gripping portion  1402  is the elongated, barrel assembly  1464  and connected to the hollow-barrel assembly is an articulating, suturing head portion  1462 . Articulating-head portion  1462 , which comprises one of the improved features of this latest form of the invention, is of a novel design that includes a generally semi-circular-shaped body  1466  having a semi-circular-shaped shuttle track  1468  and first and second end portions  1466   a  and  1466   b  ( FIG. 25 ). Operably associated with body  1466  is a generally semi-circular-shaped shuttle member  1470  that is slidably movable by the operating means of the invention along the shuttle track between a first position shown in  FIG. 25  and a second position shown in  FIG. 29 . As illustrated in  FIG. 25 , shuttle member  1470 , which has a first end  1470   a  and a second end  1470   b , is provided with a generally semi-circular-shaped needle groove or guide  1472  that extends from the first end of the shuttle member to the second end thereof. Uniquely, shuttle member  1470  as well as end portions  1466   a  and  1466   b  of body  1466 , are provided with strategically shaped circumferentially spaced apart cavities  1474  the purpose of which will be described in the paragraphs which follow. 
         [0103]    Carried within a needle guide  1472  is a generally semi-circular-shaped suturing needle  1478 . Needle  1478 , which is similar to the earlier described needle  1422 , can be constructed from metal or plastic and is incrementally movable along the needle guide from a first position shown in  FIG. 25  to a second position shown in  FIG. 29  and then to a third, further advanced position. As best seen in  FIGS. 26 and 28 , needle  1478  has first and second ends  1478   a  and  1478   b  and, rather than being circular in cross section, is generally rectangular in cross section and has upper and lower surfaces disposed within generally parallel planes (See  FIG. 27 ). The first end of the suture needle is chamfered at a precisely selected angle, while the second end thereof is provided with a pair of spaced-apart apertures  1481  and  1482 . These apertures, which receive the suture “S” (see  FIG. 13 ) extend generally perpendicular to the plane of the upper and lower surfaces of the needle. To counter the tendency of the needle to open up as it penetrates the tissue to be sutured, the point “S- 1 ” of the needle is off-center of the axis “A” of the arc of the needle (see  FIG. 28 ). 
         [0104]    As best seen in  FIGS. 25 and 29 , the first end  1466   a  of generally semi-circular-shaped body  1466  is provided with a generally conically shaped opening  1467  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1466   a  is strategically configured so as to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1472  formed in the shuttle member. 
         [0105]    Considering now in greater detail the operating means of this latest form of the invention, as will be understood from the discussion that follows, this novel operating means functions to controllably advance and retract the shuttle member  1470  along shuttle track  1468  between its first and second positions. This sequential movement of the shuttle member, in turn, uniquely causes the suturing needle  1478  to incrementally move smoothly along the needle guide from its first position to its second position and then onto further advanced positions within the shuttle head. In addition to the previously mentioned trigger mechanism  1406 , this important operating means also comprises first and second operating cables  1483  and  1485  which are strategically entrained through hollow-barrel portion  1408  in the manner illustrated in  FIGS. 21 and 22 . First and second operating cables  1483  and  1485  ( FIG. 29 ) perform a similar function and are of similar construction to the previously described operating cables  1430  and  1432 . More particularly, as in the last described embodiment, the operating cables include a first cable having a first end connected proximate the first end of the shuttle (see  FIG. 19 ) and a second end connected to a coupling mechanism of trigger mechanism  1406  (see  FIG. 3 ). Similarly, in this latest embodiment, the operating cables include a second operating cable having a first end connected proximate the second end of the shuttle (see  FIG. 19 ) and a second end connected to a return mechanism  1407  which includes a biasing means or return spring  1407   a  that is connected to the gripping portion  1402  (see  FIG. 7 ). 
         [0106]    With the construction illustrated in the drawings and described in the preceding paragraph, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1468  between the first and second positions in the manner illustrated in  FIGS. 25 and 29 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1483  will move the shuttle  1470  in a clockwise direction from the first position shown in  FIG. 25  to the second position shown in  FIG. 29 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position the extension spring acts upon the second operating cable  1483  tending to return it to its starting position and, in turn, tending to move the shuttle  1470  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c , which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9  when pressure on the trigger is released. 
         [0107]    In a manner now to be described, movement of the shuttle  1470  along the shuttle track  1468  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1472 . As previously mentioned, shuttle member  1470  as well as end portions  1466   a  and  1466   b  are provided with a plurality of strategically shaped, circumferentially spaced cavities  1474 , each of which includes a rounded apex  1474   a  and angularly extending side walls  1474   b  and  1474   c  ( FIG. 30 ). Disposed within each of these cavities  1474  is a uniquely configured needle drive means for driving the suture needle  1478  along needle guide  1472 . This needle drive means here comprises a needle-engaging member  1484  and a generally “T”-shaped, elastomeric return member  1486  that is operably associated with member  1484 . As best seen in  FIGS. 30 and 32 , needle-engaging member  1484  includes a rounded-head portion  1484   a  that is pivotally received within the rounded apex  1474   a  of the cavity  1474  and an outwardly extending needle-engaging leg  1484   b . As illustrated in  FIG. 30 , return member  1486  comprises the return means of this form of the invention to continuously, yieldably urge the free end of needle-engaging leg  1484   b  into a first position in engagement with a selected one of a plurality of circumferentially spaced-apart notches  1478   c  formed on the inner surface  1478   b  of needle  1478  (see  FIG. 26 ). More particularly, return member  1486  has an elongated portion  1486   a  that is maintained in engagement with member  1484  and a yieldably deformable leg portion  1486   b  that is normally maintained in engagement with wall  1474   b  of cavity  1474 . 
         [0108]    With the construction thus described, as the shuttle member  1470  moves from the first position shown in  FIG. 25  toward the second position shown in  FIG. 29 , the needle-engaging members will engage the needle in the manner illustrated in  FIGS. 25 and 30 , causing the needle  1478  to move along with the shuttle member and to penetrate the tissue disposed within the head opening  1489 . Unlike the prior art circular cross section suturing needles, which provide only a point contact with a needle driving member, the novel rectangular cross section needle of the present invention presents a substantially flat, grooved or notched wall that provides a superior line contact with the driving member that advances the needle. 
         [0109]    As indicated in  FIG. 30 , the return means, or member  1486  of the device, continuously urges the needle-engaging members  1484  into binding engagement with the needle. However, upon release of the trigger, which causes the shuttle to return to its starting position due to the urging of the extension spring  1407 , the return members that are disposed within the cavities of  1474  will yieldably deform in a manner to permit the needle-engaging members to pivot into the second position shown in  FIGS. 31 and 32 . With the needle-engaging members in this second position, as the trigger is released causing the shuttle member  1470  to move counterclockwise to the position illustrated in  FIG. 25 , the needle-engaging members will slide relative to the needle. However, the needle-engaging members disposed within the cavity  1474  formed in end portion  1466   b  will not deform and, accordingly, will hold the needle in place. When the trigger is once again actuated, the shuttle member  1470  will again move in a clockwise direction as illustrated in  FIG. 29 , causing the needle-engaging members to once again grip and further advance the suturing needle  1478 . As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1472 , so that the suturing can be controllably and efficiently completed. 
         [0110]    Turning to  FIGS. 33 through 38  of the drawings, still another form of the cycling, suturing and knot-tying device of this invention is there illustrated. This embodiment is similar in many respects to the embodiment illustrated in  FIGS. 20 through 32  and like numerals are used in  FIGS. 33 through 38  to identify like components. The primary differences between this embodiment and that of  FIGS. 1 through 19  resides in the somewhat differently configured articulating, suturing head  1492  and the provision of differently configured drive means for advancing the semi-circular-shaped suturing needle  1478  within the suturing head. 
         [0111]    As best seen in  FIG. 33 , articulating-head portion  1492  here comprises a generally semi-circular-shaped body  1496  having first and second end portions  1496   a  and  1496   b  and a semi-circular-shaped shuttle track  1498 . Operably associated with body  1496  is a generally semi-circular-shaped shuttle member  1500  that is slidably movable by the operating means of the invention along the shuttle track between a first position shown in  FIGS. 33 and 34  and a second position shown in  FIG. 36 . As illustrated in  FIG. 33 , shuttle member  1500 , which has a first end  1500   a  and a second end  1500   b , is provided with a generally semi-circular-shaped needle groove or guide  1502  that extends from the first end of the shuttle member to the second end thereof. Uniquely, shuttle member  1500  is also provided with a plurality of strategically shaped, circumferentially spaced cavities  1504   a  and  1504   b , the purpose of which will be described in the paragraphs which follow. 
         [0112]    Carried within needle guide  1502  is a generally semi-circular-shaped suturing needle  1478 , which is substantially identical to the earlier described needle. Suturing needle  1478  is incrementally movable along the needle guide from a first position shown in  FIG. 33  to a second position shown in  FIG. 36  and then to a third, further advanced position. 
         [0113]    As before, the first end  1496   a  of generally semi-circular-shaped body  1496  is provided with a generally conically shaped opening  1497  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1497  is strategically configured so as to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1502  formed in the shuttle member. 
         [0114]    The operating means of this latest form of the invention, which functions to controllably advance and retract the shuttle member  1500  along shuttle track  1498  between its first and second positions, is similar in most respects to that earlier described herein. In addition to the gripping portion  1402  and trigger mechanism  1406  carried by the handgrip, both of which are identical to those previously described, the operating means here comprises first and second operating cables  1506  end  1508  ( FIG. 34 ) which are strategically entrained through hollow-barrel portion  1408  of the device in the same manner as illustrated in  FIGS. 21 and 22  of the drawings. First and second operating cables  1506  and  1508  perform a similar function and are of similar construction to the previously described operating cables  1430  and  1432 . More particularly, as in the last described embodiment, the operating cables include a first cable having a first end connected proximate the first end of the shuttle (see  FIG. 19 ) and a second end connected to a coupling mechanism or trigger mechanism  1406  (see  FIG. 3 ). Similarly, in this latest embodiment, the operating cables include a second operating cable having a first end connected proximate the second end of the shuttle (see  FIG. 19 ) and a second end connected to a return mechanism  1407  which includes a biasing means or return spring  1407   a  that is connected to the gripping portion  1402  (see  FIG. 7 ). Connected to gripping portion  1402  is the elongated, hollow-barrel portion  1464  and connected to the hollow-barrel portion is the articulating, suturing head portion  1492 . 
         [0115]    As in the last described embodiment, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1498  between the first and second positions in the manner illustrated in  FIGS. 33 and 36 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle  1500  in a clockwise direction from the first position shown in  FIG. 33  to the second position shown in  FIG. 36 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407 , which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position the extension spring acts upon the second operating cable  1508 , tending to return it to its starting position and, in turn, tending to move the shuttle  1500  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c , which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position, shown in  FIG. 9 , when pressure on the trigger is released. 
         [0116]    As before, movement of the shuttle  1500  along the shuttle track  1498  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1502 . Shuttle member  1500  as well as end portions  1496   a  and  1496   b  are provided with a plurality of strategically shaped, circumferentially spaced cavities  1504   a  and  1504   b , each of which includes a rounded socket-like portion  1511  and an open body portion  1513  (see  FIGS. 34 and 35 ). Cavities  1504   a  and  1504   b  which are positioned on opposite sides of needle passageway  1502 , house uniquely configured needle drive means for driving the suture needle  1478  along needle guide  1502 . This needle drive means here comprises a needle-engaging member  1514  that includes a rounded-head portion  1514   a  that is pivotally received within the rounded socket-like portions  1511  of the cavities and a body portion  1514   b . The needle drive means also comprises return means, shown here as a yieldably deformable spring-like return member  1516  that is operably associated with member  1514 . As illustrated in  FIG. 35 , return member  1516  is constructed and arranged to continuously, yieldably urge the body portion  1514   b  of the driving member  1514  into driving engagement with needle  1478 . 
         [0117]    With the construction thus described, as the shuttle member  1500  moves from the first position shown in  FIG. 34  toward the second position shown in  FIG. 36 , the needle-engaging members  1514  will engage both sides of the needle in the manner illustrated in  FIG. 35  causing the needle  1478  to move along with the shuttle member and penetrate the tissue disposed within the head opening  1519 . As indicated in  FIG. 35 , return members  1516  continuously urge the needle-engaging members  1514  into binding engagement with the needle. However, upon release of the trigger, which causes the shuttle to return to its starting position due to the urging of the extension spring  1407   c , the return members that are disposed within cavities  1504   a  and  1504   b  formed in shuttle  1500  will yieldably deform in a manner to permit the needle-engaging members to pivot from their first driving position into their second position shown in  FIGS. 36 and 37 . With the needle-engaging members in this second position, as the trigger is released causing the shuttle member  1500  to move counterclockwise to the position illustrated in  FIG. 34 , the needle-engaging members will slide relative to the needle. However, the return members that are housed within the cavities  1504   a  and  1504   b  formed in the end portion  1504   b  will function to hold the needle in place in its advanced position. When the trigger is once again actuated, the shuttle member  1500  will again move in a clockwise direction as illustrated in  FIG. 35  and the needle-engaging members will further advance the suturing needle  1478  into the position shown in  FIG. 38 . As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1502  so that the suturing can be controllably and efficiently completed. 
         [0118]    Turning to  FIGS. 39 through 42  of the drawings, yet another form of the cycling, suturing and knot-tying device of this invention is there illustrated. This embodiment is similar in many respects to the embodiment illustrated in  FIGS. 33 through 38  and like numerals are used in  FIGS. 39 through 42  to identify like components. The primary differences between this embodiment and that of  FIGS. 33 through 38  reside in the somewhat differently configured articulating, suturing head  1522  and the provision of differently configured drive means for advancing the semi-circular-shaped suturing needle  1478  within the suturing head. 
         [0119]    As best seen in  FIG. 39 , articulating-head portion  1522  here comprises a generally semi-circular-shaped body  1526  having end portions  1526   a  and  1526   b  and a semi-circular-shaped shuttle track  1528 . Operably associated with body  1526  is a generally semi-circular-shaped shuttle member  1530  that is slidably movable by the operating means of the invention along the shuttle track between the position shown in  FIG. 39  and the position shown in  FIG. 41 . As illustrated in  FIG. 39 , shuttle member  1530  which has a first end  1530   a  and a second end  1530   b , is provided with a generally semi-circular-shaped needle groove or guide  1532  that extends from the first end of the shuttle member to the second end thereof. Uniquely, shuttle member  1530  is also provided with a plurality of strategically shaped, circumferentially spaced cavities  1534   a  and  1534   b , the purpose of which will be described in the paragraphs which follow. 
         [0120]    Carried within needle guide  1532  is a generally semi-circular-shaped suturing needle  1478 , which is substantially identical to the earlier described needle. Suturing needle  1478  is incrementally movable along the needle guide from a first position shown in  FIG. 39  to a second position shown in  FIG. 41  and then to a third, further advanced position. 
         [0121]    As before, the first end  1526   a  of generally semi-circular-shaped body  1526  is provided with a generally conically shaped opening  1527  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1527  is strategically configured so as to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1532  formed in the shuttle member. 
         [0122]    The operating means of this latest form of the invention which functions to controllably advance and retract the shuttle member  1530  along shuttle track  1528  between its first and second positions, is similar in most respects to that earlier described herein. In addition to the gripping portion  1402  and trigger mechanism  1406  carried by the handgrip, both of which are identical to those previously described, the operating means here comprises first and second operating cables  1506  and  1508  ( FIG. 39 ) which are strategically entrained through hollow-barrel portion  1408  of the device in the same manner as illustrated in  FIGS. 21 and 22  of the drawings. First and second operating cables  1506  and  1508  perform a similar function and are of similar construction to the previously described operating cables  1430  and  1432 . More particularly, as in the last described embodiment, the operating cables include a first cable having a first end connected proximate the first end of the shuttle (see  FIG. 19 ) and a second end connected to a coupling mechanism or trigger mechanism  1406  (see  FIG. 3 ). Similarly, in this latest embodiment, the operating cables include a second operating cable having a first end connected proximate the second end of the shuttle (see  FIG. 19 ) and a second end connected to a return mechanism  1407  which includes a biasing means or return spring  1407   a  that is connected to the gripping portion  1402  (see  FIG. 7 ). Connected to gripping portion  1402  is the elongated, hollow-barrel portion  1464  and connected to the hollow-barrel portion is the articulating, suturing head portion  1462  (see  FIG. 47 ). 
         [0123]    As in the last described embodiment, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1528  between the first and second positions in the manner illustrated in  FIGS. 39 and 41 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle  1530  in a clockwise direction from the position shown in  FIG. 39  to the position shown in  FIG. 41 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position the extension spring acts upon the second operating cable  1508  tending to return it to its starting position and, in turn, tending to move the shuttle  1530  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c , which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9  when pressure on the trigger is released. 
         [0124]    As before, movement of the shuttle  1530  along the shuttle track  1528  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1532 . Shuttle member  1530  as well as end portions  1526   a  and  1526   b  are provided with strategically shaped, circumferentially spaced, generally oval-shaped, tapered wall cavities  1537   a  and  1537   b , each having opposing tapered side walls. Cavities  1537   a  and  1537   b , which are positioned on opposite sides of needle passageway  1532 , house uniquely configured needle drive means for driving the suture needle  1478  along needle guide  1532  (see  FIGS. 40 and 42 ). This needle drive means here comprises generally cylindrically shaped, roller-like needle-engaging members  1538  that are closely held within the cavities for movement between a first needle-engaging drive position shown in  FIG. 40  and a second slip position shown in  FIG. 42 . As before, the needle drive means also comprises return means shown here as yieldably deformable return members  1539  that are operably associated with members  1538  and function to urge the driving members into their first position in engagement with needle  1478 . More particularly, return members  1539  here comprise small lengths of silicone tubes that are constructed and arranged to continuously, yieldably urge the driving members  1538  to roll along the cavities in a manner to be cammed into driving engagement with needle  1478  (see  FIG. 40 ). 
         [0125]    With the construction thus described, as the shuttle member  1530  moves from the starting position shown in  FIG. 39 , the needle-engaging members  1538  which are being urged into cammed engagement with the needle in the manner illustrated in  FIG. 40 , will cause the needle  1478  to move along with the shuttle member and penetrate the tissue disposed within the head opening  1541 . However, upon release of the trigger, which causes the shuttle to return to its starting position due to the urging of the extension spring  1407   c , the return members that are disposed within the cavities  1537   a  and  1537   b  formed in shuttle member  1530  will yieldably deform in the manner shown in  FIG. 40  to permit the needle-engaging members to roll into their second position shown in  FIG. 40 . With the needle-engaging members in this second position, as the trigger is released causing the shuttle member  1530  to move counterclockwise toward the starting position, the needle-engaging members will slide relative to the needle, permitting the needle to remain in place. However, the needle-engaging members that are disposed within the cavities formed in end portion  1526   b  will function to hold the needle in place in its advanced position. When the trigger is once again actuated, the shuttle member  1530  will again move in a clockwise direction causing the needle-engaging members to once again grip and further advance the suturing needle. As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1532  so that the suturing can be controllably and efficiently completed. 
         [0126]    Turning to  FIGS. 43 and 44  of the drawings, still another form of the cycling, suturing and knot-tying device of this invention is there illustrated. This embodiment is similar in most respects to the embodiment illustrated in  FIGS. 33 through 38  and like numerals are used in  FIGS. 43 and 44  to identify like components. The primary differences between this embodiment and that of  FIGS. 33 through 38  resides in the somewhat differently configured opening  1544  formed in generally semi-circular-shaped body  1546  for receiving the chamfered end of the suturing needle as the needle is incrementally advanced. More particularly, opening  1544  is here specially configured in a manner to cause the chamfered end of the needle to be deflected by the strategically curved side walls  1544   a  and  1544   b  of the opening ( FIG. 44 ), to be more precisely guided into and follow the curvature of the needle groove or guide of the shuttle member  1530  as the needle is incrementally advanced. 
         [0127]    Referring now to  FIGS. 45 through 50  as well as to  FIGS. 22 through 24  of the drawings, the various mechanisms which cooperate to move the suture head  1462  of the device from a first angularly upward position to a second downward position relative to the barrel assembly  1464  are there illustrated. These novel mechanisms comprise the previously discussed suture head-positioning means of the invention for moving the suture head  1462  from a starting position shown in  FIGS. 45 and 47  to a first angularly upward position shown in  FIGS. 48 and 50 , as well as to a second angularly downward position shown in  FIGS. 51 and 53 . 
         [0128]    Turning particularly to  FIGS. 22 ,  23  and  24 , the previously identified barrel assembly  1464  can be seen to comprise a forwardly extending connector member  1550  that is interconnected with grip portion  1461  in the manner shown in  FIG. 24 . Connector member  1550  is provided with an axial bore  1550   a  through which cables  1483  and  1485  extend. Rotatably connected to grip portion  1461  and operably associated with connector member  1550  is a hub member  1552  that includes a finger-engaging knurled portion  1554  and a reduced-diameter portion  1556 . Connected to reduced-diameter portion  1556  is an elongated outer tube  1558  to which a forward connector assembly  1560  is connected ( FIG. 23 ). 
         [0129]    Operably associated with outer tube  1558  is the articulating-head operating means of the invention for moving the suture head  1462  of the device angularly upwardly and downwardly relative to the barrel assembly  1464  in the manner indicated in  FIGS. 54 and 55 . This novel articulating-head operating means here comprises an inner-tubular member  1562  which is reciprocally movable within outer tube  1558  by rotation of an internally threaded finger-gripping member  1564  that is rotatably carried by the reduced-diameter portion  1556  of hub  1552  ( FIG. 24 ). 
         [0130]    Connected proximate the forward end of inner-tubular member  1562  is a forward operating member  1568  and connected proximate the rearward end of inner-tubular member  1562  is a rearward operating member  1570  ( FIGS. 23 and 24 ). Both forward operating member  1568  and rearward operating member  1570  include axial bores through which cables  1483  and  1485  extend. As best seen in  FIGS. 24 and 46 , rearward operating member  1570  also includes a radially outwardly extending drive rod  1572 , the outer extremity  1572   a  of which operably engages the internal threads  1564   a  of finger-gripping member  1564 . With this construction, rotation of finger-gripping member  1564  will cause the controlled reciprocal movement within outer tube  1558  between first and second positions of the inner-tubular assemblage made up of forward operating member  1568 , inner-tubular member  1562  and rearward operating member  1570 . 
         [0131]    Pivotally connected to forward operating member  1568  is an elongated operating link  1576 , the purpose of which will presently be described. As best seen in  FIG. 23 , the forward end  1576   a  of the operating link  1576  is pivotally connected to connector member  1463  ( FIG. 45 ) to which the articulating-head  1462  is connected. As illustrated in  FIGS. 48 ,  54  and  55 , connector member  1463  is pivotally connected to forward connector assembly  1560  so that forward and rearward movement of the operating link  1576  relative to the forward connector assembly will cause the suture head  1462  of the device to move angularly upwardly and downwardly relative to the barrel assembly  1464 . 
         [0132]    With the construction described in the preceding paragraphs, when the operating components of the device are in the position shown in  FIGS. 45 ,  46  and  47 , rotation of finger-engaging knob  1564  in a clockwise direction to the position shown in  FIG. 49  will cause the assemblage made up of forward operating member  1568 , inner-tubular member  1562  and rearward operating member  1570  to move telescopically rearward within outer tube  1558 . This rearward movement of the assemblage will cause the operating link  1576  to also move rearwardly in the manner shown in  FIG. 54 , resulting in the angularly upward movement of the suture head  1462  relative to the barrel assembly  1464  (see also  FIGS. 48 and 50 ). 
         [0133]    Similarly, with the operating components of the device in the position shown in  FIGS. 45 ,  46  and  47 , rotation of finger-engaging knob  1564  in a counterclockwise direction to the position shown in  FIG. 52  will cause the assemblage made up of forward operating member  1568 , inner-tubular member  1562  and rearward operating member  1570  to move telescopically forward within outer tube  1558 . This forward movement of the assemblage will cause the operating link  1576  to also move forwardly in the manner shown in  FIG. 55 , resulting in the angularly downward movement of the suture head  1462  relative to the barrel assembly  1464  (see also  FIGS. 51 and 53 ). 
         [0134]    With the novel construction thus described, during surgery the physician need only slightly rotate the finger-engaging knob  1564  in either a clockwise or counterclockwise direction in order to angularly position the suture head  1462  of the device relative to the suture site. Similarly, by gripping knurled surface  1554  of hub  1552 , the hub, along with the entire barrel assemblage, including the suture head  1462 , can be controllably rotated relative to the suture site. 
         [0135]    Turning to  FIGS. 56 through 63  of the drawings, yet another form of the cycling, suturing and knot-tying device of this invention is there illustrated and generally identified by the numeral  1580 . This embodiment is similar in some respects to the previously described embodiments and like numerals are used in  FIGS. 56 through 63  to identify like components. The primary difference between this embodiment and the previously described embodiments resides in the somewhat differently configured articulating-head portion  1582 . Articulating-head portion  1582  here comprises a generally semi-circular-shaped body  1586 , having end portions  1586   a  and  1586   b  and a semi-circular-shaped shuttle track  1588 . Operably associated with body  1586  is a generally semi-circular-shaped shuttle member  1590  that is slidably movable by the operating means of the invention along the shuttle track between the starting position shown in  FIG. 62  and the advanced position shown in  FIG. 63 . As illustrated in  FIG. 60 , body  1586  which has a first end  1586   a  and a second end  1586   b , is provided with a generally semi-circular-shaped needle groove or guide  1592  that extends from the first end of the body to the second end thereof. Carried within needle guide  1592  is a generally semi-circular-shaped suturing needle  1478 , which is substantially identical to the earlier described needle. In a manner presently to be described, suturing needle  1478  is incrementally movable along the needle guide from a first position shown in  FIG. 62  to a second position shown in  FIG. 63  and then to a third, further advanced position. For this purpose the shuttle member  1590  is provided with a plurality of strategically shaped, circumferentially spaced cavities  1594   a  and  1594   b , the function of which will be described in the paragraphs which follow. 
         [0136]    As before, the first end  1586   a  of generally semi-circular-shaped body  1586  is provided with a generally conically shaped opening  1597  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1597  is strategically configured to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1592  formed in the shuttle member. 
         [0137]    The operating means of this latest form of the invention, which functions to controllably advance and retract the shuttle member  1590  along shuttle track  1588  between its first and second positions, is similar in most respects to that earlier described herein. In addition to the gripping portion  1404  and trigger mechanism  1406  carried by the handgrip ( FIG. 56 ), both of which are identical to those previously described, the operating means here comprises first and second operating cables  1506  end  1508  ( FIG. 39 ) which are strategically entrained through hollow-barrel portion  1464  of the device in the same manner as illustrated in  FIGS. 21 and 22  of the drawings. First and second operating cables  1506  and  1508  perform a similar function and are of similar construction to the previously described operating cables  1430  and  1432 . More particularly, as in the last described embodiment, the operating cables include a first cable having a first end connected proximate the first end of the shuttle (see  FIG. 19 ) and a second end connected to a coupling mechanism or trigger mechanism  1406  (see  FIG. 3 ). Similarly, in this latest embodiment, the operating cables include a second operating cable having a first end connected proximate the second end of the shuttle (see  FIG. 19 ) and a second end connected to a return mechanism  1407  which includes a biasing means or return spring  1407   a  that is connected to the gripping portion  1402  (see  FIG. 7 ). Connected to gripping portion  1404  is the elongated, hollow-barrel portion  1464  and connected to the hollow-barrel portion is the articulating, suturing head portion  1582  (see  FIG. 58 ). 
         [0138]    As in the last described embodiment, sequential actuation and release of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1588  between the first and second positions in the manner illustrated in  FIGS. 62 and 63 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle  1590  in a clockwise direction from the position shown in  FIG. 62  to the position shown in  FIG. 63 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism is extended, as illustrated in  FIG. 9 . In its extended position, the extension spring acts upon the second operating cable  1508  tending to return it to starting position and, in turn, tending to move the shuttle  1590  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c  which comprises a part of the trigger mechanism  1406  is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9  when pressure on the trigger is released. 
         [0139]    As before, movement of the shuttle  1590  along the shuttle track  1588  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1592 . Like shuttle member  1590 , end portions  1586   a  and  1586   b  of body  1586  are provided with strategically shaped circumferentially spaced apart cavities, the purpose of which will presently be described. More particularly, shuttle member  1590  is provided with strategically shaped, circumferentially spaced cavities  1594   a  and  1594   b , each of which houses a novel first needle-engaging assembly  1602  which functions to engage needle  1478  to strategically control its movement along needle guide  1592 . Similarly, body  1586  is provided with circumferentially-spaced wall cavities  1602   a  and  1602   b , each of which houses a novel second needle-engaging assembly  1604  which functions to engage needle  1478  to temporarily secure the needle in an advanced position within needle guide  1592 . 
         [0140]    Each needle-engaging assembly  1602  comprises a needle-engaging member that includes a body, or flexure portion  1602   a , having first and second end portions  1607  and  1609 , respectively ( FIG. 61 ). First end portion  1607  which comprises an elongated locking member  1607   a , is received within and connected to the slotted portion  1611  of shuttle  1590  (see  FIG. 61 ). Second end portion  1609  which includes a generally spherical, rounded head portion  1609   a , is receivable within a selected one of a multiplicity of circumferentially spaced-apart indentations  1614  formed in needle  1478 . The body of the first needle-engaging assembly  1602  comprises a first bent flexure portion  1603  that is connected to the first extremity thereof and a second bent flexure portion  1605  that is connected to said second extremity thereof ( FIG. 61 ). 
         [0141]    In a manner presently to be described, each needle-engaging assembly  1602  functions as a drive means for driving the suture needle  1478  along needle guide  1592  (see  FIGS. 62 and 63 ). 
         [0142]    In similar fashion, each needle-engaging assembly  1604  comprises a body  1604   a  having first and second end portions  1615  and  1617 , respectively. First end portion  1615  which comprises an elongated locking member  1615   a , is received within and connected to a slotted portion  1619  of body  1586  (see  FIG. 61 ). Second end portion  1619  which comprises a generally spherical, rounded head portion  1619   a  is receivable within a selected one of the multiplicity of circumferentially spaced-apart indentations  1614  formed in needle  1478 . The body, or flexure, portion of the second needle-engaging assembly  1604  comprises a first bent portion  1621  that is connected to the first end portion thereof and a second bent portion  1623  that is connected to the second end portion thereof. In a manner presently to be described, each needle-engaging assembly  1604  functions as a braking means for temporarily holding the suture needle  1478  in an advanced position within the needle guide  1592  (see  FIGS. 62 and 63 ). 
         [0143]    As in the last described embodiment, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1592  between the first and second positions in the manner illustrated in  FIGS. 62 and 63 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle  1590  in a clockwise direction from the position shown in  FIG. 62  to the advanced position shown in  FIG. 63 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position the extension spring acts upon the second operating cable  1508  tending to return it to its starting position and, in turn, tending to move the shuttle  1590  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c  which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9  when pressure on the trigger is released. 
         [0144]    As before, movement of the shuttle  1590  along the shuttle track  1592  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1592 . 
         [0145]    With the construction thus described, as the shuttle member  1590  is urged to move forwardly from the starting position shown in  FIG. 62  toward the advanced position shown in  FIG. 63 , the central flexure portions  1602   a  of the needle-engaging assemblies  1602  will flex between their first relaxed position and their second flexed position causing the head portions  1609   a  to be urged into driving engagement with a selected one of the multiplicity of circumferentially spaced-apart indentations  1614  formed in needle  1478 . This will cause the needle  1478  to move along with the shuttle member and penetrate the tissue disposed within the head opening. However, upon release of the trigger, which tends to cause the shuttle to move counterclockwise toward the starting position due to the urging of the extension spring  1407   c , the central flexure portions  1604   a  of each of the needle-engaging assemblies  1604  will flex between their first relaxed position and their second flexed position causing the head portions  1619   a  thereof to be urged into braking engagement with selected ones of the multiplicity of circumferentially spaced-apart indentations  1614  formed in needle  1478 , thereby resisting movement of the needle toward the first position. Uniquely, this will cause the needle  1478  to remain in its advanced position as the shuttle member returns to its starting position. When the trigger is once again actuated, the shuttle member  1590  will again move in a clockwise direction causing the head portions  1602   a  of the needle-engaging assemblies  1602  to once again grip and further advance the suturing needle. As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1592  so that the suturing can be controllably and efficiently completed. 
         [0146]    The various mechanisms of this latest form of the invention which cooperate to move the suture head  1462  of the device from a first angularly upward position to a second downward position relative to the barrel assembly  1464  are of identical construction and operation to those illustrated in  FIGS. 45 through 50 . Accordingly, during surgery the physician need only slightly rotate the finger-engaging knob  1564  in either a clockwise or counterclockwise direction in order to angularly position the suture head  1462  of the device relative to the suture site. Similarly, by gripping knurled surface  1554  of hub  1552 , the hub along with the entire barrel assemblage including the suture head  1462 , can be controllably rotated relative to the suture site. 
         [0147]    Turning to  FIGS. 64 through 71  of the drawings, yet another form of the cycling, suturing and knot-tying device of this invention is there illustrated and generally identified by the numeral  1630 . This embodiment is similar in some respects to the embodiment of  FIGS. 56 through 63  and like numerals are used in  FIGS. 64 through 71  to identify like components. The primary difference between this embodiment and that of  FIGS. 56 through 63  resides in the somewhat differently configured articulating-head portion  1632 . Articulating-head portion  1632  here comprises a generally semi-circular-shaped body  1634 , having end portions  1634   a  and  1634   b  and a semi-circular-shaped shuttle track  1636  ( FIG. 67 ). Operably associated with body  1634  is a generally semi-circular-shaped shuttle member  1638  that is slidably movable by the operating means of the invention along the shuttle track between the starting position shown in  FIG. 70  and the advanced position shown in  FIG. 71 . As illustrated in  FIG. 68 , body  1634 , which has a first end  1634   a  and a second end  1634   b , is provided with a generally semi-circular-shaped needle groove or guide  1640  that extends from the first end of the body to the second end thereof. Carried within needle guide  1640  is a generally semi-circular-shaped suturing needle  1478  which is substantially identical to the earlier described needle. In a manner presently to be described, suturing needle  1478  is incrementally movable along the needle guide from a first position shown in  FIG. 70  to a second position shown in  FIG. 71  and then to a third, further advanced position. For this purpose the shuttle member  1638  is provided with a plurality of strategically shaped, circumferentially spaced cavities  1638   a  and  1638   b , the function of which will be described in the paragraphs which follow. 
         [0148]    As before, the first end  1634   a  of generally semi-circular-shaped body  1634  is provided with a generally conically shaped opening  1643  for receiving the chamfered end of the needle as the needle is incrementally advanced. The conically shaped opening  1643  is strategically configured to permit the chamfered end of the needle to deflect somewhat as it is guided into the groove or guide  1645  formed in the shuttle member. 
         [0149]    The operating means of this latest form of the invention, which functions to controllably advance and retract the shuttle member  1638  along shuttle track  1636  between its first and second positions, is similar in most respects to that earlier described herein. In addition to the gripping portion  1404  and trigger mechanism  1406  carried by the handgrip ( FIG. 64 ), both of which are identical to those previously described, the operating means here comprises first and second operating cables  1506  end  1508  ( FIG. 39 ) which are strategically entrained through hollow-barrel portion  1464  of the device in the same manner as illustrated in  FIGS. 21 and 22  of the drawings. First and second operating cables  1506  and  1508  perform a similar function and are of similar construction to the previously described operating cables  1430  and  1432 . More particularly, as in the last described embodiment, the operating cables include a first cable having a first end connected proximate the first end of the shuttle (see  FIG. 19 ) and a second end connected to a coupling mechanism or trigger mechanism  1406  (see  FIG. 3 ). Similarly, in this latest embodiment, the operating cables include a second operating cable having a first end connected proximate the second end of the shuttle (see  FIG. 19 ) and a second end connected to a return mechanism  1407  which includes a biasing means or return spring  1407   a  that is connected to the gripping portion  1402  (see  FIG. 7 ). Connected to gripping portion  1404  is the elongated, hollow-barrel portion  1464  and connected to the hollow-barrel portion is the articulating, suturing head portion  1463  (see  FIG. 66 ). 
         [0150]    As in the last described embodiment, sequential actuation and release of the trigger of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track  1636  between the first and second positions in the manner illustrated in  FIGS. 70 and 71 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle in a clockwise direction from the position shown in  FIG. 70  to the position shown in  FIG. 71 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position, the extension spring acts upon the second operating cable  1508  tending to return it to starting position and, in turn, tending to move the shuttle in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c , which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9 , when pressure on the trigger is released. 
         [0151]    As before, movement of the shuttle  1638  along the shuttle track  1636  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1640 . Like shuttle member  1638 , end portions  1634   a  and  1634   b  of body  1634  are provided with strategically shaped circumferentially spaced-apart cavities, the purpose of which will presently be described. More particularly, shuttle member  1638  is provided with strategically shaped, circumferentially spaced cavities  1638   a  and  1638   b , each of which houses a novel first needle-engaging assembly  1650  which functions to engage needle  1478  to strategically control its movement along needle guide  1640 . Similarly, body  1634  is provided with circumferentially spaced apart wall cavities  1652   a  and  1652   b , each of which houses a novel second needle-engaging assembly  1654  which functions to engage needle  1478  to temporarily secure the needle in an advanced position within needle guide  1640 . 
         [0152]    Each needle-engaging assembly  1650  here comprises a body portion  1650   a  having first and second end portions  1657  and  1659 , respectively ( FIG. 69 ). First end portion  1657  comprises an elongated locking member  1657   a  that is received within and connected to the slotted portion  1661  of shuttle  1638  (see  FIG. 69 ), while second end portion  1659  uniquely comprises a rounded connector portion  1659   a . Connected to rounded connector portion  1659   a  and extending therefrom is a plurality of uniquely configured, angularly extending, spaced apart flexure arms  1660   a ,  1660   b  and  1660   c , each of which extends from body portion  1650   a  at a different angle and each of which terminates in a generally spherical shaped needle-engaging head  1662 . Each of the needle-engaging heads  1662  is receivable within a selected one of a multiplicity of circumferentially spaced-apart indentations  1664  formed in needle  1478 . 
         [0153]    In a manner presently to be described, the flexure arms of each needle-engaging assembly  1650  functions as a drive means for driving the suture needle  1478  along needle guide  1640  (see  FIGS. 68 and 70 ). 
         [0154]    In similar fashion, each needle-engaging assembly  1654  comprises a body  1654   a  having first and second end portions  1665  and  1667 , respectively. First end portion  1665  comprises an elongated locking member  1665   a  that is received within and connected to a slotted portion  1669  of body  1634  (see  FIG. 69 ), while second end portion  1667  uniquely comprises a rounded connector portion  1667   a . Connected to rounded connector portion  1667   a  and extending angularly therefrom is a plurality of uniquely configured spaced apart flexure arms  1670   a ,  1670   b  and  1670   c , each of which terminates in a generally spherical shaped needle-engaging head  1672 . Each of the needle-engaging heads  1672  extends from body  1654   a  at a different angle and each is receivable within a selected one of a multiplicity of circumferentially spaced-apart indentations  1664  formed in needle  1478 . 
         [0155]    As in the last described embodiment, sequential actuation and release of the trigger mechanism will cause the shuttle to sequentially move along the shuttle track between the first and second positions in the manner illustrated in  FIGS. 70 and 71 . More particularly, when the trigger of the trigger mechanism is actuated, the first operating cable  1506  will move the shuttle  1590  in a clockwise direction from the position shown in  FIG. 70  to the advanced position shown in  FIG. 71 . As this occurs, the biasing means, or return spring  1407   a  of the return mechanism  1407  which is connected to the reciprocally movable coupling mechanism, is extended as illustrated in  FIG. 9 . In its extended position, the extension spring acts upon the second operating cable  1508  tending to return it to its starting position and, in turn, tending to move the shuttle  1590  in a counterclockwise direction toward its starting position. To return the trigger to its starting position following trigger actuation, a compressible coil spring  1406   c  is provided. Spring  1406   c  which comprises a part of the trigger mechanism  1406 , is compressed in the manner shown in  FIG. 9  when the trigger is actuated and functions to return the trigger to its default or starting position shown in  FIG. 9  when pressure on the trigger is released. 
         [0156]    As before, movement of the shuttle  1638  along the shuttle track  1636  causes concomitant, controlled movement of the suture needle  1478  along needle guide  1640 . 
         [0157]    With the construction thus described, as the shuttle member  1638  is urged to move forwardly from the starting position shown in  FIG. 70  toward the advanced position shown in  FIG. 71 , the arms  1660   a ,  1660   b  and  1660   c  of the needle-engaging assembly  1650  will tend to flex in a manner to cause the head portion  1662  of at least one of the arms to be urged into driving engagement with the indentations  1664  formed in needle  1478  within which the head portions reside. This will cause the needle  1478  to move along with the shuttle member and penetrate the tissue disposed within the head opening. It is to be noted that because each of the arms extends from the body portion at a different angle, if the head portion of one of the arms slips out of driving engagement with one of the indentations  1664  formed in the needle, the head portion of the adjacent arm will move into driving engagement with one of the indentations  1664 . Upon release of the trigger, which tends to cause the shuttle to move counterclockwise toward the starting position due to the urging of the extension spring  1407   c , the arms  1670   a ,  1670   b  and  1670   c  of the needle-engaging assembly  1654  will, due to their configuration tend to flex in a manner to cause the head portions  1672  thereof to be urged into braking engagement with the spaced-apart indentations  1664  formed in needle  1478  within which the head portions reside, thereby resisting movement of said needle toward the first position. Uniquely, this will cause the needle  1478  to remain in its advanced position as the shuttle member returns to its starting position. 
         [0158]    Once again, it is to be noted that because each of the arms extends from body portion  1654   a  at a different angle, if the head portion of one of the arms slips out of driving engagement with one of the indentations  1664  formed in the needle the head portion of the adjacent arm will move into driving engagement with one of the indentations  1664 . When the trigger is once again actuated, the shuttle member  1638  will again move in a clockwise direction causing the head portions  1662  of the arms of the needle-engaging assembly  1650  to once again grip and further advance the suturing needle. As the process is repeated, the needle will continue to advance in a clockwise direction along the needle guide  1640  so that the suturing can be controllably and efficiently completed. 
         [0159]    The various mechanisms of this latest form of the invention which cooperate to move the suture head  1634  of the device from a first angularly upward position to a second downward position relative to the barrel assembly  1464  are of identical construction and operation to those illustrated in  FIGS. 45 through 50 . 
         [0160]    Having now described the invention in detail in accordance with the requirements of the patent statutes, those skilled in this art will have no difficulty in making changes and modifications in the individual parts or their relative assembly in order to meet specific requirements or conditions. Such changes and modifications may be made without departing from the scope and spirit of the invention, as set forth in the following claims.