Abstract:
A suture passer comprising: a handle; a first needle mounted to the handle; a retrieving loop selectively extendable out of, and selectively retractable into, the first needle; a second needle mounted to the handle, the second needle being configured to pass suture therethrough; a housing having first and second lumens extending therethrough for receiving the first and second needles therein, respectively; wherein the suture passer is configured so that the first and second needles have (i) a first distance therebetween at the location at which the first and second needles pass through the housing, and (ii) a second distance therebetween at a location remote from the housing, and further wherein the second distance is greater than the first distance.

Description:
REFERENCE TO PENDING PRIOR PATENT APPLICATION 
       [0001]    This patent application claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 61/976,842, filed Apr. 8, 2014 by Quantum Medical Innovations, LLC and Glen Jorgensen et al. for SUTURE PASSER (Attorney&#39;s Docket No. JORGEN-4 PROV), which patent application is hereby incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates to surgical apparatus and methods in general, and more particularly to surgical apparatus and methods for passing suture. 
       BACKGROUND OF THE INVENTION 
       [0003]    A hernia occurs when part of an internal organ, most often the intestines, protrudes through an abnormal opening or weakening in the wall surrounding the abdominal cavity. 
         [0004]    There are four main types of abdominal hernias: (1) Inguinal Hernia—a bulge in the groin; (2) Femoral or Ventral Hernia—a bulge in the groin that appears between the navel and the breastbone; (3) Umbilical Hernia (newborn-related or paraumbilical hernia)—a bulge in the navel area; and (4) Incisional Hernia—a bulge in the stomach and navel area that is usually caused by a prior surgical incision in the area. A hernia is called reducible if the bulge can be manipulated back into place inside the abdomen. A hernia is called irreducible or incarcerated when the hernia cannot be reduced, e.g., because adhesions have formed in the internal sac. A hernia is characterized as strangulated if part of the herniated intestine becomes twisted or edematous (swollen), causing serious complications. 
         [0005]    Hernia repairs are sometimes subdivided into two classes, laparoscopic repair and open repair, both of which are accomplished by strengthening the defect with a synthetic hernia mesh. In the case of open repair, an incision is made in the vicinity of the defect to expose the defect area such that the hernia mesh can be attached to surrounding tissue (e.g., with sutures and/or tacks). In the case of laparoscopic repair, instruments and internal cameras specially designed for the intricate procedure make minimally invasive internal repair possible. Laparoscopic repair typically involves inserting the hernia mesh into the abdominal cavity through a small instrument port (sometimes referred to as an access cannula or a trocar) and then attaching the hernia mesh to the distal side of the defect with sutures and/or tacks, whereby to strengthen the defect. This type of hernia repair typically results in less pain for the patient and faster recovery times. 
         [0006]    Fixation of the hernia mesh over the defect is required for both open repair and laparoscopic repair in order to avoid postoperative migration of the hernia mesh. Fixation of the hernia mesh to the abdominal wall is generally accomplished using sutures and/or tacks. 
         [0007]    Currently, single-needle suture passers are generally used to pass sutures through the abdominal wall and the hernia mesh. These single-needle suture passers typically comprise a hook-and-clasp piercing tip that releasably secures the suture to the needle with a clasping detail that opens as the hook-and-clasp piercing tip is extended distally from the needle and closes when the hook-and-clasp piercing tip is withdrawn back into the needle. See  FIGS. 1 and 2 . 
         [0008]    For each suture (typically referred to as a “securing suture”), the abdominal cavity is pierced twice: (1) the first time at a first location to pass (antegrade) a first end of a securing suture from outside the body, through the abdominal wall, through the hernia mesh, and then release the first end of the securing suture within the abdominal cavity; and (2) the second time at a second, laterally-spaced location to retrieve the first end of the securing suture and to pass it (retrograde) back through the hernia mesh and abdominal wall to a point outside the body. By laterally spacing the location of the second needle penetration from the location of the first needle penetration, a portion of the securing suture will extend along a portion of the hernia mesh so as to securely engage the hernia mesh. The surgeon then ties the first end of the securing suture to a second end of the securing suture, thereby securing the hernia mesh to the abdominal wall. 
         [0009]    In some cases the hernia mesh may be “pre-equipped” with one or more “positioning sutures”, wherein the positioning sutures have been secured to the hernia mesh prior to the hernia mesh being inserted into the abdominal cavity. In this situation, after the hernia mesh has been positioned inside the abdominal cavity, a single-needle suture passer is passed (antegrade) from the region outside the body through the abdominal wall and through the hernia mesh, then the suture passer is used to grasp the free end of the positioning suture (see  FIGS. 3 and 4 ) and pull it back through the hernia mesh and the abdominal wall, so that the surgeon may thereafter use the positioning suture to hold the hernia mesh in position against the abdominal wall while securing sutures are set and tied down in the manner previously described. 
         [0010]    Improvements are needed to eliminate the time required for the aforementioned double-piercing operation when setting securing sutures using single-needle suture passers, and for ensuring the accurate placement of the first and second needle penetrations by the single-needle suture passers so as to facilitate proper positioning of the securing sutures. These improvements include the use of a twin-needle, single-penetration approach that employs a twin-needle suture passer having a first needle to pass the securing suture into the abdominal cavity and a second needle to retrieve the securing suture from the abdominal cavity. However, the twin-needle suture passers developed to date tend to suffer from a variety of limitations. 
         [0011]    To be more broadly accepted, (i) the twin needles should enter the abdominal cavity through a small (e.g., 3 mm) incision and then controlled to open to a larger spread (e.g., 10 mm) as the needles pass through the hernia mesh; (ii) the device should be easily reloaded with multiple securing sutures throughout the procedure; (iii) the device should be easily adaptable from a twin-needle suture passer for deploying multiple securing sutures to a single-needle suture retriever for grasping the loose ends of positioning sutures and pulling them back through the hernia mesh and the abdominal wall; and (iv) the device should include an added safety feature to cover the sharp tips of the needles until the sharp tips are disposed in the abdomen, whereby to protect medical personnel as the device is passed to and from the surgeon. 
       SUMMARY OF THE INVENTION 
       [0012]    The present invention comprises the provision and use of a novel twin-needle, single-penetration approach that employs a twin-needle suture passer having a first needle to pass suture into the abdominal cavity and a second needle to retrieve suture from the abdominal cavity. In accordance with the present invention, (i) the twin needles are configured to enter the abdominal cavity through a small (e.g., 3 mm) incision and then controlled to open to a larger spread (e.g., 10 mm) as the needles pass through the hernia mesh; (ii) the device is easily reloaded with multiple securing sutures throughout the procedure; (iii) the device is easily adaptable from a twin-needle suture passer for deploying multiple securing sutures to a single-needle suture retriever for grasping the loose ends of positioning sutures and pulling them back through the hernia mesh and the abdominal wall; and (iv) the device includes an added safety feature to cover the sharp tips of the needles until the sharp tips are disposed in the abdomen, whereby to protect medical personnel as the device is passed to and from the surgeon. 
         [0013]    In one preferred form of the invention, there is provided a twin-needle suture passer configured to pass suture through at least one object by passing a first end of a suture through a first needle which has been passed through the at least one object and then passing the first end of the suture through a pre-formed loop that selectively slidably protrudes from a second needle which has been passed through the at least one object, wherein withdrawing the pre-formed loop back into the second needle after the first end of the suture has been passed through the pre-formed loop captures the first end of the suture to the second needle, such that when both needles are withdrawn back through the at least one object, the first end of the suture is withdrawn back through the at least one object and is positioned to be joined to a second end of the suture, 
         [0014]    wherein the first and second needles are configured, and passed through a housing, such that the first and second needles have (i) a first distance therebetween at the location at which the first and second needles pass through the at least one object, and (ii) a second distance therebetween at the location at which the first end of the suture passes through the pre-formed loop, and further wherein the second distance is greater than the first distance. 
         [0015]    In another preferred form of the invention, there is provided a method for passing suture, the method comprising: 
         [0016]    providing a twin-needle suture passer configured to pass suture through at least one object by passing a first end of a suture through a first needle which has been passed through the at least one object and then passing the first end of the suture through a pre-formed loop that selectively slidably protrudes from a second needle which has been passed through the at least one object, wherein withdrawing the pre-formed loop back into the second needle after the first end of the suture has been passed through the pre-formed loop captures the first end of the suture to the second needle, such that when both needles are withdrawn back through the at least one object, the first end of the suture is withdrawn back through the at least one object and is positioned to be joined to a second end of the suture, 
         [0017]    wherein the first and second needles are configured, and passed through a housing, so that the first and second needles have (i) a first distance therebetween at the location at which the first and second needles pass through the at least one object, and (ii) a second distance therebetween at the location at which the first end of the suture passes through the pre-formed loop, and further wherein the second distance is greater than the first distance; 
         [0018]    passing at least the second needle through the at least one object, extending the pre-formed loop out of the second needle, and passing the first end of the suture through the pre-formed loop; 
         [0019]    retracting the pre-formed loop into the second needle; and 
         [0020]    retracting the second needle from the at least one object. 
         [0021]    In another preferred form of the invention, there is provided a suture passer comprising: 
         [0022]    a handle; 
         [0023]    a first needle mounted to the handle; 
         [0024]    a retrieving loop selectively extendable out of, and selectively retractable into, the first needle; 
         [0025]    a second needle mounted to the handle, the second needle being configured to pass suture therethrough; 
         [0026]    a housing having first and second lumens extending therethrough for receiving the first and second needles therein, respectively; 
         [0027]    wherein the suture passer is configured so that the first and second needles have (i) a first distance therebetween at the location at which the first and second needles pass through the housing, and (ii) a second distance therebetween at a location remote from the housing, and further wherein the second distance is greater than the first distance. 
         [0028]    In another preferred form of the invention, there is provided a method for passing suture, the method comprising: 
         [0029]    providing a suture passer comprising:
       a handle;   a first needle mounted to the handle;   a retrieving loop selectively extendable out of, and selectively retractable into, the first needle;   a second needle mounted to the handle, the second needle being configured to pass suture therethrough;   a housing having first and second lumens extending therethrough for receiving the first and second needles therein, respectively;   wherein the suture passer is configured so that the first and second needles have (i) a first distance therebetween at the location at which the first and second needles pass through the housing, and (ii) a second distance therebetween at a location remote from the housing, and further wherein the second distance is greater than the first distance;       
 
         [0036]    passing the first needle through at least one object, extending the retrieving loop out of the first needle, and passing the first end of the suture through the retrieving loop; 
         [0037]    retracting the retrieving loop into the first needle; and 
         [0038]    retracting the first needle from the at least one object. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0039]    These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein: 
           [0040]      FIGS. 1 and 2  are schematic views showing a prior art single-needle suture passer retrieving a securing suture in the course of a hernia repair procedure; 
           [0041]      FIGS. 3 and 4  are schematic views showing a prior art single-needle suture passer retrieving a positioning suture in the course of a hernia repair procedure; 
           [0042]      FIGS. 5-8  are schematic views showing a novel suture passer formed in accordance with the present invention; 
           [0043]      FIGS. 9-11  are schematic views showing the novel suture passer of  FIGS. 5-8  being used to retrieve a positioning suture; 
           [0044]      FIGS. 12-16  are schematic views showing the novel suture passer of  FIGS. 5-8  being used to pass and retrieve a securing suture; and 
           [0045]      FIG. 17  is a schematic view showing an alternative form of nose cone for use with the novel suture passer of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0046]    The present invention comprises the provision and use of a novel twin-needle, single-penetration approach that employs a twin-needle suture passer having a first needle to pass suture into the abdominal cavity and a second needle to retrieve suture from the abdominal cavity. In accordance with the present invention, (i) the twin needles are configured to enter the abdominal cavity through a small (e.g., 3 mm) incision and then controlled to open to a larger spread (e.g., 10 mm) as the needles pass through the hernia mesh; (ii) the device is easily reloaded with multiple securing sutures throughout the procedure; (iii) the device is easily adaptable from a twin-needle suture passer for deploying multiple securing sutures to a single-needle suture retriever for grasping the loose ends of the positioning sutures and pulling them back through the hernia mesh and the abdominal wall; and (iv) the device includes an added safety feature to cover the sharp tips of the needles until the sharp tips are disposed in the abdomen, whereby to protect medical personnel as the device is passed to and from the surgeon. 
         [0047]    Looking first at  FIGS. 5-8 , there is shown a suture passer  100  formed in accordance with the present invention. Suture passer  100  generally comprises a handle  105 , a retrieving needle  110  fixedly mounted to handle  105 , a suture needle  115  movably mounted to handle  105 , and a nose cone  120  movably mounted on retrieving needle  110  and suture needle  115 . 
         [0048]    Retrieving needle  110  comprises a shaft  125  having a distal end  130 , a proximal end  135  and a lumen  140  ( FIGS. 11 and 16 ) extending therethrough. Distal end  130  of retrieving needle  110  terminates in a sharp distal tip  145 . Proximal end  135  of retrieving needle  110  is secured to handle  105 . A retrieving shaft  150  ( FIGS. 7 ,  11  and  16 ) is movably mounted in lumen  140  of retrieving needle  110 . A retrieving loop  155  ( FIGS. 10 ,  11 ,  15  and  16 ) is secured to the distal end of retrieving shaft  150 . 
         [0049]    Retrieving loop  155  preferably comprises a loop end  157  ( FIGS. 11 and 16 ) having a generous radius which mitigates stress cracking during repeated flexing throughout the repair procedure and which provides a shape detail into which the securing suture/positioning suture can be secured, as will hereinafter be discussed in greater detail. A retrieving knob  160  is secured to the proximal end of retrieving shaft  150 . Retrieving knob  160  rides in a retrieving knob slot  165  formed in handle  105 . On account of the foregoing construction, distal movement of retrieving knob  160  in retrieving knob slot  165  causes retrieving shaft  150  to move distally in lumen  140  of retrieving needle  110  so that retrieving loop  155  projects out the distal end  130  of retrieving needle  110  ( FIGS. 10 ,  11 ,  15  and  16 ), and proximal movement of retrieving knob  160  in retrieving knob slot  165  causes retrieving shaft  150  to move proximally in lumen  140  of retrieving needle  110  so that retrieving loop  155  is retracted into the distal end  130  of retrieving needle  110  ( FIGS. 5 ,  9  and  12 - 14 ). 
         [0050]    Suture needle  115  comprises a shaft  170  having a distal end  175 , a proximal end  180  and a lumen  185  ( FIG. 16 ) extending therethrough. Distal end  175  of suture needle  115  terminates in a sharp distal tip  190 . Proximal end  180  of suture needle  115  is mounted to a suture needle mounting carriage  195  which is movably mounted within handle  105 . A suture needle knob  200  is secured to suture needle mounting carriage  195 . Suture needle knob  200  rides in a suture needle knob slot  205  formed in handle  105 . On account of the foregoing construction, distal movement of suture needle knob  200  in suture needle knob slot  205  causes suture needle mounting carriage  195  to move distally within handle  105 , whereby to move suture needle  115  distally relative to handle  105  (FIGS.  5  and  12 - 16 ), and proximal movement of suture needle knob  200  in suture needle knob slot  205  causes suture needle mounting carriage  195  to move proximally in handle  105 , whereby to move suture needle  115  proximally relative to handle  105  ( FIGS. 9-11 ). Note that when suture needle knob  200  is moved fully distal in suture needle knob slot  205 , sharp distal tip  190  of suture needle  115  is substantially aligned with sharp distal tip  145  of retrieving needle  110  (FIGS.  5  and  13 - 16 ). Note also that when suture needle knob  200  is moved fully distal in suture needle knob slot  205 , suture needle  115  is releasably locked in its fully distal position by a spring-loaded locking feature  207  which is mounted to slidable suture needle mounting carriage  195  and releasably interacts with adjacent portions of handle  105  (spring-loaded locking feature  207  is released from its locking engagement with adjacent portions of handle  105  by pressing inwardly on suture needle knob  200 , against the power of its associated spring). A suture feed funnel  210  formed in the proximal end of handle  105  allows a securing suture  215  to be advanced distally through suture feed funnel  210  and into lumen  185  ( FIG. 16 ) of suture needle  115 . 
         [0051]    Suture needle  115  comprises an arc-shaped cut-away  220  formed intermediate its length. A suture feed knob  225  is aligned with arc-shaped cut-away  220  in suture needle  115 , but suture feed knob  225  is spring-biased away from arc-shaped cut-away  220  by a spring  230 . The power of spring  230  may be overcome by the thumb or finger of a surgeon so as to force suture feed knob  225  through arc-shaped cut-away  220  and into lumen  185  of suture needle  115 , whereby to allow a surgeon to use rotation of suture feed knob  225  to manually urge securing suture  215  distally within suture needle  115 . 
         [0052]    Retrieving needle  110  and suture needle  115  are configured (e.g., bent) so that when suture needle  115  is in its distal position and nose cone  120  abuts handle  105  ( FIGS. 13-16 ), the sharp distal tips  145 ,  190  of retrieving needle  110  and suture needle  115  diverge from one another. In one preferred form of the invention, when suture needle  115  is in its distal position and nose cone  120  abuts handle  105  ( FIGS. 13-16 ), the sharp distal tips of retrieving needle  110  and suture needle  115  are positioned approximately 10 mm apart from one another. 
         [0053]    Nose cone  120  is movably mounted on retrieving needle  110  and suture needle  115 . More particularly, nose cone  120  comprises a distal tip  232  ( FIGS. 9 ,  10  and  12 ), a lumen  235  ( FIGS. 10 and 12 ) for slidably receiving retrieving needle  110  and a lumen  240  ( FIGS. 10 and 12 ) for slidably receiving suture needle  115 . Lumen  235  and lumen  240  are disposed parallel to one another. In one preferred form of the invention, lumen  235  and lumen  240  are disposed so that their outermost walls are set approximately  3  mm apart. On account of the foregoing construction, when suture needle  115  is in its distal position and nose cone  120  is moved distally ( FIG. 12 ), retrieving needle  110  and suture needle  115  can be forced into a substantially parallel configuration; and when suture needle  115  is in its distal position and nose cone  120  is moved proximally, e.g., into engagement with handle  105 , retrieving needle  110  and suture needle  105  can assume their aforementioned diverging configuration ( FIGS. 13-16 ). 
         [0054]    In one preferred form of the invention, suture passer  100  is packaged and shipped with its suture needle  115  in its distal position, with retrieving loop  155  retracted into the interior of retrieving needle  110 , and with nose cone  120  moved distally ( FIG. 12 ), so that nose cone  120  shields the sharp distal tips  145 ,  190  of needles  110 ,  115  from accidental contact with medical personnel. 
         [0055]    The suture passer of the present invention may be advantageously used with at least the following two modes of operation (although other modes of operation are also contemplated). 
       First Mode Of Operation 
       [0056]    The first mode of operation relates to suture retrieval (e.g., retrieval of the positioning suture), and will sometimes hereinafter be referred to as “the suture retrieving mode”. 
         [0057]    In this form of the invention, under the direct observation of an endoscope which has been previously inserted into the insulflated abdominal cavity, an appropriately-sized sheet of hernia mesh, which is presented in a rolled-up condition, is inserted into the abdominal cavity, whereupon the roll of hernia mesh is unrolled and centered on the hernia defect. The unrolled hernia mesh has been previously prepared for preliminary anchoring in this position by providing positioning sutures  245  that are secured to each corner of the hernia mesh. 
         [0058]    Suture passer  100  is prepared for the retrieval of the positioning sutures  245  ( FIG. 11 ) by placing it into the configuration shown in  FIG. 9 , i.e., suture needle  115  (not shown in  FIG. 9 ) is withdrawn into handle  105  by sliding suture needle knob  200  proximally in its suture needle slot  205 , and by sliding nose cone  120  proximally into engagement with handle  105 . At this point, retrieving loop  155  (not shown in  FIG. 9 ) is retracted into retrieving needle  110 . 
         [0059]    With suture passer  100  in this configuration, retrieving needle  110  is inserted, antegrade, through the abdominal wall, through the hernia mesh, and into the abdominal cavity. Then pre-formed retrieving loop  155  is extended from retrieving needle  110  as shown in  FIG. 10 , i.e., by sliding retrieving knob  160  forward (i.e., distally) in its retrieving knot slot  165 . Retrieving loop  155  is positioned in a manner that allows the retrieving loop to “lasso” the free end of a positioning suture  245  ( FIG. 11 ). To facilitate retrieval, retrieving loop  155  is fabricated from a metal (e.g., superelastic Nitinol) ribbon and constrained rotationally within retrieving needle  110 , such that a pre-formed bend in the metal ribbon consistently positions the retrieving loop  155  at an angle generally normal to the sharpening plane of the sharp distal tip  145  of retrieving needle  110 , as shown in  FIG. 11 . The metal ribbon is preferably further split and formed into the looped-shape shown in  FIG. 11 , with care being taken to provide a generous radius at the loop end  157  which mitigates stress cracking during repeated flexing throughout the repair procedure and which provides a shape detail into which the positioning suture  245  can be secured. 
         [0060]    With positioning suture  245  disposed in retrieving loop  155 , retrieving knob  160  is moved proximally in retrieving knob slot  165  so that retrieving loop  155  is withdrawn into retrieving needle  110 , whereby to bind the positioning suture  245  to suture passer  100 . Suture passer  100  is then used to pull the positioning suture  245  back through the hernia mesh and the abdominal wall. The positioning suture  245  is then released from the suture passer  100 . 
       Second Mode Of Operation 
       [0061]    The second mode of operation relates to suture passing (e.g., passing a securing suture  215 ), and will sometimes hereinafter be referred to as “the suture passing mode”. 
         [0062]    In this form of the invention, under the direct observation of an endocope that has been previously inserted into the insulflated abdominal cavity, the hernia mesh is placed approximately centered on the defect by the positioning sutures  245  previously defined. To secure the hernia mesh in place, additional sutures (i.e., securing sutures  215 ) are placed equidistant around the periphery of the hernia mesh, and placed in other positions that require additional securement as identified by the surgeon. These securing sutures  215  are required to mechanically secure the hernia mesh against movement resulting from the body motions that are expected during the first few weeks after surgery. After that, the peritoneum tissue (a lining in the abdominal cavity) grows into the porous hernia mesh substrate at the beginning of the healing process until the in-grown tissue is sufficient in strength to hold the hernia mesh in position as the healing process is completed. 
         [0063]    To place a securing suture  215 , the surgeon first approximates the location by making a small (e.g., 3 mm) incision on the abdomen skin. Then the suture passer  100  is used to deploy a securing suture through the incision. More particularly, the suture passer  100  is initially in the configuration shown in  FIG. 12 , i.e., suture needle  115  is fully distally extended so that suture needle  115  extends alongside retrieving needle  110  (suture needle  115  is releasably locked in its full-forward axial position by spring-loaded locking feature  207  which is mounted to slidable suture needle mounting carriage  195 ) and sharp distal tips  145 ,  190  of two needles  110 ,  115  are safely covered by sliding nose cone  120 . 
         [0064]    The distal tip  232  of nose cone  120  is positioned into the small (e.g., 3 mm) incision in the abdominal skin. While supporting the nose cone  120  axially, the surgeon then uses handle  105  to drive both needles  110 ,  115  forward through the abdominal wall (including the tough fascia layers and the healing perineum lining), through the hernia mesh and into the abdominal cavity under the direct view of the endoscope ( FIG. 13 ). As the two needles  110 ,  115  extend distally out of nose cone  120 , their pre-bent shape causes the spacing between the two needle tips  145 ,  190  to diverge from an entry spacing of approximately 3 mm to an expanded spacing of approximately 10 mm, as shown in  FIG. 14 . Significantly, this divergence of the two needles  110 ,  115  allows the securing suture  215  to secure multiple strands of the hernia mesh with a single pass of the securing suture, which reduces the possibility of pullout of the securing suture  215  through the hernia mesh during recovery. At the same time, this is done through a small (e.g., 3 mm) sub-dermal incision in the abdominal wall that can be stitched closed with good cosmetic results. 
         [0065]    In preparation for passing the securing suture  215  through the abdominal wall, through the hernia mesh and back through the abdominal wall, retrieving loop  155  is then extended out of retrieving needle  110  by sliding retrieving knob  160  distally as shown in  FIG. 15 . The pre-bent shape of retrieving loop  155  positions the approximate center of retrieving loop  155  so as to be directly in line with the longitudinal axis of suture needle  115 . The first end of securing suture  215  is then inserted into the suture feed funnel  210  in the proximal end of handle  105  as shown in  FIG. 8  until the securing suture  215  is just short of the distal tip  190  of suture needle  115 . Note that at this point in the procedure, securing suture  215  passes easily along the interior of suture needle  115  inasmuch as suture feed knob  225  is spring-biased away from arc-shaped cut-away  220  via spring  230 . 
         [0066]    The securing suture  215  can then be fed forward through retrieving loop  155  using suture feed knob  225  as shown in  FIG. 16 . More particularly, securing suture  215  may be fed distally when suture feed knob  225  is depressed against the power of spring  230  (that pre-loads suture feed knob  225  into a normally non-contacting position) until the suture feed knob  225  extends through arc-shaped cut-away  220  and firmly contacts the securing suture loaded in suture needle  115 . When suture feed knob  225  is thereafter rolled, securing suture  215  is driven forward within lumen  185  of suture needle  115  until securing suture  215  extends through retrieving loop  155  ( FIG. 16 ). When suture feed knob  225  is released, the suture feed knob  225  returns to its normally non-contacting position relative to securing suture  215  and the securing suture is then free to slide in suture needle  115 . 
         [0067]    Retrieving loop  155 , with securing suture  215  passing therethrough, is then withdrawn into retrieving needle  110  by retracting retrieving knob  160  in retrieving knob slot  165 . At this point the securing suture  215  is secured to the suture passer  100 . 
         [0068]    Finally, with nose cone  120  held by hand against axial movement, handle  105  is withdrawn proximally. This action causes the first end of securing suture  215  to be pulled from the abdominal cavity to the space outside the body. Once the first end of the securing suture  215  is in the space outside the body, the first end of the securing suture  215  can be released from the suture passer  100  by sliding retrieving knob  160  forward (i.e., distally) so that retrieving loop  155  once again projects out of suture needle  115 , whereupon the first end of the securing suture  215  can be removed from retrieving loop  155 . At this point, the first end of the securing suture  215  is tied to the second end of the securing suture, completing the anchoring process. 
         [0069]    It should be appreciated that as retrieving loop  155  is pulled back within retrieving needle  110 , the securing suture  215  is secured against the flat of the needle tip  145 . It should also be appreciated that when both needles  110 ,  115  are withdrawn from the abdominal cavity, the securing suture  215  is pulled taut against the hernia mesh and the abdominal wall and then released. The surgeon now has both ends of a securing suture  215  that is ready to be tied off, with the knot being sub-dermally positioned into the incision. It should be noted that the insertion incision is as small as possible for healing and cosmetic reasons, and the two needles  110 ,  115  must enter the abdomen spaced apart about 3 mm so as to be contained in the incision. However, the two needles must also spread out to about 10 mm as they pass through the hernia mesh in order to secure multiple strands of the hernia mesh for strength and resistance to pull-out. 
       Alternative Configuration 
       [0070]    In the foregoing disclosure, needles  110 ,  115  are characterized as being pre-bent so as to flair outward to a spread of approximately 10 mm ( FIGS. 13-16 ) when the needles are in an unconstrained condition, and sliding nose cone  120  is characterized as having two parallel lumens  235 ,  240  so as to selectively constrain the two needles  110 ,  115  to a spread of approximately 3 mm ( FIGS. 5 and 12 ). However, if desired, other approaches may be used to cause needles  110 ,  115  to flair outward as they pass through nose cone  120  and into the abdominal wall and hernia mesh. By way of example but not limitation, needles  110 ,  115  may be formed with a straight configuration, and lumens  235 ,  240  in nose cone  120  may be formed with a diverging configuration (e.g., in the manner shown in  FIG. 17 ), so that needles  110 ,  115  will flair outward as they pass through nose cone  120  (e.g., from a spread of approximately 3 mm at nose cone  120  to a spread of approximately 10 mm at the surgical mesh). 
       Applications other than Hernia Repair 
       [0071]    In the foregoing description, suture passer  100  is discussed in the context of its use in a hernia repair procedure. However, it should be appreciated that suture passer  100  may be used in other types of procedures as well, e.g., for laparoscopic suturing, for arthroscopic suturing, etc. 
       Modifications of the Preferred Embodiments 
       [0072]    It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.