Abstract:
A needle for use with an endoscopic stitching device includes a first end portion that is movable relative to a second end portion to allow the needle to convert from a first, mis-aligned orientation to a second, aligned orientation, thereby allowing the length of the needle in the aligned orientation to exceed the height of an end effector.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of and priority to U.S. Provisional Patent Application No. 61/906,554, filed Nov. 20, 2013, the entire disclosure of which is incorporated by reference herein. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates to devices, systems, and methods for endoscopic suturing or stitching and, more particularly, to end effectors, systems and methods for endoscopic suturing and/or stitching through an access device such as a cannula. 
       BACKGROUND 
       [0003]    Increasingly, more and more surgical procedures are being performed through small openings (e.g., an incision or a natural opening) in the skin with the goal of reducing the invasiveness of the procedures. As compared to the larger openings typically required in traditional procedures, smaller openings result in less trauma to the patient. By reducing the trauma to the patient, the time required for recovery is also reduced. Generally, the surgical procedures that are performed through small openings in the skin are referred to as “endoscopic.” If the procedure is performed on the patient&#39;s abdomen, the procedure is referred to as “laparoscopic.” Throughout the present disclosure, the term “minimally invasive” is to be understood as encompassing both endoscopic and laparoscopic procedures. Cannulas can be utilized during a minimally invasive procedure to facilitate passage of endoscopic instruments. 
         [0004]    In many surgical procedures, including those involved in endoscopic surgery, it is often necessary to suture bodily organs or tissue. Endoscopic suturing procedures can be challenging due to the small openings through which the suturing of bodily organs or tissues must be accomplished. Typically, the dimensions of the needles of endoscopic stitching devices are restricted by spatial limitations of the cannulas utilized to introduce the stitching devices into the surgical site. 
         [0005]    It would be advantageous to have an end effector of an endoscopic stitching device that can be advanced through spatially limited access devices (e.g., cannulas) while supporting long needles. The advancement of stitching devices with long needles into surgical sites would enable a clinician to suture tissue with larger thickness as compared to stitching devices with short needles. 
       SUMMARY 
       [0006]    Various embodiments of endoscopic stitching needles for use with an endoscopic stitching device are described, wherein the needle includes a first end portion that is movable relative to a second end portion. Being movable, the first end portion of the needle can be in a first, mis-aligned orientation relative to the second end portion of the needle. The first end portion of the needle can then be moved into a second, aligned orientation relative to the second end portion of the needle. The first end portion of the needle is adapted to engage a first jaw member of the endoscopic stitching device and the second end portion is adapted to engage a second jaw member of the endoscopic stitching device. 
         [0007]    In embodiments of the needle, the first end portion pivots relative to the second end portion. 
         [0008]    In some embodiments of the needle, a connecting portion is disposed between the first and second end portions. The connecting portion may be formed of a flexible material adapted to enable the first end portion to pivot relative to the second end portion. 
         [0009]    In embodiments of the needle, the first end portion includes a locking feature and the second end portion includes a mating feature. 
         [0010]    In certain embodiments of the needle, the connecting portion includes a first arm member that extends from the first end portion and a second arm member that extends from the second end portion. The first arm member may be secured to the second arm member by a pivot pin. 
         [0011]    In embodiments of the needle, the first arm member includes the locking feature and the second arm member includes the mating feature. The locking feature and the mating feature are configured to selectively engage each other to at least temporarily lock the first and second end portions of the needle in an aligned configuration. 
         [0012]    In certain embodiments of the needle, the first and second end portions are separate, and the first end portion of the needle is adapted to connect to the second end portion of the needle. The locking feature and the mating feature can be adapted to connect to form the first and second end portions into a unitary arrangement. The first and second end portions can be movable relative to each other between a first, misaligned position and a second, aligned position. In embodiments, the first and second end portions are adapted to connect in the second, aligned position. 
         [0013]    In embodiments of the needle, the first end portion is adapted to receive the second end portion. The first end portion and the second end portion can support a compressible element adapted to enable the first and second end portions to move between a first, compressed position and a second, extended position. The compressible element can include at least one of a spring and a gas. 
         [0014]    According to one aspect, an endoscopic stitching device includes an end effector and a needle. 
         [0015]    The end effector of the endoscopic stitching device includes a first jaw member and a second jaw member. The first jaw member is movable relative to the second jaw member between an open state and a closed state. The end effector defines a height in the closed state that is measured between a bottom-most surface of the end effector and a top-most surface of the end effector. 
         [0016]    In some embodiments, the needle defines a working length that is greater than the height of the end effector. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein: 
           [0018]      FIG. 1  is a perspective view of an embodiment of an endoscopic stitching device in accordance with the present disclosure; 
           [0019]      FIG. 2A  is a side view of a distal end portion of an embodiment of an end effector of the endoscopic stitching device of  FIG. 1 , the end effector shown in an insertion state and supporting an embodiment of a needle of the present disclosure, the needle being shown in an unlocked state; 
           [0020]      FIG. 2B  is a side view of the distal end portion of the end effector of  FIG. 2A  shown in a stitching state and supporting the needle of  FIG. 2A  in a locked state; 
           [0021]      FIG. 2C  is a side view of the distal end portion of the end effector of  FIGS. 2A and 2B  shown in an open state and supporting the needle of  FIG. 2A  in the locked state; 
           [0022]      FIG. 3A  is an enlarged, perspective view illustrating the needle of  FIGS. 2A and 2B  in a locked state; 
           [0023]      FIG. 3B  is a perspective view of the needle of  FIG. 3A  shown in an unlocked state; 
           [0024]      FIG. 4A  is a perspective view of another embodiment of a needle shown in an unbent configuration; 
           [0025]      FIG. 4B  is a perspective view of the needle of  FIG. 4A  shown in a bent configuration; 
           [0026]      FIG. 5  is a side, perspective view of a distal end portion of another embodiment of an end effector of the endoscopic stitching device of  FIG. 1  in an open state, this embodiment of the end effector shown supporting another embodiment of a needle in accordance with the present disclosure; 
           [0027]      FIGS. 6A-6C  are progressive, front, cross-sectional views illustrating the end effector of  FIG. 5  coupling first and second end portions of the needle of  FIG. 5 ; 
           [0028]      FIG. 7  is a side, cross-sectional view of the embodiment of the end effector of  FIG. 5  supporting another embodiment of a needle in accordance with the present disclosure; 
           [0029]      FIG. 8A  is a side view, in partial cross-section, of another embodiment of an end effector of the endoscopic stitching device of  FIG. 1  in an open state supporting another embodiment of a needle in accordance with the present disclosure, the needle being shown in an extended position; and 
           [0030]      FIG. 8B  is a side view, in partial cross-section, of a distal end portion the end effector shown in  FIG. 8A  in a closed state supporting the needle of  FIG. 8A , the needle being shown in a compressed position. 
       
    
    
     DETAILED DESCRIPTION 
       [0031]    Minimally invasive suturing devices in accordance with the present disclosure enable the use of a needle that is longer than a width of a suturing device and/or an access device used to deliver the suturing device to the surgical site. Delivery of such a relatively long needle is achieved by moving a first portion of the needle relative to a second portion of the needle in a first direction to reduce a profile of the needle from a suturing state to an insertion state. In the insertion state of the needle, the needle can be retained by an end effector of the suturing device while the end effector is disposed in a first, insertion position. Once delivered to the surgical site, the needle can be reoriented to the suturing state, e.g., by moving the first portion of the needle in a second direction relative to the second portion of the needle where the second direction is opposite the first direction. When in the suturing state, minimally invasive suturing can be achieved by passing the needle back and forth between opposed jaw members of the end effector in a conventional manner. 
         [0032]    For a more detailed description of suitable endoscopic surgical devices, systems, and methods for use with the various end effectors and needles described herein, reference can be made, for example, to U.S. Pat. No. 8,337,515 and to U.S. Patent Application Publication No. 2009/0312773, the entire contents of each of which are incorporated herein by reference. Details of various embodiments of minimally invasive suturing devices in accordance with the present disclosure will now be described in detail. 
         [0033]    As used in the following detailed description, the term “clinician” refers to a doctor, nurse, or other health care provider and may include support personnel. The terms “proximal” or “trailing” each refer to a portion of a structure closer to a clinician, and the terms “distal” or “leading” each refer to a portion of a structure farther from the clinician. 
         [0034]    Referring now in specific detail to the drawings, in which like reference numbers identify similar or identical elements,  FIG. 1  illustrates an endoscopic stitching device, shown generally at  10 . Endoscopic stitching device  10  includes a handle assembly  20  with an actuator  22 , a trigger  24 , and/or other suitable actuating mechanism (e.g., a robot, etc.). As can be appreciated, actuator  22  can be any suitable slide, knob, button, or the like. An elongate tubular body portion  30  extends distally from handle assembly  20  and defines a longitudinal axis “L” that extends through proximal and distal end portions of elongate tubular body portion  30 . An end effector  100  is supported on the distal end portion of elongate tubular body portion  30  and can be remotely operable by handle assembly  20 . End effector  100  is adapted to be particularly useful in endoscopic or laparoscopic procedures wherein an endoscopic portion of the stitching device, i.e., end effector  100 , is insertable into a surgical site, via an access device (e.g., cannula) (not shown) or the like. 
         [0035]      FIGS. 2A-2C  illustrate the details of end effector  100 . End effector  100  has a top-most surface  110   a  and a bottom-most surface  110   b  and is adapted to move between a closed state ( FIG. 2A ), a stitching state ( FIG. 2B ), and an open state ( FIG. 2C ). In the closed state, end effector  100  defines a height “h” that is measured between top-most surface  110   a  and bottom-most surface  110   b.  End effector  100  includes a first jaw member  110  and a second jaw member  120  that are pivotably coupled by a pin  130 . Each jaw member  110 ,  120  releasably supports a surgical needle such as a surgical needle  200 , described in greater detail below. As seen in  FIGS. 2B and 2C , a suture “S” can be secured to the needle, using any conventional method, before insertion of end effector  100  into the surgical site or shortly after insertion of end effector  100  into the surgical site. For example, the suture “S” can be secured to any of the presently described needles by tying and/or knotting the suture “S” to a respective one of the needles (e.g., by looping around an outer surface of the respective needle). Alternatively, and or additionally, any of the presently described needles can define any number of apertures (not shown) into and/or through which suture “S” may be secured. 
         [0036]    First jaw member  110  defines a first needle receiving recess  112  and second jaw member  120  defines a second needle receiving recess  122 . Each needle receiving recess  112 ,  122  is adapted to receive an end portion of a needle (e.g., needle  200 ) in releasable friction fit relation. As illustrated in  FIGS. 2A and 2B , upon opening of end effector  100  from the closed state to the stitching state, second needle receiving recess  122  is dimensioned to cam the surgical needle from an insertion position or unlocked state, where the surgical needle can be compressed or bent, to a stitching position or locked state, where the surgical needle is extended or elongated and at least temporarily locked. 
         [0037]    As described in U.S. Pat. No. 8,337,515 referenced above and as shown in  FIGS. 2A and 2C , each of first and second jaw members  110 ,  120  can support a grasping member  160  such as grasping members  162 ,  164 . Grasping members  162 ,  164  are axially movable, as indicated by arrows “a” and “b,” to enable a needle to be passed back and forth between the first and second jaw members  110 ,  120 . More particularly, to enable a needle to be passed back and forth between first and second jaw members  110 ,  120 , each grasping member  162 ,  164  can releasably engage an opposite end portion of a needle, alternately with the other grasping member  162 ,  164 . As can be appreciated, any of the presently described needles can define a single opening that extends between opposite end portions of the needle, and, in some embodiments, the presently described needles can define one or more openings on opposed ends of the respective needles such that grasping members  162 ,  164  can secure a needle to one of jaw members  110 ,  120  when a respective one of grasping members  162 ,  164  is engaged with a respective one of the opening(s). 
         [0038]    As seen in  FIG. 2C , end effector  100  includes a guide member  140  that defines an opening  142 . With continued reference to  FIGS. 2A-2C , guide member  140  is operatively coupled to second jaw member  120  and is selectively axially movable along second jaw member  120 , as indicated by arrow “c,” between proximal and distal positions, including various intermediate positions. Guide member  140  can be operatively coupled to an actuation mechanism  150 . Actuation mechanism  150  includes a shaft member  152  (e.g., a cable) having a distal end portion that is coupled to the guide member  140  and a proximal end portion that is coupled to actuator  22  ( FIG. 1 ) of the handle assembly  20  such that an actuation of actuator  22  translates shaft member  152  to cause guide member  140  to translate between the proximal and distal positions. 
         [0039]    In embodiments, actuation mechanism  150  can include any suitable mechanical and/or electrical component adapted to impart axial translation to guide member  140 . For example, actuation mechanism  150  can include any number of springs, levers, gears, cables, electrical circuitry, and the like that are adapted to cooperate to translate guide member  140  between the proximal and distal positions. 
         [0040]      FIGS. 3A and 3B  illustrate an embodiment of a needle, shown generally as  200 , for use with an end effector of an endoscopic stitching device such as end effector  100 . As depicted in  FIG. 2C , each of the presently described needles, including needle  200 , defines a working length “WL” and each is adapted to support a suture “S” for effectuating a suturing procedure, which, as described above, can be secured to any of the presently described needles in any conventional manner. 
         [0041]    The working length “WL” of the any of the presently described needles can be any suitable dimension. In some embodiments, the working length “WL” is greater than height “h” (see  FIGS. 2A and 2C ) of any of the presently described end effectors in the closed state. In other embodiments, the working length “WL” is less than or equal to height “h” of any of the presently described end effectors in the closed state. 
         [0042]    With reference to  FIG. 3A , needle  200  includes a first end portion  210  and a second end portion  220  that are operatively coupled together. First end portion  210  includes a first body  210   a  having a first tip end  210   b  and a first support end  210   c.  First end portion  210  includes a first arm  212  that extends from first support end  210   c  so as to be cantilevered from first end portion  210 . First arm  212  may be integrally formed with, or separately connectable to, first support end  210   c  of first body  210   a.  Although shown extending from a central portion of first support end  210   c,  first arm  212  can extend from any suitable portion of first support end  210   c.  First arm  212  defines a first pin receiving passage  212   a  and includes a mating or locking feature  214  (e.g., a recess, adhesive, protuberance, or the like). 
         [0043]    With continued reference to  FIG. 3A , second end portion  220  includes a second body  220   a  having a second tip end  220   b  and a second support end  220   c.  Second end portion  220  includes a second arm  222  that extends from second support end  220   c  so as to be cantilevered from second end portion  220 . Second arm  222  may be integrally formed with, or separately connectable to, second support end  220   c.  Although shown extending from a bottom portion of second support end  220   c,  second arm  222  can extend from any suitable portion of second support end  220   c.  Second arm  222  includes a mating or locking feature  224  (e.g., a recess, adhesive, protuberance, or the like) and defines a second pin receiving passage  222   a  that is identical to first pin receiving passage  212   a.  As can be appreciated, mating or locking feature  224  of second end portion  220  is complementary to mating or locking feature  214 . 
         [0044]    As seen in  FIGS. 3A and 3B , first and second arms  212 ,  222  of needle  200  are positioned in an offset and/or overlapping arrangement and secured together by a pin  230  that extends through first and second pin receiving passages  212   a,    222   a  of respective first and second arms  212 ,  222  to enable relative pivotal movement between first and second arms  212 ,  222 . 
         [0045]    The needle  200  is positionable between a locked state ( FIG. 3A ) and an unlocked state ( FIG. 3B ) upon relative pivoting movement between first and second end portions  210 ,  220 . In the locked state, mating or locking feature  214  of first end portion  210  is engaged with mating or locking feature  224  of second end portion  220  so that first end portion  210  and second end portion  220  are releasably locked together, at least temporarily, in an elongated arrangement. In the unlocked state, mating or locking feature  214  of first end portion  210  is disengaged from mating or locking feature  224  of second end portion  220  and one or both of first and second end portions  210 ,  220  are adapted to pivot about pin  230  relative to the other of first and second end portions  210 ,  220 . As can be appreciated, one or both of first and second end portions  210 ,  220  is/are pivoted, away from the other of first and second end portions  210 ,  220 , about pin  230 , and toward the elongated arrangement to position needle  200  in the locked state. By comparison, one or both of first and second end portions  210 ,  220  is/are pivoted, toward the other of first and second end portions  210 ,  220 , about pin  230 , and away from the elongated arrangement. 
         [0046]    With reference to  FIGS. 4A and 4B , another embodiment of a needle, shown generally as  300 , is provided that can be used with an end effector of an endoscopic stitching device such as end effector  100 . Needle  300  includes a pair of end portions  310  connected by a connection portion  320  having a pair of opposed ends  320   a,    320   b.  Each end portion of the pair of end portions  310  includes a body  310   a  having a tip end  310   b  and a support end  310   c.  Each of the opposed ends  320   a,    320   b  of connection portion  320  is secured to a support end  310   c  of one of the pair of end portions  310  to couple the pair of end portions  310  together. Connection portion  320  (and/or one or both of end portions  310 ,  320 ) is formed of a flexible material adapted to enable the pair of end portions  310  to pivot between an unbent configuration ( FIG. 4A ) and a bent configuration ( FIG. 4B ), including various intermediate configurations. In embodiments, connection portion  320  (and/or one or both of end portions  310 ,  320 ) can be formed of a shape memory material such as Nitinol or a suitable electroactive polymer. In some embodiments, connection portion  320  (and/or one or both of end portions  310 ,  320 ) can be adapted to move between the unbent and bent configurations in response to changes in temperature and/or induced stress/pressure. 
         [0047]    Needles  200  and  300  can be utilized with any suitable end effector such as end effectors  40  and  100  to enable the respective end effector to support one of the respective needles  200 ,  300  while maintaining a minimal profile suitable for insertion and/or removal through small openings such as, for example, through a  10  millimeter diameter cannula (not shown). 
         [0048]    In use, with reference again to  FIG. 2A  and with particular regard to operation of needle  200 , jaw members  110 ,  120  of end effector  100  are closed for insertion so that needle  200 , supported by end effector  100 , is disposed in an insertion position or an unlocked state. More specifically, in the unlocked state, first and second end portions  210 ,  220  of needle  200  are at least partially approximated with first end portion  210  of needle  200  supported in needle receiving recess  112  of end effector  100  and second end portion  220  of needle  200  supported in needle receiving recess  122  of end effector  100 . 
         [0049]    With reference to  FIGS. 2A-2C , jaw members  110 ,  120  of end effector  100  can be opened, for example, upon insertion into a surgical site, so that while first end portion  210  of needle  200  is maintained within needle receiving recess  112  of end effector  100 , e.g., by engagement with grasping member  162 , second end portion  220  of needle  200  is drawn from needle receiving recess  122  of end effector  100 , e.g., while disengaged from grasping member  164 . With first end portion  210  secured to jaw member  110 , opening movement of one or both jaw members  110 ,  120  of end effector  100  enables second end portion  220  of needle  200  to pivot about pivot pin  230  relative to first end portion  210  of needle  200  as second end portion  220  cams out of second needle receiving recess  122 . As jaw members  110 ,  120  move from the insertion state ( FIG. 2A ) to the stitching state ( FIG. 2B ), needle receiving recess  122  cams second end portion  220  relative to first end portion  210  until needle  200  is elongated and positioned in the locked state (see  FIG. 2B ). 
         [0050]    Alternatively, and or additionally, guide member  140  can be advanced distally and/or proximally, for example, upon an actuation of actuation mechanism  150 , to engage second end portion  220  of needle  200  (e.g., with a distal end portion of guide member  140 ) and provide axial force to second end portion  220  to facilitate movement of second end portion  220  and orient needle  200  into the locked state. As can be appreciated, guide member  140  can be adapted to be translated distally and/or proximally as necessary to facilitate a positioning of needle  200  into the locked state. Additionally or alternatively, needle  200 , in some embodiments, can be oriented from the unlocked state to the locked state while simultaneously secured to both jaw members  110 ,  120  (e.g., with first and second end portions at least partially secured within respective needle receiving recesses  112 ,  122  of jaw members  110 ,  122  by partially advanced grasping members  162 ,  164 ). 
         [0051]    Upon positioning needle  200  in the locked state, end effector  100  can then be used to effectuate a suturing procedure similar to that described in U.S. Pat. No. 8,337,515 referenced above. For example, handle assembly  20  is actuated to pivot one or both of first and second jaw members  110 ,  120  between open and closed states for passing needle  200  between jaw members  110 ,  120  and drawing suture “S” through tissue. More particularly, with needle  200  secured to needle receiving recess  112  of first jaw member  110  (e.g., with grasping member  162 ), an actuation of a trigger  24  ( FIG. 1 ) other actuator of handle assembly  20  closes jaw members  110 ,  120  around tissue so that needle  200  pierces the tissue and is guided into needle receiving recess  122  of the second jaw member  120  to secure needle  140  thereto (e.g., with grasping member  164 ) and effectuate a first stitch. As can be appreciated, grasping member  164  can be distally advanced while grasping member  162  is proximally withdrawn to effectuate the transference of needle  200  between jaw members  110 ,  120 . In embodiments, each grasping member  162 ,  164  can be distally advanced and/or proximally withdrawn independent of the other grasping member  162 ,  164 . In some embodiments, grasping members  162 ,  164  can be simultaneously proximally withdrawn and/or simultaneously distally advanced. 
         [0052]    After completion of the first stitch, jaw members  110 ,  120  can then be opened again so that needle  200  can be transferred back from second jaw member  120  to the first jaw member  110  in like fashion upon another closing of jaw members  112 ,  114  to effectuate another stitch. This process, in whole, or in part, can be repeated as necessary until the tissue is sutured as desired. 
         [0053]    Upon completion of the suturing procedure, guide member  140  can be positioned to receive second end portion  220  of needle  200  within opening  142  of guide member  140  to facilitate a pivoting movement of second end portion  220  of needle  200  relative to first end portion  210  of needle  200  when needle  200  is retained in needle receiving recess  112  (e.g., friction fit and/or grasping member  162 ). For example, when needle  200  is disposed in a locked state, second end portion  220  of needle  200  can be positioned within opening  142  of guide member  140 , such as by translating guide member  140  and/or pivoting jaw members  110 ,  120  of end effector  100  as appropriate. Then, a subsequent sufficient proximal movement of guide member  140  can impart an axial and/or rotational force on second end portion  220  of needle  200  to unlock first and second end portions  210 ,  220  of needle  200 . Upon unlocking needle  200 , jaw members  110 ,  120  of end effector  100  and/or guide member  140  can be manipulated as appropriate to reposition first and second end portions  210 ,  220  within respective needle receiving recesses  112 ,  122  of respective first and second jaw members  110 ,  120  so that end effector  100  can be closed around needle  200  and back into the insertion position, for example, for removal from the surgical site. 
         [0054]    Since the operation of needle  300  is similar to the use of needle  200  as detailed above, the operation of needle  300  is only described herein to the extent necessary to describe the differences in operation of needle  300 . Needle  300  can be positioned in the bent or approximated configuration ( FIG. 4B ), for example, while supported by an end effector such as end effector  100  or  100 , to enable the end effector to maintain a minimal profile during insertion and/or removal to/from a surgical site (e.g., through a small surgical or natural opening). Needle  300  can also be arranged in the unbent or unapproximated configuration ( FIG. 4A ), for example, to effectuate surgical suturing when coupled to the end effector upon being advanced to a surgical site. Due to the flexibility of connecting portion  320  of needle  300 , needle  300  can be positioned between the bent and unbent configurations by a predetermined pivoting movement of jaw members of any suitable end effector and/or by predetermined actuation of any guide feature, such as guide member  140  of end effector  100 . More particularly, needle  300  can be manipulated as necessary to achieve the minimal profile arrangement between needle  300  and the respective end effector supporting needle  300 . However, connecting portion  320  has sufficient rigidity to enable needle  300  to be utilized to perform a suturing procedure. 
         [0055]    In temperature responsive embodiments of needle  300 , for example, needle  300  is biased or urged from the bent configuration to the unbent configuration upon being subject to a predetermined temperature such as body temperature. Once inserted in the body, the temperature responsive properties of this embodiment of needle  300  maintain the needle  300  in the unbent configuration so that needle  300  can be used to effectuate a suturing procedure. 
         [0056]    When finished suturing with the temperature responsive embodiment of needle  300 , removal from the surgical site may be achieved by releasing needle  300  from both jaw members of one of the presently described end effectors and separating needle  300  from the end effector (e.g., with a separate grasping device) so that the end effector may be closed and withdrawn through the access device separate from needle  300 . 
         [0057]    As another example, in stress/pressure responsive embodiments of needle  300 , needle  300  is biased or urged from the bent configuration to the unbent configuration upon being subject to a predetermined stress or pressure such as compressive closure force(s) imparted through an end effector that is greater than the closure force(s) required to effectuate a suturing procedure. More particularly, this embodiment of needle  300  has sufficient rigidity to effectuate a suturing procedure; however, this embodiment of needle  300  will bend upon an application of a predetermined amount of compressive closure force(s) that is greater than a rigidity threshold of the needle that is suitable for suturing. Thus, to remove from the surgical site when finished suturing, compressive closure forces can be applied to this embodiment of needle  300  that are greater than the closure forces required for suturing to thereby bend this embodiment of needle  300  back into the bent configuration to enable the end effector to achieve the minimal profile required during insertion. This minimal profile will enable a simultaneous removal of this embodiment  300  and the end effector. Alternatively, and/or additionally, this embodiment of needle  300  can be released from the end effector so that each is separately withdrawn as described above. 
         [0058]      FIG. 5  illustrates another embodiment of an end effector, shown generally as  400 , supporting another embodiment of a needle, shown generally as  500  and described in greater detail below. End effector  400  is substantially similar to end effector  100  and is only described herein to the extent necessary to describe the differences in operation and construction. End effector  400  is adapted for use with an endoscopic stitching device and includes a first jaw member  410  and a second jaw member  420  that are pivotally connected. First jaw member  410  defines a first needle receiving recess  412  and second jaw member  420  defines a second needle receiving recess  422 . First and second jaw members  410 ,  420  are adapted for relative movement between open and closed states for effectuating a suturing procedure, for example, by passing needle  500 , with suture “S” coupled to needle  500 , back and forth through tissue between first and needle receiving recesses  412 ,  422  of respective first and second jaw members  410 ,  420  similar to that described above with respect to end effector  100  and needle  200 . 
         [0059]    As seen in  FIGS. 6A-6C , needle  500  includes a first end portion  510  and a second end portion  520 . First end portion  510  includes a connecting end  510   a,  an opposed tip end  510   b,  and an outer surface  510   c.  A mating recess  512  is defined in connecting end  510   a.  Mating recess  512  may be formed in any suitable shape (e.g., circular and non-circular cross-sections including any polygonal shape). Tip end  510   b  is adapted to be releasably received within needle receiving recess  412  of end effector  400 . Second end portion  520  includes a connecting end  520   a,  an opposed tip end  520   b,  and an outer surface  520   c.  A mating protuberance  522  (e.g., bump, nub, rod, etc.) is located on connecting end  520   a  of second end portion  520 . Mating protuberance  522  is complementary to (e.g., keyed to) mating recess  512  of first end portion  510 . In embodiments, first end portion  510  includes a mating protuberance and second end potion  520  defines a mating recess. 
         [0060]    In an insertion position, as seen in  FIG. 6A , first and second end portions  510 ,  520  of needle  500  are supported by end effector  400  in a first, laterally misaligned configuration. End effector  400  can include a pair of grasping members (not shown) similar to grasping members  162 ,  164  described above. Each grasping member of the pair of grasping members is adapted to engage one of first and second end portions  510 ,  520  such that the pair of grasping members simultaneously support both first and second end portions  510 ,  520  during insertion into a surgical site. 
         [0061]    In the laterally misaligned configuration, tip ends  510   b,    520   b  of respective first and second end portions  510 ,  520  of needle  500  are secured within respective needle receiving recesses  412 ,  422  of end effector  400  and disposed in longitudinally aligned relation to one another, while connecting ends  510   a,    520   a  (and respective mating recess and protuberance  512 ,  522 ) of respective first and second end portions  510 ,  520  of needle  500  are separated and disposed in laterally-adjacent relation with one another with each end portion  510 ,  520  imposing a lateral force on the other to maintain first and second end portions  510 ,  520  in the misaligned configuration. Further, in the misaligned configuration, connecting end  510   a  of first end portion  510  can be closer to second jaw member  420  than first jaw member  410  and connecting end  520   a  of second end portion  520  can be closer to first jaw member  410  than second jaw member  420 . In addition, connecting ends  510   a,    520   a  of respective first and second end portions  510 ,  520  can be spaced apart such that outer surfaces  510   c,    520   c  of respective first and second end portions  510 ,  520  are disposed in contacting relation when first and second end portions  510 ,  520  are misaligned. Although first end portion  510  is shown left (when viewed from the front of device) of second end portion  520  in the insertion position, second end portion  520  can be positioned left of first end portion  510  in the insertion position. 
         [0062]    With reference to  FIG. 6B , first and second jaw members  410 ,  420  can be unapproximated (as indicated by arrows “e”), for example, subsequent to an insertion, so that first and second end portions  510 ,  520  are drawn apart until disposed in spaced-apart relation. By virtue of being spaced-apart, first and second end portions  510 ,  520  no longer impose lateral forces on one another, enabling first and second end portions  510 ,  520  to rotate about the respective first and second jaw members  410 ,  420  in opposite radial directions until aligned with one another relative to the longitudinal axis. When first and second end portions  510 ,  520  are aligned relative to the longitudinal axis, mating recess  512  and mating protuberance  522  of respective first and second end portions  510  are longitudinally aligned. 
         [0063]    As seen in  FIG. 6C , first and second jaw members  410 ,  420  can then be approximated (as indicated by arrows “f”), connecting first and second end portions  510 ,  520  via respective mating recess and protuberance  512 ,  522 . The connection of first and second end portions  510 ,  520  forms needle  500  into a unitary arrangement suitable for use in a suturing procedure. To effectuate the suturing procedure and pass needle  500  back and forth between first and second jaw members  410 ,  420 , the grasping members are movable in alternate distal and/or proximal relation relative to one another and first and second jaw members  410 ,  420  are moveable between open and closed states. 
         [0064]    Upon completion of the suturing procedure, needle  500  can be released from end effector  400  so that each is separately withdrawn as described above with respect to the temperature responsive embodiment of needle  300 . 
         [0065]    Rather than having end portion  510 ,  520  oriented in offset lateral relation, the end portions of the needle may be oriented in longitudinal offset relation as shown in the embodiment of  FIG. 7 .  FIG. 7  illustrates another embodiment of a needle, shown generally as needle  600  positioned in end effector  400  in an insertion position. Needle  600  is substantially similar needle  500  and is only described herein to the extent necessary to describe the differences in construction and operation of needle  600 . Needle  600  includes a first end portion  610  and a second end portion  620 . First end portion  610  has a connecting end  610   a  and a tip end  610   b.  Connecting end  610   a  includes a mating protuberance  612 . Second end portion  620  has connecting end  620   a  and a tip end  620   b.  Connecting end  620   a  of second end portion  620  includes a mating recess  622  that is complementary to mating protuberance  612  of first end portion  610 . In the insertion position, connecting ends  610   a,    620   a  (and respective mating protuberance and recess  612 ,  622 ) of respective first and second end portions  610 ,  620  are disposed in longitudinally adjacent relation to one another, while tip ends  610   b,    620   b  are disposed in longitudinally aligned relation to one another. Although first end portion  610  is shown proximally of second end portion  620  in this insertion position, second end portion  620  can be positioned proximally of first end portion  610  in this insertion position. 
         [0066]    In use, similar to that described above with respect to needle  500 , end effector  400  can be moved between an open or unapproximated position and a closed or approximated position to couple first and second end portions  610 ,  620  into a unitary arrangement that forms needle  600 . Needle  600  can then be utilized to effectuate a suturing procedure as described above with respect to needle  500  and end effector  400 . Upon completion of the suturing procedure, needle  600  and/or end effector  400  can be removed from the surgical site as described above with respect to needle  500  and end effector  400 . 
         [0067]    As can be appreciated, although the embodiments of first and second end portions of needles  500  and  600  are shown positioned in offset lateral ( FIG. 6A ) and/or longitudinal ( FIG. 7 ) relation in the respective insertion positions of needles  500 ,  600 , any of the first and second end portions, or portions thereof, of the needles  500 ,  600  can be disposed in any suitable relation to any opposed first and/or second end portion, or portions thereof, of the needles  500 ,  600 , including laterally, longitudinally, and/or combinations thereof. 
         [0068]      FIGS. 8A and 8B  illustrate another embodiment of an end effector, shown generally as  700 , that supports another embodiment of a needle, shown generally as  800 . End effector  700  is substantially similar to end effectors  40  and  400  and is only described herein to the extent necessary to describe the differences in operation and construction of end effector  700 . End effector  700  is adapted for use with an endoscopic stitching device and includes a first jaw member  710  and a second jaw member  720  that are pivotally connected. First jaw member  710  defines a first needle receiving recess  712  and second jaw member  720  defines a second needle receiving recess  722 . First and second jaw members  710 ,  720  are adapted for relative movement between open and closed states for effectuating a suturing procedure. 
         [0069]    As seen in  FIG. 8A , needle  800  is adapted to support a suture “S” and includes a first end portion  810 , a second end portion  820 , and a compressible element  830  supported between first and second end portions  810 ,  820  to enable second end portion  820  to slidably translate through first end portion  810  (as indicated by arrow “g”), relative to first end portion  810 , between a first, compressed position and a second, extended position. The compressible element  830  can be adapted to bias first and second end portions  810 ,  820  towards the extend position. First end portion  810  has an outer surface  810   a  and an inner surface  810   b.  Inner surface  810   b  defines a cavity  810   c.  Cavity  810   c  is dimensioned to support compressible element  830 . First end portion  810  includes a tip end  812  and a support end  814 . Second end portion  820  has an outer surface  820   a  and includes a tip end  822  and a support end  824 . Compressible member  830  is formed of a compressible material and includes a first end  830   a  and a second end  830   b.  First end  830   a  is secured to a trailing end of support end  824  of second end portion  820  in a leading end portion of cavity  810   c.  Second end  830   b  is secured to a trailing end portion of cavity  810   c  adjacent to tip end  812  of first end portion  810 . Compressible member  830  can include a spring. In embodiments, compressible member  830  includes gas. 
         [0070]    An approximation of first and second jaw members  710 ,  720  of end effector  700  compresses needle  800  from an extended position ( FIG. 8A ) to a retracted or compressed position ( FIG. 8B ). In the compressed position, needle  800  enables end effector  700  to maintain a minimal profile for insertion and/or removal of end effector  700  and needle  800  through a small opening. In the extended position, needle  800  can be used to effectuate a suturing procedure. 
         [0071]    Any of the components of the presently described devices can be formed of any suitable metallic and/or polymeric material. Securement of any of the components of the presently described devices to any of the other components of the presently described devices can be effectuated using known fastening techniques such welding (e.g., ultrasonic), crimping, gluing, etc. 
         [0072]    Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. For example, when finished using the present minimally invasive suturing devices, removal from the surgical site may be achieved while one of the presently described needles is secured to one of the presently described end effectors by sequentially pulling the access device and the end effector out of the incision in the patient&#39;s skin, with the access device being removed first (while remaining supported about the shaft of the suturing device) and the end effector being removed second. More particularly, with the access device removed, the end effector can be readily drawn through the incision since the patient&#39;s skin will have sufficient elasticity to enable removal of the end effector without reducing the height of the end effector. Subsequent to the removal of the end effector through the incision, the access device can be removed from the suturing device by advancing the access device off of the distal end of the end effector. 
         [0073]    Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.