Patent Publication Number: US-2006020274-A1

Title: Manipulatable grasping needle

Description:
BACKGROUND OF THE INVENTION  
     FIELD OF THE INVENTION  
      The present invention relates to manipulatable grasping needles for suturing tissue. More particularly, the present invention relates to apparatus and methods for suturing tissue within a hollow body organ using a needle apparatus which is configured to grasp and pass sutures into or through tissue.  
      Various devices and methods for grasping free ends or lengths of suture and passing the suture material through tissue are known. One method generally involves attaching a suture end to a needle and passing the needle through the tissue using a needle manipulating device. Once passed through the tissue, another device is typically employed to retrieve or otherwise manipulate the needle and suture.  
      Other methods generally utilize sharpened needle tips which are configured to retain a suture. The needle tip is then able to penetrate the tissue and leave the suture end on the far side of the tissue where it can be grasped for further manipulation. Such grasping mechanisms generally employ various configurations such as the use of wire-like hooking elements, looped wires, etc. Some devices employ suture grasping elements, such as forceps jaws, with sharpened tips to grasp and pass the suture material.  
      However, many of the conventional devices have limitations in applications such as closed surgery, especially arthroscopic or laparoscopic surgery, where space and visibility constraints at the surgical site render it difficult to fully extend a suture grasping device to easily grasp a suture. Moreover, many of the devices are constrained to regions within the body accessible via straight-line access. This is typically due to the rigidity of the tool shaft upon which the graspers or needles are employed.  
      Furthermore, because of the typical size and rigidity of the tool, such a suture passing instrument is typically inserted within a patient as a separate tool which occupies valuable space. Additionally, other tools are typically needed to facilitate the manipulation of the suture material through the tissue.  
     BRIEF SUMMARY OF THE INVENTION  
      Regions of tissue within a body may be secured and/or manipulated in a number of various ways. One apparatus which may be utilized particularly for piercing and/or suturing tissue while passing lengths of suture through tissue may generally comprise a needle body having a piercing tip, and a grasping arm positioned proximally of the tip wherein the grasping arm is adapted to project from the needle body and releasably retain a length of suture. Such an apparatus may be utilized either alone or it may further comprise an endoscopic device defining at least one lumen for advancing the needle body therethrough. The grasping arm may be articulated to project from the needle body to release or grasp the length of suture as desired.  
      The needle body and grasping arm may be positioned at the distal end of an elongate flexible member which may be tubular and may be sufficiently flexible to allow for the advancement of the needle body and elongate member through an endoscopic device. Alternatively, the elongate member may be formed as a rigid shaft for percutaneous or laparoscopic procedures. One or more sections of the elongate member may be further configured to be articulatable to conform to a desired shape. An elongate member having one or several articulatable sections may enable the assembly to be manipulated about or around tissue such that suture manipulation is facilitated.  
      A handle operably connected to the proximal end of the tubular member may be used to manipulate the piercing and grasping assembly into an open or closed configuration as well as articulate the assembly into a desired configuration through the use of, e.g., control wires or rods. Moreover, the elongate flexible member may be fabricated from a variety of materials, e.g., polymers, metals configured to provide flexibility, etc.  
      The needle body may be comprised of a needle, which may be at least partially hollow such that tissue anchor(s) may be positioned therewithin for deployment within or upon a tissue region. The needle body may have a tapered or sharpened tip for piercing into the tissue, and the needle body itself may be alternatively made of opposing tapered jaws which form a singular piercing tip when closed. As the piercing and grasping assembly is advanced into or through tissue, a length of suture may be releasably retained by the assembly between the needle body and the grasping arm, which may be positioned proximally of the tip and/or needle body or may itself form the piercing tip.  
      Once the piercing and grasping assembly has been desirably advanced into or through tissue, the assembly may be actuated into an open configuration where the grasping arm may project from the needle body. In the open configuration, the grasping arm may be open relative to the needle body such that the suture may be released from the piercing and grasping assembly. Alternatively, the piercing and grasping assembly may be manipulated to grasp a free length of suture. A linkage assembly, which may be actuated via a push and/or pull wire contained within the tubular member, may be used to open and close the needle body and the grasping arm. Both the needle body and grasping arm may each be actuated into an opened configuration relative to the tubular member; alternatively, the linkage assembly may be utilized to actuate a single member, i.e., needle body or grasping arm, into an opened configuration for suture manipulation or release.  
      Additionally, either the needle body or grasping arm, or both, may define a notch or groove to provide for clearance for suture material when retained between the needle body and grasping arm. Also, a curved or arcuate hooking member may also be provided to facilitate suture retrieval when grasping the suture.  
      In one illustrative use, the piercing and grasping assembly may be advanced through a tissue region or tissue fold while retaining a length of suture to be passed through. Once the assembly has been pierced through the tissue, the grasping arm and/or needle body may be articulated into an open configuration to release the suture. After the suture is freed, the assembly may be closed and withdrawn from the tissue. The assembly may then be articulated to the opposing side of the tissue and opened to receive the free suture for further manipulation. This procedure may be repeated as many times as necessary or a knot may be tied to simply secure the tissue.  
      To facilitate the handling of the suture, an additional needle assembly may be used in combination with one or more needle assemblies. Moreover, any variety of tools for endoluminally visualizing, grasping, plicating, manipulating, affixing, securing, etc., portions of gastric tissue may be utilized with the assembly for performing a variety of procedures.  
      In another example, the needle assembly and flexible elongate member may be advanced through an endoscopic device into a patient. One such procedure may entail transorally advancing the assembly through an endoscopic device into the patient&#39;s stomach to treat regions of tissue within the stomach.  
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  shows an example of one variation of the manipulatable grasping needle having a flexible delivery shaft.  
       FIG. 2A  shows a detail side view of the manipulatable needle of  FIG. 1  in a closed configuration for piercing tissue.  
       FIG. 2B  shows the needle of  FIG. 2A  in an open configuration for releasing or grasping suture or other material.  
       FIG. 2C  shows another variation of the manipulatable needle distal end having an articulatable portion.  
       FIG. 3A  shows yet another variation of the manipulatable needle having a notch or groove defined in at least one of the grasping arms to accommodate a suture.  
       FIG. 3B  shows yet another variation of the manipulatable needle having a curved or hooked portion for facilitating retrieval of a suture.  
       FIGS. 4A and 4B  shows an example of a tissue anchor which may be positioned within the needle body and deployed from the needle body, respectively.  
       FIGS. 5A  to  5 F show an example of one use for the manipulatable needle in which the needle may be passed through a tissue fold while retaining a suture and then withdrawn from the tissue and articulated to the opposing side of tissue for additional manipulation of the suture.  
       FIG. 6  shows a partial cross-sectional view of another example in which an additional tool or manipulatable needle may be utilized in manipulating the suture as it is passed through the tissue fold.  
       FIG. 7A  shows a perspective view of an example of a continuous stitch through a tissue plication which may be created utilizing a manipulatable needle.  
       FIG. 7B  shows a perspective view of another example of how a tissue anchor may be anchored against a tissue surface to secure a tissue plication utilizing the manipulatable needle to tighten the suture.  
       FIG. 8  shows an illustrative view of how a manipulatable needle may be advanced through a working lumen of an endoscopic device and utilized within a hollow body organ, such as a stomach, along with an additional tool if desired.  
       FIGS. 9A  to  9 F show an example of another variation of a manipulatable needle in which a separate needle body may be deployed and/or captured via a grasper configured to allow for rotation of the needle body.  
       FIGS. 10A  to  10 D show an example of yet another variation of a manipulatable needle in which a separate needle body may be deployed and/or captured via a grasper which is configured to rotate the needle body.  
       FIGS. 11A  to  11 C show side and detail views, respectively, of yet another variation in which a suture grasper may be integrated along the body of the needle assembly.  
       FIG. 12A  shows a side view of another variation of a manipulatable needle in which a pair of piercing jaws is positionable on a distal end of an elongate flexible member.  
       FIGS. 12B and 12C  show side views of the needle body of  FIG. 12A  in which a single jaw is articulatable and in which both jaws are articulatable, respectively.  
       FIG. 12D  shows a perspective view of the needle body of  FIG. 12A .  
       FIG. 12E  shows a side view of a variation of the needle body of  FIG. 12A  in which a portion of the elongate flexible member is articulatable.  
       FIG. 12F  shows a perspective view of the needle body of  FIG. 12E .  
       FIGS. 13A and 13B  show side views of another variation of a manipulatable needle having a pivotable latch in closed and open configurations, respectively.  
       FIGS. 14A and 14B  show side views of yet another variation of a manipulatable needle where the grasping arm may extend along a majority of the length of the needle body.  
       FIG. 15  shows a side view of the variation of  FIGS. 14A and 14B  where the elongated grasping arm may be utilized to slide over a tissue surface in retrieving a length of suture. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
      In creating tissue plications, a tissue plication tool having a distal tip may be advanced (transorally, transgastrically, etc.) into the stomach. The tissue may be engaged or grasped and the engaged tissue may be moved to a proximal position relative to the tip of the device, thereby providing a substantially uniform plication of predetermined size. Examples of creating and forming tissue plications may be seen in further detail in U.S. patent application Ser. No. 10/735,030 filed Dec. 12, 2003, which is incorporated herein by reference in its entirety.  
      Once the tissue plication has been formed, it may be secured in a number of different ways. One apparatus which may be utilized for piercing tissue as well as passing lengths of suture through tissue may be seen in the illustrative view of  FIG. 1 , which shows one variation of manipulatable needle assembly  10  in a closed or piercing configuration. As shown, an elongate flexible member  12  may be tubular such that at least one lumen is defined through the length of flexible member  12 . Handle  14  may be positioned at a proximal end of flexible member  12  and control handle  16  may be likewise positioned. Control handle  16  may be configured to enable the articulation of piercing and grasping assembly  18  into an open or closed configuration, as described in further detail below. Control handle  18 , as well as handle  14 , which is positioned at a distal end of flexible member  12 , may be operably connected to piercing and grasping assembly  18 , e.g., via control wires, which may run through the length of flexible member  12 .  
      Flexible member  12  may be made from a variety of flexible materials such as polymers. If made from a polymeric material, flexible member  12  may be reinforced along its length as necessary using various methods such as interspersing metallic braids, weaves, reinforcing wires, etc., throughout the length of the flexible member  12 . Alternatively, metallic materials, e.g., stainless steel, platinum, etc., and particularly superelastic metals and alloys, e.g., Nitinol, etc., may be utilized in constructing flexible member  12  provided that the material is sufficiently adapted to flex when manipulated. In the case of stainless steel or like metals, the length of flexible member  12  may be scored or perforated to allow for additional flexibility. Moreover, the diameter of flexible member  12  may be varied to suit the application in which assembly  10  may be employed. For example, if assembly  10  were advanced, e.g., through a conventional endoscope for use in a patient&#39;s stomach, flexible member may range anywhere in diameter from 2-3 mm and may have a length greater than or less than 100 cm. These dimensions are merely intended to be illustrative and are not intended to limit the size or scope of the assembly  10 .  
      As generally shown, piercing and grasping assembly  18  may be comprised of needle body  20 , which has a tapered or sharpened tip  22  for piercing into or through tissue. Needle body  20  may also define an opening or lumen  24  therethrough for retaining and passing a tissue anchor, as described further below. As seen in the detail side view of  FIG. 2A , piercing and grasping assembly  18  may be configured into a low-profile closed configuration for advancement into the body and for piercing into or through tissue. As piercing and grasping assembly  18  is advanced into or through tissue, a length of suture  36  may be releasably retained by assembly  18  between needle body  20  and grasping arm  26 , which may be positioned proximally of tip  22  and/or needle body  20 .  
      Once piercing and grasping assembly  18  has been desirably advanced into or through tissue, assembly  18  may be actuated into an open configuration where grasping arm  26  may project from needle body  20 , as shown in  FIG. 2B . In the open configuration, grasping arm  26  may be open relative to needle body  20  such that suture  36  may be released from piercing and grasping assembly  18 . Alternatively, piercing and grasping assembly  18  may be manipulated to grasp a free length of suture. Linkage assembly  28 , which may be actuated via a push and/or pull wire (not shown) contained within tubular member  12 , may be used to open and close needle body  20  and grasping arm  26 . As shown, both needle body  20  and grasping arm  26  may each be actuated into an opened configuration relative to tubular member  12 ; alternatively, linkage assembly  28  may be utilized to actuate a single member, i.e., needle body  20  or grasping arm  26 , into an opened configuration for suture manipulation or release.  
      Elongate tubular member  12  may be flexible or it may also be constructed as a rigid shaft. In either case, one or several portions of elongate member  12  may comprise an articulatable section  30  along a length of elongate member  12 . A section of member  12  just proximal of piercing and grasping assembly  18  may be configured to be articulatable, as shown in  FIG. 2C , such that assembly  18  may be articulated via handle  14 . One or several control wires may be routed through elongate member  12  in any number of ways to enable articulatable section  30  to conform to a desired shape. An elongate member  12  having one or several articulatable sections  30  may enable assembly  18  to be manipulated about or around tissue such that suture manipulation is facilitated.  
      alternative needle assembly  32  is shown in the detail side view of  FIG. 3A . This variation is likewise generally comprised of needle body  20  and grasping arm  26 ; however, a notch or groove  34  may be defined in either needle body  20 , grasping arm  26 , or both along the areas facing one another. Such a notch or groove  34  may be defined to provide for clearance for suture material when retained between needle body  20  and grasping arm  26 .  
      Moreover, a suture hook or groove  42  may be further defined along either needle body  20 , as shown in the alternative needle assembly  40  in  FIG. 3B , along grasping arm  26 , or both. Suture hook or groove  42  may simply be configured as a curved or arcuate hooking member or it may simply be configured as a protrusion. Furthermore, suture hook or groove  42  may be provided independent of or additional to notch or groove  34 .  
      The piercing and grasping assembly  18  may be utilized in a variety of different procedures. In one instance, assembly  18  may be advanced into a hollow body organ, e.g., a stomach, and used to pierce through created tissue plications and deposit soft tissue anchors for securing the tissue plications. Examples of methods and devices for creating tissue plications may be seen in further detail in U.S. patent application Ser. No. 10/735,030 which has been incorporated by reference above. As shown in  FIG. 4A , an expandable tissue anchor  44  may be seen positioned within opening  24  of needle body  20  for delivery. Suture  46  ending in terminal loop  48  may be seen passing through and from tissue anchor  44 . Once assembly  18  has been desirably passed through tissue and appropriately positioned, tissue anchor  44  may be ejected from needle body  20 , e.g., using a pusher mechanism. Once free from the constraints of needle body  20 , tissue anchor  44  may be free to expand for anchoring against a tissue surface, as seen in  FIG. 4B . Further details relating to tissue anchors and mechanisms which may be utilized for ejecting and positioning such anchors are disclosed in further detail in U.S. patent application Ser. No. 10/840,950 filed May 7, 2004, which is incorporated herein by reference in its entirety.  
      In another example of how grasping needle assembly  10  may be utilized,  FIGS. 5A  to  5 F illustrate a partial cross-sectional view in which piercing and grasping assembly  18  may be passed through tissue fold F while retaining suture  50  and then withdrawn from the tissue fold F and articulated to the opposing side of tissue fold F for additional manipulation of suture  50 . Such a procedure may be utilized to secure tissue fold F or it may be performed so that an object may be anchored within the body to the tissue fold F via anchored suture  50 .  
      As seen in  FIG. 5A , tissue fold F may be formed utilizing any number of methods described above or otherwise conventionally known. Piercing and grasping assembly  18  may be advanced towards tissue fold F while releasably retaining a length of suture  50  to be deposited through tissue fold F. Elongate tubular member  12  may comprise a flexible member and/or it may also comprise a rigid shaft, depending upon the desired procedure to be performed. Moreover, tubular member  12  may further comprise one or more articulatable sections to facilitate manipulation of piercing and grasping assembly  18  about or around tissue fold F.  
      Once assembly  18  has been pierced through tissue fold F, as shown in  FIG. 5C , grasping arm  26  and/or needle body  20  may be articulated into an open configuration to release suture  50  from assembly  18  on the distal side of tissue fold F, as shown in  FIG. 5D . After suture  50  has been freed from assembly  18 , grasping arm  26  and/or needle body  20  may be configured into its closed configuration and withdrawn from tissue fold F, as shown in  FIG. 5E . Assembly  18  may then be articulated to the opposing distal side of tissue fold F and opened to receive the free suture  50  for further manipulation, as shown in  FIG. 5F . This procedure may be repeated or a knot may be tied to simply secure the tissue fold F.  
      To facilitate the handling of suture  50 , an additional needle assembly  60  may be used in combination with one or more needle assemblies  18 , as shown in the partial cross-sectional view of  FIG. 6 . Moreover, any variety of tools for endoluminally visualizing, grasping, plicating, manipulating, affixing, securing, etc., portions of gastric tissue may be utilized with the assembly  18  for performing a variety of procedures. Other examples of applicable tools may be seen in U.S. patent application Ser. Nos. 10/734,547 and 10/734,562, both filed Dec. 12, 2003 and both incorporated herein by reference in their entirety. Other examples of various tools which may be utilized are also further described in U.S. patent application Ser. No. 10/639,162 filed Aug. 11, 2003 and 10/672,375 filed Sep. 26, 2003, each of which is also incorporated herein by reference in its entirety.  
       FIG. 7A  shows a perspective view of tissue fold F with suture  50  in a running stitch to secure the plication as one example of a potential procedure which may be accomplished utilizing assembly  18  either alone or in combination with any one of the above-mentioned tools.  FIG. 7B  shows a perspective view of tissue fold F with suture  50  utilized with tissue anchor  44  in securing tissue fold F as yet another example. As mentioned above for  FIGS. 4A and 4B , assembly  18  may be passed through tissue fold F and then utilized to deploy tissue anchor  44  from the needle body. Once tissue anchor  44  has been deployed, assembly  18  may be manipulated to knot suture  50  about tissue fold F. Assembly  18  may then be further manipulated to grasp a free end of suture  50 , e.g., at suture terminal end  48 , and suture  50  may be pulled or tensioned via assembly  18  in the direction of the arrow shown such that tissue anchor  44  becomes drawn securely against the tissue surface of fold F. Other variations or modifications for knotting or securing suture  50  and/or tissue anchor (or tissue anchors)  44  against tissue fold F are intended to be included in the scope of this disclosure and the claims below.  
      In another example for utilizing grasping needle assembly  10 ,  FIG. 8  shows an illustrative view of how a flexible tubular member  12  (optionally with or without an articulatable section) and assembly  18  may be advanced through a working lumen  74  of an endoscopic device  70 . As illustrated, endoscopic device  70 , which may comprise a conventional endoscope or a rigidizable endoscope, may be advanced transorally through a patient&#39;s esophagus ES and into a stomach ST. Once the distal portion of endoscopic device  70  has been desirably positioned, assembly  18  may be advanced through a working lumen  74  optionally with one or more additional tools  72  having end effectors in adjacent lumens for performing any number of procedures upon the tissue.  
       FIGS. 9A  to  9 F show an alternative needle assembly  80  which may be utilized in a manner similar to that described above. Generally, assembly  80  may comprise a separate needle body  82  having a tapered or sharpened tip  84  for piercing into and/or through tissue. An opening  88  may be defined through needle body  82  for passage of suture  50  therethrough. A proximal end of needle body  82  may be configured into a rounded sphere-like member  86  to facilitate the grasping and retrieval of needle body  82 .  
      In use, once needle body  82  has been passed through tissue via delivery tube or catheter  90 , needle body  82  may be released to enable delivery tube  90  to be articulated about the tissue. To recapture needle body  82 , delivery tube  90  may be positioned adjacent to proximal end  86  of needle body  82 , as shown in  FIG. 9A . Once delivery tube  90  has been desirably positioned, grasper  92  may be advanced out of delivery tube  90  via elongate member  94 , as shown in  FIG. 9B . Grasper  92  may be configured to form spherically-shaped grasping arms which may be clamped over proximal end  86  in a complementary pivoting relationship. Proximal end  86  may then be securely grasped via grasper  92 , as shown in  FIGS. 9C and 9D . As grasper  92  is withdrawn within delivery tube  90 , as shown in  FIGS. 9E and 9F , needle body  82  may be forced to automatically rotate about proximal end  86  into a straightened configuration relative to delivery tube  90 .  
      Another variation is shown in needle assembly  100 , generally comprising needle body  102  which defines opening  104  for passage of suture  50  therethrough. Two or more articulatable grasping arms  106 ,  108  may be positioned to extend from an elongate member  110 . In operation, assembly  100  may be utilized in the same or similar manner as assembly  80  above. Once needle body  102  is to be grasped, delivery tube or catheter  112  may be advanced adjacent to needle body  102 . In this variation, grasping arms  106 ,  108  may be articulated to become angled relative to elongate member  110  to facilitate the grasping of needle body  102 , as shown in  FIGS. 10A and 10B . Once needle body  102  has been securely grasped, grasping arms  106 ,  108  may be rotated or straightened such that needle body  102  is aligned in parallel with delivery tube or catheter  112 , as shown in  FIG. 10C . Grasping arms  106 ,  108  may be articulated, e.g., via control wires routed through elongate member  110 . Once aligned, needle body  102  may then be withdrawn proximally into delivery tube or catheter  112  to retrieve not only the needle but also suture  50 . Needle body  102  may be further articulated and passed through another area of tissue or another procedure, as desired, may be performed.  
      Yet another variation for a grasping needle assembly is shown in the illustrative side view of needle assembly  120  in  FIG. 11A . This variation may generally comprise needle body  122  which defines a lumen at least partially therethrough. An opening or port  124  may be defined along a surface of needle body  122  within which suture  50  may be releasably retained. Needle body  122  may be positioned at a distal end of tubular member  126 , which may be flexible along its length and/or comprise one or more articulatable sections.  
      An inner member or block  132  may be slidably positioned within needle body  122  such that a portion of block  132  which defines a suture-receiving notch or groove  134  passes adjacent to opening or port  124 , as shown in the detail view in  FIG. 11B . Notch or groove  134  may be defined along block  132  such that a hooked member  128  is formed distally of notch  134 . To actuate block  132  to slide longitudinally, an inner tubular member or control rod  130  may be routed through tubular member  126  and control rod  130  may be manipulated via its proximal end to slide block  132  back and forth.  
      In use, notch or groove  134  may be aligned with opening  124 , as shown in  FIG. 11B , such that a length of suture  50  may be positioned within notch or groove  134 . To secure suture  50  to needle body  122 , control rod  130  may be actuated proximally such that block  132  is pulled proximally and suture  50  is held between hooked member  128  and an edge of opening  124 , as shown in  FIG. 11C . Needle body  122 , along with suture  50 , may thus be passed through tissue. To release suture  50  from needle body  122 , block  132  may be translated distally to thus release suture  50  from between hooked member  128  and opening  124 .  
      Yet another needle assembly variation is shown in the side view of  FIG. 12A  in needle assembly  140 . Piercing and grasping assembly  142  may be positioned at a distal end of elongate flexible member  150  and may generally comprise opposing jaws, e.g., upper and lower grasping arms  144 ,  146 , respectively, which are articulatable between an open and closed configuration. Each of the grasping arms  144 ,  146  may define a tapered or sharpened tip such that when grasping arms  144 ,  146  are in a closed configuration, a singular piercing tip is formed to facilitate entry into or through tissue. A notch or groove  148  may be formed in one or both grasping arms  144 ,  146  to accommodate a suture  50  when releasably held therebetween.  
      In articulating grasping arms  144 ,  146  into its open configuration when grasping or releasing suture  50 , one or both grasping arms  144 ,  146  may be articulated to open relative to one another. For instance,  FIG. 12B  shows a variation  140  where a single grasping arm  144  may be articulated to open.  FIG. 12C  shows another variation  140 ′ in which both grasping arms  144 ,  146  may be articulated to open.  FIG. 12D  shows a perspective view of grasping assembly  142  and the piercing tip formed by grasping arms  144 ,  146  positioned upon the distal end of flexible member  150 .  
       FIG. 12E  shows another variation in which flexible tubular member  150  may comprise one or more articulatable sections  152 . The operation of articulatable section  152  is similar to that described above.  FIG. 12F  shows a perspective view of grasping arms  144 ,  146  along with articulatable section  152 .  
       FIGS. 13A and 13B  show side views of yet another variation of the piercing and grasping assembly  160  in closed and open configurations. In this variation, assembly  160  may comprise needle body  162  having a tapered piercing tip  164 . Suture retaining notch or groove  166  may be defined along the length of needle body  162 , preferably on a side of needle body  162  opposite to the tapered piercing tip  164 . As shown in  FIG. 13A , grasping or retaining arm  168  is shown in a closed configuration while retaining suture  50 . To release or to grasp suture  50 , as shown in  FIG. 13B , arm  168  may be opened, e.g., via pivot  170 , located on a distal end of arm  168  such that arm  168  opens proximally of needle body  162 . To grasp suture  50 , needle body  162  may be pulled proximally via elongate tubular member  172  to scoop up suture  50 .  
       FIGS. 14A and 14B  show yet another variation in piercing and grasping assembly  180  in which a length of elongated grasping arm  184  may be such that it resides along a majority of a length of needle body  182 . As seen in the closed configuration in  FIG. 14A , grasping arm  184  may have a length which resides along needle body  182  preferably opposite to tapered piercing end  186 . Assembly  180  may be manipulated via elongate tubular member  188 . When grasping arm  184  is opened, as shown in  FIG. 14B , the lengthened arm  184  may facilitate the grasping of suture  50 .  
      Moreover, retrieval of suture  50  may be facilitated by having grasping arm  184  define an atraumatic distal tip. When retrieving suture  50  from a surface of tissue  190 , elongate tubular member  188  may be advanced distally while allowing grasping arm  184  to slide over tissue surface  190 , as shown by the arrows in  FIG. 15 , to facilitate grasping suture  50  from the surface.  
      Although a number of illustrative variations are described above, it will be apparent to those skilled in the art that various changes and modifications may be made thereto without departing from the scope of the invention. Moreover, although specific configurations and applications may be shown, it is intended that the manipulatable needles, endoscopic devices, etc., may be utilized in various types of procedures in various combinations as practicable. It is intended in the appended claims to cover all such changes and modifications that fall within the true spirit and scope of the invention.