Patent Publication Number: US-2022218329-A1

Title: Medical devices having tissue grasping surfaces and features for manipulating surgical needles

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This patent application is a continuation of U.S. application Ser. No. 16/511,545 (filed Jul. 15, 2019) (entitled “Medical Devices Having Tissue Grasping Surfaces and Features for Manipulating Surgical Needles”), which claims priority to and the filing date benefit of U.S. Provisional Application No. 62/698,434 (filed Jul. 16, 2018) (entitled “Medical Devices Having Tissue Grasping Surfaces and Features for Manipulating Surgical Needles”), both of which are incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     The embodiments described herein relate to grasping tools, more specifically to medical devices, and still more specifically to endoscopic tools. More particularly, the embodiments described herein relate to medical devices that include jaws having a self-righting needle alignment portion that can be used, for example, in surgical applications. 
     Known techniques for Minimally Invasive Surgery (MIS) employ instruments to manipulate tissue that can be either manually controlled or controlled via computer-assisted teleoperation. Many known MIS instruments include a therapeutic or diagnostic end effector (e.g., forceps, a cutting tool, or a cauterizing tool) mounted on a wrist mechanism at the distal end of an extension (also referred to herein as the main tube or shaft). During an MIS procedure, the end effector, wrist mechanism, and the distal end of the main tube can be inserted into a small incision or a natural orifice of a patient to position the end effector at a work site within the patient&#39;s body. The optional wrist mechanism can be used to change the end effector&#39;s orientation with respect to the main tube to perform the desired procedure at the work site. Known wrist mechanisms generally provide the desired degrees of freedom (DOFs) for movement of the end effector. For example, for forceps or other grasping tools, known wrist mechanisms are often able to change the pitch and yaw of the end effector with reference to the main tube. A wrist may optionally provide a roll DOF for the end effector, or the roll DOF may be implemented by rolling the main tube. An end effector may optionally have additional mechanical DOFs, such as grip or knife blade motion. In some instances, wrist and end effector mechanical DOFs may be combined. For example, U.S. Pat. No. 5,792,135 (filed May 16, 1997) discloses a mechanism in which wrist and end effector grip DOFs are combined. 
     To enable the desired movement of the wrist mechanism and end effector, known instruments include tension members (e.g., cables, cable/hypotube combinations, tension bands) that extend through the main tube of the instrument and that connect the wrist mechanism to a transmission or actuator (also referred to herein as a backend mechanism). The backend mechanism moves the cables to operate the wrist mechanism. For computer-assisted systems, the backend mechanism is motor driven and can be operably coupled to a processing system to provide a user interface for a doctor to control the instrument. 
     Patients benefit from continual efforts to improve the effectiveness of MIS methods and tools. For example, reducing the size and/or the operating footprint of the main tube and wrist mechanism can allow for smaller entry incisions, thereby reducing the negative effects of surgery, such as pain, scarring, and undesirable healing time. But, producing small diameter medical instruments that implement the clinically desired functions for minimally invasive procedures can be challenging. Specifically, simply reducing the size of known wrist mechanisms by “scaling down” the components will not result in an effective solution because required component and material properties do not scale. 
     Another way to reduce the negative effects of surgery is to minimize the number of times that the wrist mechanism or end effector is moved into and out of the operation area of the patient. For example, some medical instruments have end effectors with gripping jaws coupled to the wrist mechanism, which can be used for performing clinical functions including cutting, dissection, incising, cauterizing, destroying tissue, and suturing. Such known medical instruments have an opposing set of jaws that can be operated to contact tissue and interact with other medical instruments. Some instruments include jaws that can grip a surgical needle therebetween and manipulate the needle to perform suturing functions. However, it can be difficult to orient the needle between the jaws of these instruments at a desired orientation for suturing. Further, it can be challenging to maintain the orientation of the needle when gripped between the jaws and while maneuvering the needle under surgical conditions, such as while maneuvering the needle within a small operating area and within a lubricious environment. Moreover, these conventional instruments are typically withdrawn from the clinical operations area during use by the operator to switch instruments (e.g., between a tissue gripping instrument and a suturing instrument) or modify the needle orientation according to surgical needs and conditions, so as to avoid the high risk of the needle slipping during such adjustments. Such manipulations can slow the suturing process and increase related challenges for maintaining a sterile clinical environment. 
     Thus, a need exists for improved endoscopic tools including tools for performing suturing clinical functions. Improvements may include wrist mechanisms having jaws with one or more gripping portions providing enhanced retention of surgical needles for suturing, and improved flexibility for quickly changing or modifying the needle orientation during use. 
     SUMMARY 
     This summary introduces certain aspects of the embodiments described herein to provide a basic understanding. This summary is not an extensive overview of the inventive subject matter, and it is not intended to identify key or critical elements or to delineate the scope of the inventive subject matter. 
     A medical device includes a clevis, a first jaw, and a second jaw. The first jaw is coupled to the clevis and has a first gripping portion and a second gripping portion. The second gripping portion includes a first needle alignment portion and the first gripping portion is configured to engage a target tissue. The second jaw is coupled to the clevis and has a third gripping portion and a fourth gripping portion. The fourth gripping portion includes a second needle alignment portion and the third gripping portion is configured to engage the target tissue. The second jaw is movable with respect to the first jaw between an open orientation and a closed orientation. The second needle alignment portion is located opposite and aligned with the first needle alignment portion when the second jaw is in the closed orientation. The first needle alignment portion and the second needle alignment portion are configured to receive a curved portion of a needle between the first needle alignment portion and the second needle alignment portion when the second jaw is in the open orientation. The first and second needle alignment portions define a clamp path within which the curved portion of the needle is received when the second jaw is in the closed orientation. The clamp path has a radius of curvature corresponding with a radius of the curved portion of the needle, and a center of the radius of curvature is located at a pre-determined orientation with respect to the first and second jaws. 
     In some embodiments, the first and the second needle alignment portions are configured to rotate the needle by clamping the curved portion of the needle when the second jaw moves from the open orientation to the closed orientation such that the curved portion of the needle aligns with the radius of curvature of the clamp path. In some embodiments, the pre-determined orientation includes an upward orientation in which the center of the radius of curvature is located on an opposite side of the second jaw from the first jaw when the second jaw is in the closed orientation. In some embodiments, the pre-determined orientation includes a downward orientation in which the center of the radius of curvature is located on a same side of the second jaw as the first jaw when the second jaw is in the closed orientation. 
     In some embodiments, the clamp path is a first clamp path, the radius of curvature is a first radius of curvature, the pre-determined orientation is a first pre-determined orientation, the first gripping portion includes a third needle alignment portion, the third gripping portion includes a fourth needle alignment portion, and the third needle alignment portion and the fourth needle alignment portion are configured to receive the curved portion of the needle when the second jaw is in the open orientation. The third and fourth gripping portions define a second clamp path within which the curved portion of the needle is received when the second jaw is in the closed orientation. The second clamp path has a second radius of curvature corresponding with the radius of the curved portion of the needle, and a center of the second radius of curvature is located at a second pre-determined orientation with respect to the first and second jaws. 
     In some embodiments, the first needle alignment portion includes a pair of first clamp supports extending toward the second needle alignment portion when in the closed orientation. The pair of first clamp supports are laterally spaced apart on the first jaw with respect to a longitudinal axis of the first and second jaws when the second jaw is in the closed orientation. The second needle alignment portion includes a second clamp support extending toward the first needle alignment portion when in the closed orientation. The second clamp support is located along the longitudinal axis of the first and the second jaws when in the closed orientation. The second clamp support and the pair of first clamp supports define the clamp path when the second jaw is in the closed orientation. 
     In some embodiments, the first needle alignment portion and the second needle alignment portion are located at proximal portions of the first and the second jaws. The first needle alignment portion of the first jaw includes a first proximal needle alignment portion and the second needle alignment portion of the second jaw includes a second proximal needle alignment portion. The second gripping portion and the fourth gripping portions are located at distal portions of the first and the second jaws. The second gripping portion includes a first distal needle alignment portion, and the fourth gripping portion includes a second distal needle alignment portion. The first and second proximal needle alignment portions are located opposite and aligned with each other when the first and the second jaw are in the closed orientation. The first and second distal needle alignment portions are located opposite and aligned with each other when the first and the second jaw are in the closed orientation. The first and second proximal needle alignment portions are configured to retain the needle in a proximal orientation when in the closed orientation. The first and second distal needle alignment portions are configured to retain the needle in a distal orientation when in the closed orientation. 
     In some embodiments, an apparatus includes a clevis, a first jaw, and a second jaw. The first jaw is coupled to the clevis and has a proximal end portion, a distal end portion, and a first needle alignment portion located between the proximal end portion and the distal end portion. The first needle alignment portion includes a first clamp support. The second jaw is coupled to the clevis and has a proximal end portion, a distal end portion, and a second needle alignment portion located between the proximal and distal end portion of the second jaw. The second needle alignment portion includes a second clamp support and is movable with respect to the first jaw between an open orientation and a closed orientation. The first and the second jaws define a longitudinal axis when the second jaw is in the closed orientation. The first and the second clamp supports extend toward each other when the second jaw is in the closed orientation. The second clamp support is located opposite and distally offset from first clamp support along the longitudinal axis when the second jaw is in the closed orientation. The first clamp support and the second clamp support define a clamp path within which a curved portion of a needle is received when the second jaw is in the closed orientation. The clamp path defines a needle orientation plane that intersects the longitudinal axis. The needle orientation plane is non-perpendicular with respect to the longitudinal axis when the second jaw is in the closed orientation. 
     Other medical devices, related components, medical device systems, and/or methods according to embodiments will be or become apparent to one with skill in the art upon review of the following drawings and detailed description. It is intended that all such additional medical devices, related components, medical device systems, and/or methods included within this description be within the scope of this disclosure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a plan view of a minimally invasive teleoperated medical system according to an embodiment, being used to perform a medical procedure such as surgery. 
         FIG. 2  is a perspective view of an optional auxiliary unit of the minimally invasive tele-operated surgery system shown in  FIG. 1 . 
         FIG. 3  is a perspective view of a user control console of the minimally invasive tele-operated surgery system shown in  FIG. 1 . 
         FIG. 4  is a front view of a manipulator unit, including a plurality of instruments, of the minimally invasive tele-operated surgery system shown in  FIG. 1 . 
         FIG. 5A  is a diagrammatic side view of a portion of an instrument of a surgery system shown in an open orientation, according to an embodiment. 
         FIG. 5B  is a diagrammatic side view of the portion of the instrument of  FIG. 5A  shown in a closed orientation. 
         FIG. 5C  is a diagrammatic cross-sectional end view of the portion of the instrument of  FIG. 5B  in the closed orientation viewed from line X-X shown in  FIG. 5B . 
         FIG. 6A  is a diagrammatic side view of a portion of an instrument of a surgery system shown in an open orientation, according to an embodiment. 
         FIG. 6B  is a diagrammatic side view of the portion of the instrument of  FIG. 6A  shown in a first closed orientation with a needle clamped at a distal portion of the instrument. 
         FIG. 6C  is a diagrammatic side view of the portion of the instrument of  FIG. 6A  shown in a second closed orientation with a needle clamped at a proximal portion of the instrument. 
         FIG. 6D  is a diagrammatic cross-sectional end view of the portion of the instrument of  FIG. 6C  in the second closed orientation viewed from line L-L shown in  FIG. 6C . 
         FIG. 7A  is a diagrammatic side view of a portion of an instrument of a surgery system shown in an open orientation, according to an embodiment. 
         FIG. 7B  is a diagrammatic side view of the portion of the instrument of  FIG. 7A  shown in a closed orientation. 
         FIG. 8  is a perspective view of an instrument of a surgery system in a first orientation, according to an embodiment. 
         FIG. 9A  is an enlarged, side perspective view of a distal end portion of the instrument indicated by the region Z shown in  FIG. 8 , according to an embodiment, in a first, closed orientation clamping a needle between the instrument jaws, in which the first link and smaller components, such as the idler pulleys and tension members, have been removed for clarity. 
         FIG. 9B  is a side view of the distal end portion of the instrument shown in  FIG. 9A . 
         FIG. 9C  is an exploded, perspective view of the distal end portion of the instrument of  FIG. 9A . 
         FIGS. 10A and 10B  are perspective views of the distal end portion of the instrument of  FIGS. 9A-9C , shown in exploded views. 
         FIG. 11A  is a cross-sectional view of the distal end portion of  FIG. 9A  as viewed from line Y-Y shown in  FIG. 9A . 
         FIG. 11B  is a close view of the area identified as region W shown in  FIG. 11A . 
         FIG. 11C  is a close view of the area identified as region L shown in  FIG. 9B . 
         FIG. 12  is an enlarged, side perspective view of a distal end portion of an instrument, according to an embodiment, shown in a first, closed orientation clamping a needle between the instrument jaws, in which the first link and smaller components, such as the idler pulleys and tension members, have been removed for clarity. 
         FIG. 13  is an enlarged side view of the distal end portion of the instrument shown in  FIG. 12 . 
         FIGS. 14A and 14B  are perspective views of the distal end portion of the instrument of  FIG. 12  shown in partially exploded views. 
         FIG. 15  is an enlarged, side perspective view of a distal end portion of an instrument, according to an embodiment, shown in a first, closed orientation clamping a needle between the instrument jaws, in which the first link and smaller components, such as the idler pulleys and tension members have been removed for clarity. 
         FIGS. 16A and 16B  are perspective views of the distal end portion of the instrument of  FIG. 15 . 
         FIG. 17  is an enlarged, side perspective view of a distal end portion of an instrument, according to an embodiment, shown in a first, closed orientation clamping an example needle between the instrument jaws, in which the first link and smaller components, such as the idler pulleys and tension members, have been removed for clarity. 
         FIGS. 18A and 18B  are perspective views of the distal end portion of the instrument of  FIG. 17 . 
     
    
    
     DETAILED DESCRIPTION 
     The embodiments described herein can advantageously be used in a wide variety of grasping, cutting, manipulating, and suturing surgical operations associated with minimally invasive surgery. In particular, the instruments described herein can be low-cost, disposable instruments that facilitate being used for only one clinical event and/or one or more particular functions procedures during the clinical event. As described herein, the instruments include a pair of jaws having a gripping portion on each jaw. The gripping portions can be configured to engage a target tissue. Moreover, each of the gripping portions can include a needle alignment portion configured to receive a curved portion of a needle therebetween when the jaws are in an open orientation, as well as to clamp the needle when the jaws are in the closed orientation to maintain the needle in a pre-determined orientation. 
     As used herein, the term “about” when used in connection with a referenced numeric indication means the referenced numeric indication plus or minus up to 10 percent of that referenced numeric indication. For example, the language “about 50” covers the range of 55 to 55. Similarly, the language “about 5” covers the range of 4.5 to 5.5. 
     The term “flexible” in association with a part, such as a mechanical structure, component, or component assembly, should be broadly construed. In essence, the term means the part can be repeatedly bent and restored to an original shape without harm to the part. Certain flexible components can also be resilient. For example, a component (e.g., a flexure) is said to be resilient if possesses the ability to absorb energy when it is deformed elastically, and then release the stored energy upon unloading (i.e., returning to its original state). Many “rigid” objects have a slight inherent resilient “bendiness” due to material properties, although such objects are not considered “flexible” as the term is used herein. 
     A flexible part may have infinite degrees of freedom (DOF&#39;s). Flexibility is an extensive property of the object being described, and thus is dependent upon the material from which the object is formed as well as certain physical characteristics of the object (e.g., cross-sectional shape, length, boundary conditions, etc.). For example, the flexibility of an object can be increased or decreased by selectively including in the object a material having a desired modulus of elasticity, flexural modulus, and/or hardness. The modulus of elasticity is an intensive property of (i.e., is intrinsic to) the constituent material and describes an object&#39;s tendency to elastically (i.e., non-permanently) deform in response to an applied force. A material having a high modulus of elasticity will not deflect as much as a material having a low modulus of elasticity in the presence of an equally applied stress. Thus, the flexibility of the object can be decreased, for example, by introducing into the object and/or constructing the object of a material having a relatively high modulus of elasticity. Examples of such parts include closed, bendable tubes (made from, e.g., NITINOL®, polymer, soft rubber, and the like), helical coil springs, etc. that can be bent into various simple or compound curves, often without significant cross-sectional deformation. 
     Other flexible parts may approximate such an infinite-DOF part by using a series of closely spaced components that are similar to a serial arrangement of short, connected links as snake-like “vertebrae.” In such a vertebral arrangement, each component is a short link in a kinematic chain, and movable mechanical constraints (e.g., pin hinge, cup and ball, live hinge, and the like) between each link may allow one (e.g., pitch) or two (e.g., pitch and yaw) DOFs of relative movement between the links. A short, flexible part may serve as, and be modeled as, a single mechanical constraint (a joint) that provides one or more DOF&#39;s between two links in a kinematic chain, even though the flexible part itself may be a kinematic chain made of several coupled links having multiple DOFs, or an infinite-DOF link. 
     As used herein, the word “clamp path” refers to path for the curved portion of the needle that is defined by the needle alignment portions of the jaws when the jaws are in the closed orientation. 
     As used herein, the word “distal” refers to direction towards a work site, and the word “proximal” refers to a direction away from the work site. Thus, for example, the end of a tool that is closest to the target tissue would be the distal end of the tool, and the end opposite the distal end (i.e., the end manipulated by the user or coupled to the actuation shaft) would be the proximal end of the tool. 
     Further, specific words chosen to describe one or more embodiments and optional elements or features are not intended to limit the invention. For example, spatially relative terms—such as “beneath”, “below”, “lower”, “above”, “upper”, “proximal”, “distal”, and the like—may be used to describe the relationship of one element or feature to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., translational placements) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures were turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features. Thus, the term “below” can encompass both positions and orientations of above and below. A device may be otherwise oriented (e.g., rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Likewise, descriptions of movement along (translation) and around (rotation) various axes includes various spatial device positions and orientations. The combination of a body&#39;s position and orientation define the body&#39;s pose. 
     Similarly, geometric terms, such as “parallel”, “perpendicular”, “round”, or “square”, are not intended to require absolute mathematical precision, unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as “round” or “generally round,” a component that is not precisely circular (e.g., one that is slightly oblong or is a many-sided polygon) is still encompassed by this description. 
     In addition, the singular forms “a”, “an”, and “the” are intended to include the plural forms as well, unless the context indicates otherwise. The terms “comprises”, “includes”, “has”, and the like specify the presence of stated features, steps, operations, elements, components, etc. but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, or groups. 
     Unless indicated otherwise, the terms apparatus, medical device, instrument, and variants thereof, can be interchangeably used. 
     Aspects of the invention are described primarily in terms of an implementation using a da Vinci® Surgical System, commercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif. Examples of such surgical systems are the da Vinci Xi® Surgical System (Model IS4000) and the da Vinci Si® Surgical System (Model IS3000). Knowledgeable persons will understand, however, that inventive aspects disclosed herein may be embodied and implemented in various ways, including computer-assisted, non-computer-assisted, and hybrid combinations of manual and computer-assisted embodiments and implementations. Implementations on da Vinci® Surgical Systems (e.g., the Model IS4000, the Model IS3000, the Model IS2000, the Model IS1200) are merely presented as examples, and they are not to be considered as limiting the scope of the inventive aspects disclosed herein. As applicable, inventive aspects may be embodied and implemented in both relatively smaller, hand-held, hand-operated devices and relatively larger systems that have additional mechanical support. 
       FIG. 1  is a plan view illustration of a computer-assisted teleoperation system. Shown is a medical device, which is a Minimally Invasive Robotic Surgical (MIRS) system  1000  (also referred to herein as a minimally invasive teleoperated surgery system), used for performing a minimally invasive diagnostic or surgical procedure on a Patient P who is lying on an Operating table  1010 . The system can have any number of components, such as a user control unit  1100  for use by a surgeon or other skilled clinician S during the procedure. The MIRS system  1000  can further include a manipulator unit  1200  (popularly referred to as a surgical robot), and an optional auxiliary equipment unit  1150 . The manipulator unit  1200  can include an arm assembly  1300  and a tool assembly removably coupled to the arm assembly. The manipulator unit  1200  can manipulate at least one removably coupled tool assembly  1400  (also referred to herein as a “tool”) through a minimally invasive incision in the body or natural orifice of the patient P while the surgeon S views the surgical site and controls movement of the tool  1400  through control unit  1100 . 
     An image of the surgical site is obtained by an endoscope (not shown), such as a stereoscopic endoscope, which can be manipulated by the manipulator unit  1200  to orient the endoscope. The auxiliary equipment unit  1150  can be used to process the images of the surgical site for subsequent display to the Surgeon S through the user control unit  1100 . The number of tools  1400  used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room, among other factors. If it is necessary to change one or more of the instruments  1400  being used during a procedure, an assistant removes the instrument  1400  from the manipulator unit  1200  and replaces it with another instrument  1400  from a tray  1020  in the operating room. Although shown as being used with the instruments  1400 , any of the instruments described herein can be used with the MIRS  1000 . 
       FIG. 2  is a perspective view of the control unit  1100 . The user control unit  1100  includes a left eye display  1112  and a right eye display  1114  for presenting the surgeon S with a coordinated stereo view of the surgical site that enables depth perception. The user control unit  1100  further includes one or more input control devices  1116 , which in turn cause the manipulator unit  1200  (shown in  FIG. 1 ) to manipulate one or more tools. The input control devices  1116  provide at least the same degrees of freedom as instruments  1400  with which they are associated to provide the surgeon S with telepresence, or the perception that the input control devices  1116  are integral with (or are directly connected to) the instruments  1400 . In this manner, the user control unit  1100  provides the surgeon S with a strong sense of directly controlling the instruments  1400 . To this end, position, force, and tactile feedback sensors (not shown) may be employed to transmit position, force, and tactile sensations from the instruments  1400  back to the surgeon&#39;s hands through the input control devices  1116 . 
     The user control unit  1100  is shown in  FIG. 1  as being in the same room as the patient so that the surgeon S can directly monitor the procedure, be physically present if necessary, and speak to an assistant directly rather than over the telephone or other communication medium. In other embodiments however, the user control unit  1100  and the surgeon S can be in a different room, a completely different building, or other remote location from the patient allowing for remote surgical procedures. 
       FIG. 3  is a perspective view of the auxiliary equipment unit  1150 . The auxiliary equipment unit  1150  can be coupled with the endoscope (not shown) and can include one or more processors to process captured images for subsequent display, such as via the user control unit  1100 , or on another suitable display located locally and/or remotely. For example, where a stereoscopic endoscope is used, the auxiliary equipment unit  1150  can process the captured images to present the surgeon S with coordinated stereo images of the surgical site via the left eye display  1112  and the right eye display  1114 . Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope. As another example, image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations. 
       FIG. 4  shows a front perspective view of the manipulator unit  1200 . The manipulator unit  1200  includes the components (e.g., arms, linkages, motors, sensors, and the like) to provide for the manipulation of the instruments  1400  and an imaging device (not shown), such as a stereoscopic endoscope, used for the capture of images of the site of the procedure. Specifically, the instruments  1400  and the imaging device can be manipulated by teleoperated mechanisms having a number of joints. Moreover, the instruments  1400  and the imaging device are positioned and manipulated through incisions or natural orifices in the patient P in a manner such that a kinematic remote center of motion is maintained at the incision or orifice. In this manner, the incision size can be minimized. 
       FIGS. 5A-5C  are diagrammatic illustrations of an instrument  2400  of a surgery system, according to an embodiment. In some embodiments, the instrument  2400  or any of the components therein are optionally parts of a surgical system that performs minimally invasive surgical procedures and which can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The instrument  2400  (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system  1000  shown and described above. The instrument  2400  includes a clevis  2510 , a first jaw  2462 , and a second jaw  2482 . The first jaw  2462  is coupled to the clevis  2510  and has a first gripping portion  2464  and a second gripping portion  2465 . The first gripping portion  2464  on the first jaw  2462  is configured to engage a target tissue during use and, as shown in the examples of  FIGS. 5A and 5B , can be located at a proximal end of the first jaw  2462 . The second gripping portion  2465  can be located at an opposite distal end of the first jaw  2462  and includes a first needle alignment portion  2475  as discussed further below. 
     The second jaw  2482  is coupled to the clevis  2510  and has a third gripping portion  2484  and a fourth gripping portion  2485 . The fourth gripping portion  2485  includes a second needle alignment portion  2495 . Similar to the first gripping portion  2464  of the first jaw, the third gripping portion  2484  is also configured to engage the target tissue (not shown). Moreover, the first gripping portion  2464  and the third gripping portion  2484  are configured to cooperate with each other to more effectively engage the target tissue by clamping the tissue between opposite gripping portions on each of the jaws. As indicated by the arrow AA in  FIG. 5A , the second jaw  2482  is movable with respect to the first jaw  2462  for moving between the open orientation shown in  FIG. 5A , and the closed orientation shown in  FIG. 5B . The second needle alignment portion  2495  of the second jaw  2482  is located opposite to, and aligned with, the first needle alignment portion  2475  when the second jaw is in the closed orientation shown in  FIG. 5B . 
     The second jaw  2482  can be moved relative to the first jaw  2462  by any suitable mechanism. For example, in some embodiments, one or more tension members (e.g., cables, not shown) can be coupled to the second jaw  2482  to rotate the second jaw  2482  relative to the first jaw  2462  about the clevis  2510 . Although the first jaw  2462  is shown as being stationary relative to the clevis  2510 , in some embodiments, both the second jaw  2482  and the first jaw  2462  can move relative to the clevis  2510 . In other embodiments, the second jaw  2482  can remain stationary relative to the clevis  2510  while the first jaw  2462  is moved relative to the clevis  2510 . 
     Referring to  FIG. 5A , the first needle alignment portion  2475  and the second needle alignment portion  2495  are configured to receive a curved portion  2011  of a needle  2010  between the first needle alignment portion and the second alignment portion when the second jaw  2482  is in the open orientation. The first needle alignment portion  2475  and second needle alignment portion  2495  define a clamp path  2476  (see  FIGS. 5B and 5C ) when the second jaw  2482  is in the closed orientation. The curved portion  2011  of the needle  2010  is received between the first and second needle alignment portions  2475 ,  2495  when the second jaw moves from the open orientation shown in  FIG. 5A  to the closed orientation shown in  FIGS. 5B and 5C , during which the clamp path  2476  is formed between the first and the second jaw  2462 ,  2482  that closes about the curved portion  2011  of the needle. Thus, as described in greater detail along with  FIG. 5C , the instrument  2400  can act as a self-righting needle holder for quickly and easily holding the needle in suturing position between the jaws. 
     Referring to  FIG. 5C , the clamp path  2476  that is defined between the first and second needle alignment portions  2475 ,  2495  has a radius of curvature, R ClampPath , that corresponds to the needle radius of curvature, R Needle , at the curved portion  2011  of the needle. In some embodiments, the radius of curvature R ClampPath  is equal to the needle radius of curvature R Needle . When the needle  2010  is retained within the clamp path  2476  and while the second jaw is in the closed orientation shown in  FIGS. 5B and 5C , the curved portion  2011  of the needle  2010  aligns with radius of curvature of the clamp path  2476 . In this manner, a center C RN  of the radius of curvature, R Needle , of the needle  2010  is guided by the first and second needle alignment portions when clamping the curved portion of the needle  2010  within the clamp path  2476 . In some embodiments, the clamp path radius of curvature R ClampPath  is larger or smaller than the needle radius of curvature R Needle  such that the instrument can hold needles of different sizes and varying curvatures in accordance with surgical requirements while still self-guiding the needle into the desired alignment and orientation in the instrument. Whether the clamp path has the same radius of curvature, R ClampPath , or a radius that is larger or smaller than the needle radius of curvature R Needle , the clamp path radius of curvature R ClampPath  nonetheless includes a sufficient number of needle contact points to define the curved clamp path, engage the curved portion  2011  of the needle, and guide it into the orientation shown in  FIG. 5C . 
     As shown by the arrows BB in  FIGS. 5A-5C , when the second jaw  2482  moves to the closed orientation, it engages the needle  2010  as it clamps the needle between the jaws. During this movement to the closed orientation, the second jaw rotates the needle  2010  relative to the jaws such that the center C RN  of the radius of curvature, R Needle , is located at a pre-determined orientation with respect to the first and second jaws. In particular, as shown in  FIG. 5C , the center C RN  of the radius of curvature, R Needle , is coincident with the center C CP  of the radius of curvature R ClampPath  of the clamp path  2476 . Further, the center C RN  of the radius of curvature, R Needle , becomes coincident with the center C CP  of the radius of curvature R ClampPath  of the clamp path  2476  such that an apex, AP, of the curved needle portion  2011  matches an apex of the proximal clamp path  2476 . The pre-determined orientation can be a desired orientation with respect to the instrument  2400  for performing suturing functions. For example, as shown in  FIG. 5B , in some embodiments, the pre-determined orientation of the center C CP  of the radius of curvature R ClampPath  of the clamp path  2476  (and thus, the center C RN  of the radius of curvature, R Needle ) intersects a longitudinal axis A L  of the first jaw  2462  and the second jaw  2482  at the first and second needle alignment portions  2475 ,  2495  at an angle of about ninety degrees. In other embodiments, however, the radius of curvature R ClampPath  of the clamp path  2476  intersects a longitudinal axis A L  of the first jaw  2462  and the second jaw  2482  at the first and second needle alignment portions  2475 ,  2495  at any suitable angle. 
     Thus, the first and second needle alignment portions  2475  and  2495  cooperate to self-align the needle while moving the second jaw  2482  into a clamped arrangement for suturing functions. As such, when the second jaw  2482  moves from the open orientation shown in  FIG. 5A  to the closed orientation shown in  FIGS. 5B and 5C  while the curved portion  2011  of the needle is located between the first and second needle alignment portions  2475 ,  2495 , the first and second alignment portions of the jaws are configured to engage the curved portion  2011  of the needle  2010 . The jaws proceed to rotate the needle  2010  by clamping the curved portion  2011  of the needle during movement to closed orientation, such that the curved portion of the needle aligns with radius of curvature of the clamp path. In this manner, a needle  2010  can be readily clamped in place between the jaws of the instrument  2400  into a secure needle-driver, suturing arrangement with the instrument  2400 . The instrument can thereby be manipulated to drive the needle  2010  while the needle is securely clamped to the instrument and retained in a desired pre-configured orientation for performing suturing functions. The aligned curvatures between the needle and the clamp path  2476  while the needle  2010  is retained in this clamped arrangement firmly retains and orients the needle with respect to the instrument. 
     Additionally, the inclusion of the first gripping portion  2464  and the third gripping portion  2484  provides surfaces that can engage the target tissue. In this manner, the instrument  2400  can manipulate tissue (via the first gripping portion  2464  and the third gripping portion  2484 ) during a first operation and then manipulate the needle  2010  (via the first and second needle alignment portions  2475 ,  2495 ) during a second operation without the need to remove the instrument from the worksite. This arrangement provides greater flexibility during surgical procedures and can minimize the operation time and reduce the number of entries and withdrawals from the surgical site. For instance, the first gripping portion  2464  and the third gripping portion  2484  can be used to perform minor adjustments in the placement and proximity of opposing tissues to be sutured, after which the first and second needle alignment portions  2475 ,  2495  can quickly clamp and self-orient the needle  2010  to perform suturing functions. 
     Although the first and second needle alignment portions  2475 ,  2495  are shown as being configured to rotate the needle in an upward orientation, in other embodiments, the first and second needle alignment portions  2475 ,  2495  (and any of the needle alignment portions described herein) can be configured to rotate the needle in a downward orientation (or any other suitable orientation). Similarly stated, the first and second needle alignment portions  2475 ,  2495  are shown including the center C CP  of the radius of curvature R ClampPath  of the clamp path  2476  on an opposite side of the second jaw  2482  as the first jaw  2462 . In other embodiments, the first and second needle alignment portions  2475 ,  2495  can the center C CP  of the radius of curvature R ClampPath  of the clamp path  2476  on the same side of the second jaw  2482  as the first jaw  2462 . 
     Although the instrument  2400  includes a first pair of gripping portions configured to engage a target tissue and a second pair of gripping portions configured to manipulate a needle, in other embodiments an instrument can include multiple sets of needle alignment portions. For example,  FIGS. 6A-6D  show an instrument  3400 , which includes certain aspects, preferences and features as instrument  2400  described above along with  FIGS. 5A-5C , except as described herein. Like numbers described herein for  FIGS. 6A-6D  refer to like features of  FIGS. 5A-5C . Instrument  3400  shown in  FIGS. 6A-6D  differs from instrument by optionally including an additional needle alignment portion on each of the jaws. As discussed in greater detail below along with  FIG. 6D , the additional set of needle alignment portions can provide an additional pre-determined orientation for the needle for the additional set of needle alignment portions that can be different from the pre-determined orientation shown in  FIGS. 5B and 5C , such as providing a pre-determined orientation option that is 180 degrees from the other. 
     Referring to  FIG. 6A , the instrument  3400  includes a clevis  3510 , a first jaw  3462 , and a second jaw  3482 . The first and second jaws are each coupled to the clevis and are movable with respect to each other between an open orientation ( FIG. 6A ) and a closed orientation ( FIGS. 6B and 6C ). The first jaw  3462  includes a first proximal needle alignment portion  3471  and a first distal needle alignment portion  3475 . The second jaw  3482  is coupled to the clevis  3510  and includes second proximal needle alignment portion  3491  and a second distal needle alignment portion  3495 . As indicated by the pair of arrows CC in  FIG. 6A , the first jaw  3462  and the second jaw  3482  are movable with respect to each other between an open orientation shown in  FIG. 6A , and the closed orientation shown in  FIG. 6B . The first proximal needle alignment portion  3471  of the first jaw  3462  is located opposite to, and aligned with, the second proximal needle alignment portion  3491  when the first jaw and the second jaw are in the closed orientation shown in  FIG. 6B . Similarly, the first distal needle alignment portion  3475  of the first jaw  3462  is located opposite to, and aligned with, the second distal needle alignment portion  3495  when the first jaw and the second jaw are in the closed orientation shown in  FIG. 6B . Although the first jaw  3462  and the second jaw  3482  are shown as moving relative to each other and to the clevis  3510 , in some embodiments, only the first jaw  3462  or the second jaw  3482  can move relative to the clevis  3510  and to each other. 
     Referring to  FIG. 6A , the first distal needle alignment portion  3475  and the second distal needle alignment portion  3495  are configured to receive a curved portion  3011  of a needle  3010  therebetween when the first jaw  3462  and the second jaw  3482  are rotated apart from each other in an open orientation. The first distal needle alignment portion  3475  and second distal needle alignment portion  3495  define a distal clamp path  3476  (see  FIG. 6B ) that is similar to clamp path  2476  of instrument  2400  discussed above when the first jaw  3462  and the second jaw  3482  are in the closed orientation. The curved portion  3011  of the needle  3010  can be received between the first and second distal needle alignment portions  3475 ,  3495  when the first and second jaws move relative to each other from the open orientation shown in  FIG. 6A  to the closed orientation shown in  FIG. 6B  in a similar manner as described above for instrument  2400 . Thus, the instrument  3400  can likewise act as a self-righting needle holder for quickly and easily holding the needle in a suturing position at a distal end of the instrument between the jaws, which operates similar to the self-righting needle functions described above for instrument  2400 . 
     In addition, the first proximal needle alignment portion  3471  and second proximal needle alignment portion  3491  of instrument  3400  further define a proximal clamp path  3477  (see  FIGS. 6C and 6D ) in addition the distal clamp path  3476 . In some embodiments, the proximal clamp path  3477  can function in a similar manner as the distal clamp path  3476  to provide similar self-righting and needle clamping functionality to that provided by distal clamp path  3476 , but can also do so at a second, proximal position along the instrument in comparison with the distal clamp path  3476 . In some circumstances, it can be beneficial to have more than one self-righting needle position along the instrument that can provide another option for performing suturing functions with respect to the particular surgical environment, such as geometric access factors available to the suture site, the freedom of movement available for moving within the access space for suturing functions, or the clamp force and needle driving requirements for forming sutures in the particular tissue and location for the surgical environment. In other embodiments, the proximal clamp path  3477  can be configured to function in a different manner compared with distal clamp path  3476 , such as to provide a different self-righting needle holding functionality that can, for example, provide a different needle holding orientation, be configured to clamp different types or sizes of needles, or provide differing self-righting or clamping retention abilities. 
     Referring to  FIGS. 6A and 6B , the first and second proximal needle portions  3471  and  3491  can be configured to provide different needle holding functionality compared with the distal needle portions  3475  and  3495 . Similar to the first and second distal needle portions  3475  and  3495 , the first and second proximal needle portions  3471  and  3491  can hold the curved portion  3011  of the needle  3010  between the opposing needle portions when the needle is received between them and the first and second jaws move relative to each other, such as from the open orientation shown in  FIG. 6A  to the closed orientation shown in  FIGS. 6B and 6C . In a similar manner, the proximal clamp path  3477  can also formed between the first and the second jaws  3462 ,  3482  when in the closed orientation, such that the proximal clamp path  3477  also closes about the curved portion  3011  of the needle. However, different from the distal clamp path  3476 , the proximal clamp path  3477  in the embodiment shown in  FIG. 6C  is configured to provide a proximal needle orientation between the first and second proximal needle alignment portions  3471  and  3491  that differs from the distal needle orientation between the first and second distal needle alignment portions  3475  and  3495 . In particular, the embodiment of  FIG. 6C  includes a proximal needle orientation that is about 180 degrees opposite from the distal needle orientation. Stated differently, the embodiment shown in  FIGS. 6C and 6D  includes a distal needle orientation that is directed toward the second jaw  3482  with respect to the first jaw  3462  (e.g., directed in an upward orientation if the second jaw is oriented upward with respect to the first jaw), and an opposite proximal needle orientation that is directed toward the first jaw  3462  with respect to the second jaw  3482  (e.g., directed in a downward orientation if the first jaw is oriented downward with respect to the second jaw). 
     Thus, in a similar manner as instrument  2400  discussed above along with  FIGS. 5A-5C , the instrument  3400  can likewise act as a self-righting needle holder for quickly and easily holding the needle in a suturing position at a distal end of the instrument between the jaws. In addition, the instrument  3400  can further provide additional self-righting needle holding functionality at a proximal position along the instrument in comparison with the distal needle alignment portions  3475  and  3495 . Moreover, instrument  3400  is configured in the embodiment shown in  FIGS. 6C and 6D  to hold the needle in a self-righting proximal orientation that is opposite from the orientation of the self-right distal orientation. Stated differently, the embodiment of instrument  3400  can hold the needle  3010  in two opposite orientations to provide options as appropriate for the surgical environment, while still be providing self-righting functionality for both of the opposite orientations. 
     Providing the opposite needle holding orientations along with self-righting functionality for each of these orientations when clamping the needle (see  FIGS. 6A and 6B ) can be beneficial for various surgical environments and conditions, as well as for user preferences. For example, many sutures disposed at various locations on a patient can be easier to perform by driving the needle  3010  into the target tissue from a particular location based on surgical factors and conditions, such as many wound locations encouraging needle access to occur from below the wound (e.g., for suturing a wound located on the underside of a body part that should not be moved, or suturing from within a body cavity). The distal needle orientation shown in  FIG. 6B , as an example, can provide an advantageous orientation for guiding the needle from an underside for these environments. Further, other surgical environments can encourage driving the needle into the target tissue (not shown) from a different orientation and direction of movement, such as driving the needle into the tissue in a clockwise or counter-clockwise direction from a position disposed above the wound based on surgical factors like wound geometry or tissue tension. 
     The proximal needle orientation shown in  FIG. 6C , as an example, can be an advantageous orientation for guiding the needle for these sutures. Providing the proximal and distal needle orientation with opposite orientations in the same instrument  3400  along with configuring the instrument to provide self-righting functionality for the needle with either left or right handed orientations, can enable the user to quickly change the orientation of the needle that is held in the instrument, and to do so without withdrawing/re-engaging the instrument  3400  from the surgical area (i.e., for easily changing between the orientation of  FIG. 6B  vs.  6 C). The embodiment of instrument  3400  can be configured to receive the needle between the jaws when in the open orientation with the needle tip placed on either lateral side of the instrument based on left or right-handed preferences and/or surgical factors while still providing self-righting functionality to guide the needle into the corresponding orientation at which it is held for driving the needle. Thus, instrument  3400  can provide significant flexibility for adapting the orientation of the needle  3010  during use as appropriate according to the surgical environment, user preferences, ease of access for suturing, etc. The instrument  3400  can further do so without incurring time-consuming instrument adjustments, while avoiding increased risk of contamination from the removal/entry of the instrument, and while firmly clamping the needle in the appropriate orientation when the jaws clamp on the needle and are located in the closed orientation. 
     The self-righting actions shown in  FIG. 6B  can operate in a similar manner as was discussed above along with instrument  2400  along with moving the first and second jaws  3462  and  3482  with respect to each other into the closed, clamped orientation. Similarly, the self-righting actions shown in  FIG. 6C  can operate in a similar, but opposite manner to provide an opposite orientation for the needle. With reference to  FIG. 6D  along with  FIG. 6C , when instrument  3400  receives the needle  3010  between the first proximal needle orientation portion  3471  and the corresponding and opposed second proximal needle orientation portion  3491 , and the first and second jaws move with respect to each other into the closed orientation shown in  FIG. 6D , the needle  3010  is clamped between the first and second needle orientation portions. When in the closed orientation of  FIG. 6D , the proximal clamp path  3477  is defined between the first and the second proximal needle alignment portions  3471 ,  3491 , which has a radius of curvature, R ClampPath , that corresponds to the needle radius of curvature, R Needle  at the curved portion  3011  of the needle. The proximal clamp path  3477  includes a sufficient number of needle contact points to define the curved clamp path, engage the curved portion  3011  of the needle, and guide it into the opposite proximal orientation shown in  FIGS. 6C and 6D  vs. the distal orientation shown in  FIG. 6B . 
     As shown by the arrows EE in  FIGS. 6C and 6D , when the second jaw  3482  moves to the closed orientation and clamps the needle between the jaws, it rotates the needle  3010  relative to the jaws such that the center C RN  of the radius of curvature, R Needle , is located at a pre-determined distal orientation with respect to the first and second jaws. In particular, as shown in  FIG. 6C , the center C RN  of the radius of curvature, R Needle , becomes coincident with the center C CP  of the radius of curvature R ClampPath  of the clamp path  3476  such that an apex, AP, of the curved needle portion  3011  matches an apex of the proximal clamp path  3477 . The pre-determined orientation can be a desired orientation with respect to the instrument  3400  for performing suturing functions. For example, as shown in  FIG. 5B , in some embodiments, the pre-determined orientation of the center C CP  of the radius of curvature R ClampPath  of the clamp path  3477  (and thus, the center C RN  of the radius of curvature, R Needle ) can intersect a longitudinal axis A L  of the first jaw  3462  and the second jaw  3482  at the first and second proximal needle alignment portions  3471 ,  3491  at an angle of about ninety degrees. In other embodiments, however, the radius of curvature R ClampPath  of the clamp path  3477  can intersect a longitudinal axis A L  of the first jaw  3462  and the second jaw  3482  at the first and second needle alignment portions  3471 ,  3491  at any suitable angle. 
     Thus, the first and second proximal needle alignment portions  3471  and  3491  can cooperate to self-align the needle in either of the pair of opposite orientations shown in the  FIG. 6B  vs.  6 C options, as well as to allow the needle to easily be switched between the orientations. As such, when the first and second jaws  3462  and  3482  move with respect to each other from the open orientation shown in  FIG. 6A  to the closed orientations shown in  FIGS. 6B-6D , and while the curved portion  3011  of the needle is located between the corresponding needle alignment portions ( 3471  and  3491 , or  3475  and  3495 ), the needle alignment portions of the jaws are configured to engage the curved portion  3011  of the needle and rotate the needle  3010  into the driving orientation at which it is held for suturing functions. 
     The corresponding pairs of needle alignment portions in  FIGS. 6A-6D  are shown as being configured to rotate the needle into one of the orientations shown in  FIGS. 6B and 6C  such that the needle can be oriented perpendicular with respect the longitudinal axis A L . In other embodiments, the needle alignment portions (and any of the needle alignment portions described herein) can be configured to rotate the needle in various different orientations and combinations of orientations. For example,  FIGS. 7A and 7B  show an instrument  4400 , which can provide different needle alignment orientations from those discussed above. The instrument includes certain aspects, preferences and features as are described above along with instruments  2400  and  3400 , except as described herein. Like numbers described herein for  FIGS. 7A and 7B  refer to like features of  FIGS. 5A-5C and 6A-6D . Instrument  4400  shown in  FIGS. 7A and 7B  differs from the distal needle orientation portions of instruments  2400  and  3400  by optionally being configured to guide the needle  4010  during self-righting movements to be oriented in a pre-determined needle holding orientation for the clamped needle  4010  that is shown in  FIG. 7B , which can be configured to have an orientation that is not perpendicular with respect to the longitudinal axis A L  of the instrument  4400 . Stated differently, the clamped needle  4010  is held in a non-normal orientation with respect to the longitudinal axis of the instrument  4400  such that the needle defines an offset angle of rotation, Θ, vs the perpendicular positions of the previous instruments  2400  and  3400 . 
     The embodiment of  FIGS. 7A and 7B  can be configured in a similar manner as instruments  2400  and  3400 . Thus, instrument  4400  can include one or more tissue contact portions (e.g., gripping portions; not shown in  FIGS. 7A and 7B ), as well as one or more additional sets of needle orientation portions (also not shown in  FIGS. 7A and 7B ) that can hold the needle in multiple different and/or similar orientations within the instrument  4400  during needle driving functions. Further, as is shown in  FIGS. 7A and 7B , the instrument  4400  can also include a corresponding set of needle orientation portions  4465  and  4485  that are configured to provide the offset angle of rotation arrangement shown in  FIG. 7B  for needle driving functions, and can do so without including the additional portions shown and discussed above along with instruments  2400  and  3400 . Rather, this arrangement can be configured to provide customized orientations for holding the needle for suturing function that can provide benefits for particular surgical situations and types of surgical functions. As an example, in a situation in which access to a wound to be sutured is limited to an elongate distal region, such as within a patient&#39;s throat or other similarly shaped cavity, customized holding orientations for the needle within the instrument  4400  can be beneficial for the needle driving functions, which when combined with some of the beneficial aspects and features discussed above pertaining to self-righting functionality and options for easily changing or adjusting the needle without removing the instrument  4400  from the surgical environment, can provide a customized instrument that is well adapted for the particular surgical functions along with providing additional benefits pertaining to quickly and easily adjusting the instrument in vivo. 
     Referring to  FIGS. 7A and 7B , the instrument  4400  includes a clevis  4510 , a first jaw  4462 , and a second jaw  4482 . The first jaw  4462  is coupled to the clevis  4510  and has a first gripping portion  4465 . The second jaw  4482  is coupled to the clevis  4510  and the first jaw  4462 , and has a second gripping portion  4485 . The first gripping portion  4465  on the first jaw includes a first needle alignment portion  4475 . Likewise, the second gripping portion  4485  on the second jaw includes a second needle alignment portion  4495 . As indicated by the arrow EE in  FIGS. 7A and 7B , the second jaw  4482  is movable with respect to the first jaw  4462  for moving between the open orientation shown in  FIG. 7A , and the closed orientation shown in  FIG. 7B . The second needle alignment portion  4495  of the second jaw  4482  is located opposite the first needle alignment portion  4475  when the first and second jaws are in the closed orientation shown in  FIG. 7B . However, unlike instruments  2400  and  3400 , the first needle alignment portion  4475  is not aligned with the second needle alignment portion  4495  when the first and second jaws are in the closed orientation. 
     Rather, as shown in  FIG. 7B , the first needle alignment portion  4475  on the first jaw and the second needle alignment portion  4495  on the second jaw are offset by a particular distance as appropriate for the intended suturing usage of the instrument  4400 , which in some embodiments can be a customized longitudinal offset distance, G. In some embodiments, the offset distance G can include the second needle configuration portion  4495  of the second jaw  4482  being distally offset with respect to the first needle configuration portion  4475  along the longitudinal axis, A L , of the instrument  4400  as is shown in  FIG. 7B . In other embodiments, the offset distance G can have an offset arrangement such that the first needle configuration portion  4475  is distally offset along the longitudinal axis A L  with respect to the second needle configuration portion  4495 . In other embodiments, the offset distance and customized arrangement of the first and second needle configuration portions can be different in various ways that provide various non-normal holding orientations for the needle, such as providing needle orientations in opposite directions (e.g., downward to the extent needle  4010  shown in  FIG. 7B  can be considered an upward orientation), or in other arrangements such as configuring the needle to be primarily proximally oriented when the needle is held in a needle driving orientation. 
     Referring to  FIG. 7B , the distal offset distance G between the corresponding needle configuration portions allows instrument  4400  to maintain self-righting needle functionality in a similar manner as discussed above along with instruments  2400  and  3400  while also clamping the curved portion of the needle therebetween. However, the distal offset distance G results in the providing a non-normal orientation when forming the clamp path  4476 . In other words, the offset distance between the needle configuration portions  4475  and  4495  can define a clamp path  4476  that is distally angled such that the clamp path lies within a lateral plane with respect to the longitudinal axis, A L , which is non-normal and defines an angle, θ, extending away from the longitudinal axis. Thus, as shown in  FIG. 7B , when the instrument  4400  guides the needle  4010  to provide self-righting functionality similar to the functionality discussed above along with instruments  2400  and  3400 , the clamped orientation in which the needle  4010  is held for needle driving functions is a non-normal orientation. However, the needle orientation is likewise coincident with the clamp path  4476 , such that the orientation of the needle when held in the needle driving orientation also defines an angle, Θ, in which the needle is rotated from a perpendicular orientation shown in  FIGS. 5A-5C and 6A-6D . Stated differently, the needle confirmation portions  4475  and  4495  can be offset with respect to each other in order to provide customized orientations for the needle during needle driving functions. 
     In some embodiments, an instrument can combine self-righting needle holder functionality with tissue engaging functionality in an instrument having multiple degrees of freedom for moving in many directions, such as providing self-righting needle driving functionality in a wrist mechanism without limiting its ranges of motions. For example,  FIGS. 8-11C  show various views of an instrument  5400 , according to an embodiment, which generally includes the same preferences and features as described above along with instruments  2400  and  3400  except as described hereafter in an instrument configured to move in multiple directions. Accordingly, like numbers refer to like features as described above. In some embodiments, the instrument  5400  or any of the components therein are optionally parts of a surgical assembly that performs minimally invasive surgical procedures, and which can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The instrument  5400  (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system  1000  shown and described above. The instrument  5400  includes a transmission assembly  5700  (that can function as an actuator mechanism), an instrument shaft  5410 , a wrist assembly  5500 , and an end effector  5460 . 
     The wrist assembly  5500  includes a link configured as a proximal first link (not shown), a distal second link  5610 , and a first jaw  5462  and a second jaw  5482  that are both part of the end effector  5460 . Each of the pair of jaws are coupled to the distal second link  5610  in an opposing relationship with each other, so that the pair of jaws can cooperate with each other to clamp, grasp, or otherwise interface with a target tissue (not shown). The instrument  5400  further includes one or more tension members (not shown), which have been omitted in  FIGS. 8-11C  to more clearly show features pertaining to the needle holding features. However, the instrument  5400  generally includes multiple tension members (not shown) that couple the transmission mechanism  5700  to the wrist assembly  5500 . The instrument  5400  is configured such that movement of the tension members can produce rotation of the wrist assembly  5500  (i.e., pitch rotation) about a first axis of rotation, A 1 , yaw rotation of the end effector  5460  about a second axis of rotation, A 2 , grip rotation of the jaws of the end effector  5460  about the yaw axis, or any combination of these movements. Thus, the instrument  5400  is configured to perform a variety of articulation movements along portions of the wrist assembly  5500  and the end effector  5460 . 
     The transmission mechanism  5700  produces movement of the plurality of tension members (not shown), which operate to produce the desired articulation movements (pitch, yaw, or grip) at the wrist assembly  5500 . Specifically, the transmission mechanism  5700  includes components and controls to move some of the tension members in a proximal direction (i.e., to pull in certain tension members) while simultaneously allowing the distal movement (i.e., releasing or “paying out”) of other of the tension members in equal lengths. In this manner, the transmission mechanism  5700  can maintain the desired tension within the tension members, and can ensure that the lengths of the tension members are conserved (i.e., moved in equal amounts) during the entire range of motion of the wrist assembly  5500 . In some embodiments, for example, the transmission assembly  5700  can be any of the transmission assemblies shown and described in International Patent Application No. PCT/US2017/062258, (filed Nov. 14, 2017), entitled “Cable Length Conserving Medical Instrument,” which is incorporated herein by reference in its entirety. In other embodiments however, conservation of the lengths of the tension members is not required. 
     Referring now to  FIG. 8 , the articulable wrist mechanism  5500  of the instrument  5400  is coupled to the shaft  5410 , which can be any suitable elongated shaft that couples the wrist assembly  5500  to the transmission mechanism  5700 . Specifically, the instrument shaft  5410  includes a proximal end portion  5411  that is coupled to a housing of the transmission mechanism  5700 , and a distal end portion  5412  that is coupled to the wrist assembly  5500 . The instrument shaft  5410  defines a passageway or series of passageways through which the tension members (not shown) and other components (e.g., electrical wires, ground wires, or the like) can be routed from the transmission mechanism  5700  to the wrist assembly  5500 . Although shown as being cylindrical, in other embodiments the instrument shaft  5410  can have any suitable shape. 
     Referring now to  FIGS. 9A-9C , the wrist assembly  5500  includes a proximal first link (not shown) that is coupled to the distal end portion  5412  of the instrument shaft  5410 , and a distal second link  5610 , which is articulably coupled to an end effector  5460 . In this manner, the first link (not shown) and the second link  5610  form the wrist assembly  5500  having a first axis of rotation A 1  (also referred to as the pitch axis) about which the second link  5610  can rotate relative to the first link (not shown). As shown in  FIG. 9C , the first link (not shown) and the second link  5610  define a longitudinal centerline C L  that intersects the pitch axis A 1  when the instrument is in an initial (or “straight” configuration). The first link (not shown) defines various bores and/or guide paths that can contain (or allow passage of) various components of the wrist assembly including the tension members (not shown) and various electrical components and connections. 
     The distal second link  5610  has a proximal end portion  5611  and a distal end portion  5612 . The proximal end portion  5611  includes a joint portion  5640  that is rotatably coupled to the joint portion of the first link (not shown). The distal end portion  5612  of the second link  5610  includes a connector  5680  that is coupled to the end effector  5460 . In this manner, the first jaw  5462  and the second jaw  5482  of the end effector  5460  can rotate relative to the second link  5610  about a second axis of rotation A 2  (also referred to as the yaw axis). The connector  5680  is a pin-type connector and includes the pin  5683  which is supported by (and placed within) the pin openings  5682 . In some embodiments, the connector  5680  can include any of the structure and features of the pinned joints shown and described in U.S. Pat. No. 9,204,923 B2 (filed Jul. 16, 2008), entitled “Medical Instrument Electronically Energized Using Drive Cables,” which is incorporated herein by reference in its entirety. As shown in  FIGS. 9B and 9C , the second axis of rotation A 2  (also referred to as the yaw axis) is non-parallel to the pitch axis A 1 . Thus, the instrument  5400  provides for up to three degrees of freedom (i.e., a pitch motion about the first axis of rotation A 1 , a yaw rotation about a second axis of rotation A 2 , and a grip motion about the second axis of rotation A 2 . 
     Referring now to  FIGS. 9C, 10A and 10B , the first jaw  5462  of the end effector  5460  includes a proximal pulley portion  5467  and a distal end portion  5463 . Similarly, the second jaw  5482  includes a proximal pulley portion  5487  and a distal end portion  5483 . The proximal pulley portions  5467 ,  5487  of the jaws  5462 ,  5482  are each rotatably coupled to the distal end portion  5612  of the distal second clevis  5610  at connector  5680  via pin  5683  to rotate about the second axis A 2 . One or more of the tension members (not shown) are coupled to each of the proximal pulley portions  5467 ,  5487  to drive movement of a corresponding one of the jaws  5462 ,  5482  including moving the jaws with respect to each other and rotating the jaws with respect to the second link  5610 , such as when a tension member (not shown) applies a tensile force along a perimeter portion of a proximal pulley portion  5467 ,  5487 . In this manner, the first and second jaws  5462 ,  5482  can each rotate about the pin  5683  and relative to the second link  5610  via the second axis of rotation A 2 . As such, application of a force by the corresponding tension members (not shown) to each of the proximal pulley portions  5467 ,  5487  can produce a torque on the first jaw  5462  and the second jaw  5482  about a yaw axis, which can result in rotation of the first jaw  5462  and the second jaw  5482 , or the application of a gripping force between the jaws. 
     The first jaw  5462  includes a first distal gripping portion  5465  located at a distal end portion thereof, which further includes a first proximal gripping portion  5464  and a first distal gripping portion  5465 . The second jaw  5484  likewise includes a second contact portion  5483  located at a distal end thereof, which further includes a second proximal gripping portion  5484  and a second distal gripping portion  5485 . The first distal gripping portion  5465  on the first jaw  5462  and the second distal gripping portion  5485  on the second jaw  5482  are each configured to engage a target tissue during use and, as shown in the examples of  FIGS. 9A-9C , can be located at a distal end of the corresponding first and second jaw  5462 ,  5482 . The first proximal gripping portion  5464  can be located at an opposite proximal end of the first jaw  5462 , and the second proximal gripping portion  5484  can be located at an opposite proximal end of the second jaw  5482 . In addition, as discussed further below, the first proximal gripping portion  5464  includes a first needle alignment portion  5471 , and the second proximal gripping portion  5484  includes a second needle alignment portion  5491 . 
     The first distal gripping portion  5465  and the second distal gripping portion  5485  are configured to cooperate with each other to more effectively engage the target tissue by clamping the tissue between opposite gripping portions on each of the jaws. As indicated by the arrow HH shown in  FIG. 9B , the first jaw  5462  and the second jaw  5482  are movable with respect to each other for moving between an open orientation (not shown), which can be similar to the open orientation shown in  FIG. 6A  for the instrument  3500 , and the closed orientations shown in  FIGS. 8, 9A and 9B . The second proximal needle alignment portion  5491  of the second jaw  5482  is located opposite to, and aligned with, the first proximal needle alignment portion  5471  when the first and the second jaws are a closed orientation, such as the closed orientations shown in  FIGS. 9A and 9B . As discussed in greater detail below, the needle alignment portions can be configured for self-righting needle functions when the first and second jaws are moving from an open to closed orientations, as well as for needle clamping for suturing. 
     Referring to  FIG. 11A , the first proximal needle alignment portion  5471  and the second proximal needle alignment portion  5491  are configured to receive a curved portion  5011  of a needle  5010  between the first and second proximal needle alignment portions  5471 ,  5491  when the first and second jaws  5462  and  5482  are in the open orientation (not shown). The first proximal needle alignment portion  5471  and second proximal needle alignment portion  5485  define a clamp path  5476  therebetween when the first and second jaws  5462  and  5482  are in the closed orientation. The curved portion  5011  of the needle  5010  can be received between the first and second proximal needle alignment portions  5471 ,  5491  when the first and the second jaws  5462 ,  5482  are in an open orientation, in which the curved portion is not limited to having a particular alignment when inserted and received. The first and second proximal needle alignment portions  5471 ,  5491  are configured to engage the curved portion  5011  while the first and second jaws  5462 ,  5482  move with respect to each other toward the closed orientation and clamp the curved portion  5011  to thereby hold the needle in its pre-configured orientation. 
     Thus, in a manner similar to the instruments  2400 ,  3400  and  4400  discussed above, the instrument  5400  can function as a self-righting needle holder in which a needle  5010  can be quickly and easily received, self-aligned and clamped into a pre-configured needle driver orientation with respect to the instrument for performing suturing functions. In addition, the instrument  5400  can be used to engage tissue via its contact portions  5463 ,  5483  for performing other surgical functions, such as gripping, cutting or cauterizing the tissue. The combinations of functionalities can be provided by the contact portions  5463 ,  5483  and the needle alignment portions  5464 ,  5484 , which benefits are further enhanced by the ranges of movements provided by the wrist mechanism arrangement of the instrument  5400 . Thus, instrument  5400  is configured to provide a wide range of surgical functions including engaging tissue via its contact portions and suturing via its needle alignment portions within wide ranges of motion, as well as quickly changing between surgical functions which doing so. 
     Referring to  FIG. 11A , the clamp path  5476  that is defined between the first and second proximal needle alignment portions  5471 ,  5491  has a radius of curvature, R ClampPath , which corresponds to the needle radius of curvature, R Needle , at the curved portion  5011  of the needle. In some embodiments, the radius of curvature R ClampPath  is equal to the needle radius of curvature R Needle . When the needle  5010  is retained within the clamp path  5476  and while the second jaw is in the closed orientation shown in  FIGS. 9A and 9B , the curved portion  5011  of the needle  5010  aligns with radius of curvature of the clamp path  5476 . In this manner, a center C RN  of the radius of curvature, R Needle , of the needle  5010  is guided by the first and second proximal needle alignment portions when clamping the curved portion of the needle  5010  within the clamp path  5476 . In some embodiments, the clamp path radius of curvature R ClampPath  is larger or smaller than the needle radius of curvature R Needle  such that the instrument can hold needles of different sizes and varying curvatures in accordance with surgical requirements while still self-guiding the needle into the desired alignment and orientation in the instrument. Whether the clamp path has the same radius of curvature, R ClampPath , or a radius that is larger or smaller than the needle radius of curvature R Needle , the clamp path radius of curvature R ClampPath  nonetheless includes a sufficient number of needle contact points to define the curved clamp path, engage the curved portion  5011  of the needle, and guide it into the orientation shown in  FIGS. 9A and 9B . 
     As shown by the arrows HH in  FIGS. 9A and 9B , when the second jaw  5482  moves to the closed orientation and clamps the needle between the jaws, it rotates the needle  5010  relative to the jaws such that the center C RN  of the radius of curvature, R Needle , is located at a pre-determined orientation with respect to the first and second jaws. In particular, as shown in  FIG. 11A , the center C RN  of the radius of curvature, R Needle , is coincident with the center C CP  of the radius of curvature R ClampPath  of the clamp path  5476 . In particular, as shown in  FIG. 11A , the center C RN  of the radius of curvature, R Needle , becomes coincident with the center C CP  of the radius of curvature R ClampPath  of the clamp path  5476  such that an apex, AP, of the curved needle portion  5011  matches an apex of the proximal clamp path  5476 . The pre-determined orientation can be a desired orientation with respect to the instrument  5400  for performing suturing functions. For example, as shown in  FIG. 9B , in some embodiments, the pre-determined orientation of the center C CP  of the radius of curvature R ClampPath  of the clamp path  5476  (and thus, the center C RN  of the radius of curvature, R Needle ) intersects a longitudinal axis of the first jaw  5462  and the second jaw  5482  at the first and second proximal needle alignment portions  5471 ,  5491  at an angle of about ninety degrees. In other embodiments, however, the radius of curvature R ClampPath  of the clamp path  5476  intersects a longitudinal axis of the first jaw  5462  and the second jaw  5482  at the first and second proximal needle alignment portions  5471 ,  5491  at any suitable angle. 
     Thus, the first and second proximal needle alignment portions  5471  and  5491  cooperate to self-align the needle while moving the first and second jaws  5462  and  5482  into a clamped arrangement for suturing functions. As such, when the first and second jaws  5462  and  5482  move from the open orientation (not shown) to the closed orientation shown in  FIGS. 9A and 9B , and while the curved portion  5011  of the needle is located between the first and second proximal needle alignment portions  5471 ,  5491 , the first and second proximal alignment portions of the jaws are configured to engage the curved portion  5011  of the needle to rotate the needle  5010 . These needle alignment portions do so by clamping the curved portion  5011  of the needle, such that the curved portion of the needle aligns with radius of curvature of the clamp path  5476 . In this manner, a needle  5010  can be readily clamped in place between the jaws of the instrument  5400  into a secure needle-driver, suturing arrangement with the instrument, such that the instrument can be manipulated to drive the needle  5010  while the needle is securely clamped to the instrument and retained in a desired pre-configured orientation for performing suturing functions. The aligned curvatures between the needle and the clamp path  5476  while the needle  5010  is retained in this clamped arrangement cooperate to firmly retain and orient the needle with respect to the instrument. 
     Referring now to  FIGS. 11B and 11C , the first proximal needle alignment portion  5471  on the first jaw  5462  can include a pair of clamp supports  5472  that are laterally spaced apart from each other across the width of the first jaw  5462 , such that one of the pair of clamp supports  5472  is located at each side of the first jaw, and a gap is defined between the clamp supports. Each of the pair of clamp supports  5472  includes a clamp surface  5474  that is offset from the first jaw  5462  toward the second jaw  5482  when in the closed orientation. As such, the pair of clamp supports  5472  together provide a raised support platform with the respect to the gap that is defined between the clamp supports. The second proximal needle alignment portion  5491  on the second jaw  5482  can be located opposite from and aligned with the first proximal needle alignment portion  5471  when the first and second jaws are in the closed orientation. The second proximal needle alignment portion  5491  includes a central clamp support  5492  that is centered laterally across the width of the second jaw  5482 , such that it is located opposite from and aligned with the gap between the clamp supports  5472  when the first and second jaws are in the closed orientation. The central clamp support also includes a support surface  5494 , which when in the closed orientation, is oriented in an opposite direction from the support surfaces  5474  of the pair of clamp supports  5472  and is aligned with the gap formed by the lateral offset between the pair of clamp supports. The support surface  5494  is also offset in a similar, yet opposite manner than the pair of clamp supports, such that the support surface  5494  of the central clamp extends away from the second jaw and toward the first jaw when the first and second jaws are in the closed orientation. 
     Thus, as shown in  FIG. 11B , the pair of laterally spaced support surfaces  5474  of the pair of clamp supports  5472  that extend away from the first jaw  5462  can cooperate with the laterally centered support surface  5494  of the central clamp support  5492  that extends away from the second jaw  5482  to define a curved clamp path  5476  extending widthwise across the first and second jaws  5462 ,  5482  when the first and second jaws are in the closed orientation. Further, each of the clamp surfaces on the pair of clamp supports includes at least one point of contact, PT 1  and PT 3 , and the clamp surface on the central clamp support includes at least one point of contact PT 2 , that can engage the curved portion  5011  of the needle  5010  and form a contact point therewith during self-righting and clamping functions. Thus, the instrument  5400  is configured such that the contact points PT 1 -PT 3  can engage the bend portion  5011  of the needle  5010  while the jaws are moving from the open to the closed orientation after the needle is inserted to place the bend portion  5011  between the jaws while in the open orientation. The contact points PT 1 -PT 3  of the support surfaces engage and clamp on the bend portion  5011  when the first and second jaws move from the open to the closed orientation as discussed above along with  FIG. 11A  to perform self-righting functions along with clamping the needle. 
     The support surfaces  5474  and  5494  of the clamp supports can have any appropriate configuration for defining the clamp path  5476 , performing the self-driving functions, and clamping the needle  5010  during suturing. In some embodiments, one or more of the support surfaces can define a depression  5473 ,  5493  as shown in  FIG. 11C , which can enhance the stability of operation for the self-righting functions, and increase hold strength when clamping the needle. In some embodiments, the depression  5473 ,  5493  can form a notch in the clamp support. In some embodiments (not shown), one or more of the support surfaces can be angled to improve further the amount and size of contact between the clamp supports and the bend portion  5011 . In other embodiments, the clamp surfaces can include combinations of orientations to increase retention of the needle during suturing and provide additional options for clamping the needle  5010 , such as combinations of options including angled surfaces, peaked surfaces and/or surfaces forming depressions. 
     For example,  FIGS. 12, 13, 14A and 14B  show an instrument  6400 , which can provide multiple options for needle alignment orientations, needle clamping strengths, needle holding locations, and the amount of needle alignment portions located on a single instrument. The instrument  6400  includes certain aspects, preferences and features as are described above along with instruments  2400 ,  3400 ,  4400 , and  5400 , except as described herein. Like numbers described herein for  FIGS. 5A-11C  refer to like features of  FIGS. 12-14B . Instrument  6400  shown in  FIGS. 12-14B  differs from instruments described above by providing a combined functionality gripping and needle alignment portion  6471  that can be used for tissue engaging functions including tissue grabbing functions. In addition, the needle alignment portion  6471  can be used for needle alignment functions including self-righting needle functions, needle clamping, and suturing functions. In addition, the needle alignment portion  6471  can provide multiple needle clamping along its length as appropriate for its usage and based on the surgical environment. Thus, instrument  6400  can provide a highly versatile tool that can be used to provide many different tissue-engaging functions including grabbing, cutting, moving or otherwise surgically manipulating tissue. In addition, instrument  6400  can quickly and easily allow a needle to be installed along multiple locations of the instrument, self-righted and clamped, and used for suturing. 
     Referring to  FIGS. 12 and 13 , the first jaw  6462  includes a first proximal gripping portion  6464  and a first distal gripping portion  6465 , as well as a first proximal needle alignment portion  6471 , and a first distal needle alignment portion  6475 . In addition, the second jaw  6482  includes a second gripping portion  6484  extending longitudinally along the jaw, which includes a central clamp support  6492  having a pair of angled surfaces  6493  that extend along each side of a peak  6494 . The first proximal needle alignment portion is disposed along the first jaw in a manner similar to the first proximal needle alignment portion  5471  discussed above along with  FIGS. 9B-11C  except for the angular, sloped shape of the pair of clamp supports  6472  that can provide enhanced clamping and engagement. However, the first jaw  6462  further includes a plurality of needle alignment portions that are formed in series in the longitudinal direction of the first jaw extending from the first proximal needle alignment portion  6471  to the first distal needle alignment portion  6475  located at the distal end portion  6463  of the first jaw. Thus, as shown in  FIG. 12 , the first distal needle alignment portion  6475  includes at least two pairs of clamp supports  6472  arranged in series adjacent to each other and formed in series in a distal direction along the longitudinal axis of the first jaw. The first distal needle alignment portion  6465  includes pairs of clamp supports  6472  that are also arranged in series in the longitudinal direction along the first jaw as in the first proximal needle alignment portion  6464 . 
     Referring to  FIG. 12 , the first proximal gripping portion  6464  and the first distal gripping portion  6465  also include the series of pairs of spaced apart clamp supports  6472  that extend in the longitudinal direction along the first jaw for the needle alignment portions. The series of lateral peaks from the pairs of clamp supports  6472 , as well as the V-shaped depression defined between each pair of the clamp supports, forms the gripping portions  6464  and  6465  as well as the needle alignment portions. 
     Thus, the first jaw  6462  is configured as a single, integrated arrangement of needle alignment portions that also form the gripping portions. The laterally peaked, V-shaped pairs of clamp supports arranged in series provide a tooth-like shape along the first jaw, which enhances the grip between target tissue (not shown) and the tooth-like surface of the first jaw  6462 . Further, the series of clamp supports that are arranged along the first jaw provide multiple needle alignment portions in the longitudinal direction of the first jaw from the first proximal portion  6464  to the distal end  6465 , in which a needle  6010  could be clamped for suturing. 
     Each of the pairs of clamp supports  6472  include a clamp surface  6474  that defines a V-shaped depression between the lateral, outer portion of each of the pairs of clamp supports  6472 . In addition, each of the clamp supports  6472  for a pair of clamp supports the laterally slopes from the lateral edge portions of the first jaw  6462  to the center the V-shaped depression, which is located at longitudinal center of the first jaw as shown in  FIGS. 14A and 14B . The V-shape of the depression defined by the clamp supports  6472  better matches the curvature of the curved needle portion  6011 , which can provide for larger sized points of contact between the clamp surfaces  6474  and the needle during self-righting functions and when holding the needle during suturing. 
     The second jaw  6482  includes a single gripping portion  6484  that is formed as a central peak  6492  and a corresponding pair of angled lateral surfaces  6494  disposed on each side of the peak  6492 , which extends along the longitudinal length of the second jaw  6482 . As such, the second jaw  6482  also provides a single, integrated gripping portion  6484  and needle alignment portion  6492  along its length, which allows for gripping functions or needle clamping function to be performed at multiple locations along the second jaw  6482 . Thus, the first jaw  6462  and the second jaw  6482  provide a highly flexible instrument that can perform gripping functions, and needle righting and clamping functions at multiple locations along its length. Instrument  6400  provides combined, multi-functional portions along its length using peaked and angled surfaces formed on both the first and second jaw. In other embodiments, combined, multi-functional portion can be provided along the length of the instrument based on other combinations of features along the length of the jaws. For example,  FIGS. 15-16B  shown an instrument  7400  that also provides combined gripping functionality and self-righting needle functionality along the length of its first and second jaws. The instrument  7400  includes certain aspects, preferences and features as are described above along with other instruments including instrument  6400 , except as described herein. Like numbers described herein previously refer to like features of  FIGS. 15-16B . 
     Instrument  7400  shown in  FIGS. 15-16B  differs from instruments described above and, in particular, from instrument  6400  by providing a combined functionality gripping portion  7464  that is integrated with a needle alignment portion  7471  that can be used for needle self-alignment and clamping, along the length of the first jaw  7462  and the second jaw as discussed below. Instrument provides this combined, integrated functionality via series of pairs of spaced apart clamp supports  7471  in each of the pairs of supports are disposed along lateral edge portions of the first jaw  7462 , which is similar to the arrangement of instrument  6400 . However, instrument  7400  makes use of smaller, tooth shaped clamp supports without forming a depression or similar structure to form a clamp path between the pairs of clamp supports  7471  or to engage the curved portion  7011  of the needle. Similarly, the second jaw  7482  includes a peak arrangement for a gripping portion  7484  having a peak that extends along its length, which likewise includes a series of small teeth that correspond with the series of teeth formed along the first jaw  7462 . 
     The tooth-shaped features extending along the lateral portions of the first jaw  7462  and along the peak  7492  of the first jaw are configured to engage the curved portion of the needle  7011  at least three contact portions in a manner similar, for example, with the three contact points discussed along with  FIG. 11B  above and instrument  5400 . However, the arrangement of small teeth for instrument  7400  provide an arrangement of stress concentrating features, which improve the clamping force and amount of engagement between each of the teeth and the needle  7010 . Thus, instrument  7400  can provide a highly versatile tool that can be used to provide tissue engaging functions and needle self-righting and clamping functions along the length of its jaws, and to do so with enhanced levels of engagement and retention force between the jaws and the needle. 
     Referring now to  FIGS. 17, 18A and 18B , an instrument  8400  is shown, which is similar to instrument  5400  described above and that generally includes the same preferences and features as described above along with instrument  5400  except as described hereafter. Accordingly, like numbers refer to like features described above. In particular, instrument  8400  can be arranged as an option with respect to instrument  5400 , which can be modified to include to expand its proximal needle alignment portion  8471 ,  8491  from a single proximal needle alignment portion defined by the first  8462  and second jaws  8482 , to two needle alignment portions  8471 ,  8491  and  8475 ,  8495  disposed adjacent to one another in the longitudinal direction of the jaws. Such an optional modification provides the advantages of instrument  5400  described above, along with expanding its functionality to include more than one needle alignment portion. 
     Further, in a manner similar to the dual needle alignment arrangement described above along with instrument  3400  and  FIGS. 6A-6D , the expanded arrangement of instrument  8400  can be configured to provide two different orientations for the needle  8010 . As shown in  FIG. 17  vs.  FIGS. 18A and 18B , the orientation of the needle when clamped between the jaws for suturing can be in an orientation similar to the orientation of instrument  5400  that is shown in  FIG. 17 . In addition, the needle can be retained in an opposite orientation as shown in  FIGS. 18A and 18B , which can provide advantages according to the surgical environment and further enhances the versatility of the instrument  8400 . 
     While various embodiments have been described above, it should be understood that they have been presented by way of example only, and not limitation. Where methods and/or schematics described above indicate certain events and/or flow patterns occurring in certain order, the ordering of certain events and/or operations may be modified. While the embodiments have been particularly shown and described, it will be understood that various changes in form and details may be made. 
     For example, any of the instruments described herein (and the components therein) are optionally parts of a surgical assembly that performs minimally invasive surgical procedures, and which can include a patient-side cart, a series of kinematic linkages, a series of cannulas, or the like. Thus, any of the instruments described herein can be used in any suitable surgical system, such as the MIRS system  1000  shown and described above. Moreover, any of the instruments shown and described herein can be used to manipulate target tissue during a surgical procedure. Such target tissue can be cancer cells, tumor cells, lesions, vascular occlusions, thrombosis, calculi, uterine fibroids, bone metastases, adenomyosis, or any other bodily tissue. The presented examples of target tissue are not an exhaustive list. Moreover, a target structure can also include an artificial substance (or non-tissue) within or associated with a body, such as for example, a stent, a portion of an artificial tube, a fastener within the body or the like. 
     For example, any of the jaws can be constructed from any material, such as medical grade stainless steel, nickel alloys, titanium alloys, or the like. Further, any of the links, jaws, tension members, or components described herein can be constructed from multiple pieces that are later joined together. For example, in some embodiments, a link can be constructed by joining together separately constructed components. In other embodiments, however, any of the links, jaws, tension members, or components described herein can be monolithically constructed. 
     Although various embodiments have been described as having particular features and/or combinations of components, other embodiments are possible having a combination of any features and/or components from any of embodiments as discussed above. Aspects have been described in the general context of medical devices, and more specifically surgical instruments, but inventive aspects are not necessarily limited to use in medical devices.