Patent Publication Number: US-2023157684-A1

Title: Suture delivery system

Description:
RELATED APPLICATIONS 
     This is a continuation of U.S. patent application Ser. No. 16/091,936, filed Oct. 5, 2018, which application is a 371 national phase of PCT/EP2017/059233, filed Apr. 19, 2017, and claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Application No. 62/324,422, filed Apr. 19, 2016, the disclosures of which are incorporated, in their entirety, by this reference. 
    
    
     BACKGROUND 
     The present invention relates to a suture delivery system. In one configuration it relates to a suture delivery system which operably provides for deployment of an anchoring or suture deployment system may be usefully employed in surgery. 
     There are difficulties sometimes associated with the closure of wound sites for example, where the defect is greater than two centimeters in length. There are difficulties in particular in finding the fascia layer through which a suture must be passed to ensure good and adequate fascial recruitment and there is also the risk of damaging internal structures when deploying a suture passer. When suturing abdominal wounds a retractor is often used to open the defect and present the abdominal layers to the user making it easier to place the suture through the relevant layers. The device disclosed here provides for retractor functionality while enabling accurate and protected suture deployment. 
     The consequences of inadequate closure may be serious. For example, the patient may be subject to an early or late onset hernia, wound dehiscence, bowel stricture, infection, or bleeding from the defect. 
     SUMMARY 
     These needs and others are addressed in accordance with the present teaching which provides a suture delivery system intended to enable safer and more repeatable wound closure subsequent to a laparoscopic, single port or general surgical procedures where abdominal closure is required. The principle disclosed herein may be applied to a wide variety of closure scenarios. 
     Accordingly there is provided a device, kit and method as defined in the claims that follow. 
     These and other features of the present teaching will be better understood with reference to the drawings which follow which are provided to assist in an understanding of the present teaching and are not to be construed as limiting in any fashion. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present teaching will now be described with reference to the accompanying drawings in which: 
         FIGS.  1 A,  1 B, and  2    show configurations of devices that may be provided in accordance with the present teaching. 
         FIGS.  3 A,  3 B,  3 C,  3 D,  3 E, and  3 F  show shows an alternative arrangement of the device of  FIG.  1   . 
         FIGS.  4  and  5    show multiple views of another embodiment of the device in accordance with the present teaching. 
         FIG.  6    shows a section views of the device of  FIGS.  4  and  5    with a preloaded anchor. 
         FIGS.  7 A,  7 B,  8 A, and  8 B  show alternative arrangements for the reloading or delivery of anchors through a guide channel in accordance with the present teaching. 
         FIG.  9    shows the device of  4  and  5  used to secure a prosthetic mesh. 
         FIGS.  10 A,  10 B,  10 C,  10 D, and  10 E  show multiple views of the device of  FIGS.  4  and  5    configured to deliver a loop of suture. 
     
    
    
     DETAILED DESCRIPTION 
     The teaching of the present invention will now be described with reference to exemplary embodiments thereof which are provided to assist with an understanding of the present teaching and are not to be construed as limiting in any way. It will be appreciated that modifications can be made to the exemplary arrangements which follow without departing from the spirit or scope which is only to be limited insofar as is deemed necessary in the light of the appended claims. 
     Within the context of the present teaching a suture delivery system advantageously allows for the delivery of suture within an abdominal cavity of the patient. It will be appreciated that the following discussion regarding the specifics of the abdominal cavity and abdominal wall should not be construed as limiting in that a system provided in accordance with the present teaching may be used with other types of tissue including but not limited to organs, bones or the like. The use of a suture delivery system per the present teaching may be used for closure of a wound post completion of a surgical procedure. In such a configuration the device is used to accurately guide the suture or suture anchor assembly, where the suture is coupled to an anchor, through the abdominal wall and is held within the wall by the anchors that will remain deployed within the abdominal cavity, a subsequent tightening of the sutures will cause the sides of the incision, or break in the abdominal cavity to be brought together to close the wound. The adoption of such a technique will advantageously require the use of bioabsorbable anchors, as the anchors will remain within the abdominal cavity during the healing process prior to their ultimate disintegration. For scenarios where permanent support is required, non-absorbable sutures and anchors may be used utilizing materials such as PEEK, PE, Nylon, Stainless Steel, or Nickel Titanium alloys. 
     In a further embodiment the anchors may be made from a ferromagnetic material so that a magnet could be passed down a trocar and the anchors would be attracted to and adhere to the magnet, allowing them to be drawn out through the trocar. The advantage of this approach is that direct visualization may not be necessary. Alternatively, the anchors may be themselves magnets and a ferromagnetic pick up device could be employed through the trocar to pick up the anchors. 
       FIG.  1 A  shows an example of the device  50  with a driver tool  500  inserted through it. A driver tool or suture passer may be passed through the section of the device  300  that will be position adjacent to the tissue requiring suturing to ensure an appropriate recruitment of tissue. A deployment channel  320  is configured with an optimal angle suture stability post deployment. The device features a landing zone  110  that cooperates with the tissue being retracted and a lip  105  that ensures tissue stability. As shown in  FIG.  2   , a finger hole is  130  is provided for controlling the device in this configuration but a handle or other interface could also be provided. A slot could also be provided in the deployment channel  320  to ease suture removal after deployment. 
       FIG.  1 B  show the device in a projected view and illustrates the position of the suture channel entrance  310  and exit  330 . The device also features a sharps protector  115  which prevents the sharp tip of the suture passer or anchor driver from causing injury. This is an advantageous feature as it obviates the need for internal visualization during deployment in laparoscopic procedures and provides additional safety in open surgery settings. The tip of the device  120  is configured to be atraumatic to facilitate safe and efficient delivery. 
       FIG.  2 A  shows a defect  400  with tissue  450  either side. In the provided configuration the device is inserted through the defect and the grip is position to provide good anchoring into the tissue. The driver  500  may be inserted at this point or the tool may be rotated to retract the edges of the defect towards the visual field of the user for easier deployment prior to driver deployment. In the configuration shown a suture anchor  600  comprised of a suture  610  and an anchor  620  is deployed through each side of the defect enabling subsequent approximation. The device can be repeatedly deployed in sets of two to enable longer defects to be approximated. In the scenario where a suture passer is used the suture would be deployed through one side and then picked up thorough the opposite side using the retractor guide to deliver the passer in each instance. 
     As described above, the present teaching provides a suture delivery device  50  that operably may be used to deliver suture and/or anchors within a defect. The device  50  comprises a head portion  130 , a body portion  140  and a foot portion  150 . The device is configured such that the foot portion  150  is operably presented first into a defect  400  and engages with an inner surface  410  of the defect. The body portion  140  comprises a suture driver guide channel  320  having an entry port  310  provided on a first side of the body portion  140  and an exit port  320  provided on a second side of the body portion  140 . The foot portion  150  defines a landing zone  110  at or proximal to the exit port within which at least a portion of surface of the defect is operably received. In this way and as shown in  FIG.  2   , a suture driver passing through the suture driver guide channel  320  will exit the exit port and pass into the surface of the defect within the landing zone. The foot includes an anchoring feature  107  which anchors the device and facilitates tissue manipulation during use. 
     The foot portion comprises an inner surface  200  provided proximal to the landing zone and an outer surface  210  arranged distally to the landing zone. The inner surface provides an abutment surface defining a limit of travel of a suture driver passing through the suture driver guide channel. The foot portion further comprises a blunt leading surface  220 . The foot portion further defines a volume  205  having an open mouth, the landing zone being accessed through the mouth. The volume  205  may be a closed volume as shown in  FIG.  2 B  or may be provided as an open volume having gaps or apertures provided proximal to the leading surface  120 . The foot portion may further comprises a lip  105 , the lip defining an engagement surface for contacting with and gripping against the inner surface of the defect. In this way, on gripping against the inner surface of the defect, at least a portion of the defect is received into the mouth of the foot portion. 
     As shown in  FIG.  1 B , the exit port is located above the mouth and the guide channel is angularly orientated relative to the mouth of the foot portion such that operably, on receipt of at least a portion of the defect into the landing zone, a suture driver passing through the guide channel will pass through first and second surfaces of the defect prior to contact with the abutment surface. 
     The body  140  comprises a shoulder region  141 , the entry port  310  being defined in the shoulder region. Advantageously, the width of the body portion below the shoulder  141  is greater than the width of the body portion above the shoulder. In this way the length of the channel  320  may be maximized to provide additional structural integrity to the path and also ensure that the angle of attach of the driver when presented through the channel is maintained. By locating the entry port  310  within the shoulder region it will also be appreciated that visualization of presentation of the driver  500  is facilitated. 
     The guide channel in this arrangement is desirably orientated at an angle in the range 20 to 45 degrees relative to a vertical axis of the body. More typically, the present inventor has found that by providing the guide channel within the body so as to be orientated at an angle of about 30 degrees relative to a vertical axis of the body that it is easier to ensure accurate presentation of suture—with anchor as appropriate—to a particular portion of the defect as shown in  FIG.  2   . 
     The guide channel is typically positioned at a desirable distance (within the range 5 to 10 mm has been found optimum) relative to an edge of the device to enable repeatable spacing between sets of deployed sutures along the length of a defect. 
     As was described above the device is arranged such that the foot portion is operably presented first into a defect and engages with the defect. The device is arranged such that it will contact with both the side wall  415  of the defect and the inner surface  410  of the abdominal wall. By contacting the abdominal wall in two planes, and receiving tissue into a tissue receiving portion defined in the device between the two contacting surfaces, the present teaching advantageously ensures that the suture driver  500  when passing through the suture driver guide channel  320  will exit the exit port  330  and pass into the surface of the defect within the landing zone. The surface within which the exit port is defined is a second surface of the guide device and as shown in  FIG.  2    operably abuts against the side wall of the defect. The foot portion defines a contact surface  105  that operably abuts against the inner surface of the abdominal wall such the second surface is substantially perpendicular to the foot portion contact surface. 
     While not shown in the Figures, the device may be configured such that the body comprises an access channel or slot along the length of the guide channel. The purpose of the slot is to facilitate extraction of suture that has been passed through the guide channel and is located within the defect without requiring a removal of the device from the defect. So as to restrict the escape from the guide channel of other deliverable elements, the slot has a diameter smaller than the diameter of the guide channel. Typically the diameter of the slot is about 0.5 to 1.5 mm. 
     As shown in the Figures, the device head portion  130  provides a contact surface to user engagement to facilitate a location of the device within the defect. In this exemplary arrangement, the head portion is offset from a longitudinal axis of the body. Similarly, and evident from the side view of  FIG.  1 A , the foot portion  150  is also offset from a longitudinal axis of the body. By having each of the head portion and foot portion offset to the same side of the body, and desirably wherein the head portion is orientated above the foot portion the user or operator of the device is assisted in identification of the location of the foot portion within the defect when the foot portion is not visible to an operator—such as when the foot portion is located through a defect and within the abdominal cavity—such as shown in  FIG.  2 B . 
     In this arrangement of  FIG.  2 B  it is clearly shown that each of the foot portion and the head portion extend laterally away from the body portion and are offset an equal distance from the longitudinal axis of the body portion. 
     The side surface of the body facilitates a retraction of the abdominal wall or other fascial layer so as to provide surgical access. The device therefore provides a dual function as a retractor and a suture delivery device. This device may be provided singularly or as part of a suture delivery kit comprising the device as described previously in combination with a suture driver arranged to deliver suture through the guide channel. With such a kit operable passage of the suture driver through the defect effects delivery of the suture though a first and second surface of the defect, as shown in  FIG.  2 B . When the suture is coupled to an anchor, the kit may be used to deliver anchors through at least a portion of a defect. Rotation of the device after delivery of a first anchor at first side of the defect then allows the user to facilitate delivery to a second side of the defect— FIG.  2 B  shows an already delivered anchor on the right hand side while the device is now presented and arranged to deliver the anchor to the left hand side. 
     In the alternative arrangement of  FIG.  3    a guide  800  comprises a handle portion  805  and a guide portion  825  and a foot portion  850 . The guide portion  825  is operably inserted into a defect defined within the abdominal wall. The guide portion comprises a tissue receiving cut-out portion  870  which is defined within the body of the device. First  811  and second  815  surfaces extend inwardly from the outer surface of the guide to define the tissue receiving cut-out portion and are arranged such that in use, abdominal wall tissue will invaginate into the tissue receiving cut-out portion  870  and contact against the surfaces  811  and  815 . A guide channel  835  is defined within body of the guide and leads to the tissue cut out portion. The guide channel  835  comprises a proximal opening  810  on a first, operably upper, surface  806  of the guide  800  and terminates from a distal opening  830 . The distal opening  830  is defined within the second surface  815 , which operably defines an upper, surface  815  of the tissue receiving cut-out portion  870 . The trajectory of the channel is configured such a driver delivered through the channel will intersects with and pass through tissue that may be disposed within the cut-out portion. 
     A driver  500  and anchor  230  as previously described may be used to deliver an anchor through the tissue which is received within the tissue receiving cut-out portion. Upon exiting the distal opening  830  and travelling through the tissue, the orientation of the guide channel  835  serves to direct the driver into a receiving chamber  855  defined within the first surface  811  of the tissue receiving cut-out portion. This chamber  855  comprises inner surfaces which protect the inner organs from puncture in a similar fashion to that described above with reference to  FIGS.  1  and  2   . 
     In this embodiment the distal opening of the guide channel exits on a flat surface  815 . An alternative arrangement would be that the surface below the exit was undercut. In this arrangement, an undercut is defined below the distal opening  830  such that the surface  815  does not extend in a planar continuous fashion to the intersection with the surface  811 . This could be advantageous in exaggerating the amount of tissue captured by the suture. It will be appreciated that the length and diameter of the suture guide channel can be dimensioned to limit the depth to which the tip of the driver extends, which would prevent the driver tip impacting against surfaces of the receiving chamber  855 . Alternately the receiving chamber could be filled with a silicone gel, which would prevent particulate liberated from the bottom surface of the receiving chamber from being drawn out of the receiving chamber. 
     Similarly to what was described with reference to  FIGS.  1  and  2    the device of  FIG.  3    is arranged such that the foot portion  850  is operably presented first into a defect and engages with an inner surface of the defect. The device is arranged such that it will contact with both the side wall  415  of the defect and the inner surface  410  of the abdominal wall  450 , Refer to  FIGS.  3 C- 3 E . By contacting the abdominal wall in two planes, and receiving tissue into a tissue receiving portion defined in the device between the two contacting surfaces, the present teaching advantageously ensures that the suture driver  500  when passing through the suture driver guide channel  835  will exit the exit port  830  and pass into the surface of the defect within the landing zone. The surface within which the exit port is defined is a second surface of the guide device and as shown in  FIG.  3 C  operably abuts against the side wall of the defect. The foot portion defines a contact surface  105  that operably abuts against the inner surface of the abdominal wall such the second surface is substantially perpendicular to the foot portion contact surface. 
     Turning now to  FIG.  4   , another exemplary suture delivery system in accordance with the present teaching is shown. In this arrangement the system comprises multiple components which are then assembled to form the final part, whereas the guides of  FIGS.  1 - 3    are a single molded piece. With this arrangement surfaces of the receiving portion are replaceable. Such an arrangement advantageously addresses potential issues arising from multiple contacts with the same surface. As will be appreciated from the above, the present teaching uses the inner surfaces of the receiving portion as a stop against which the driver contacts during use. A potential difficulty with having drivers repeatedly contact the same surface, which can arise for example in scenarios where multiple anchors are being deployed, is that the sharp needle tip of the driver may repeatedly contact the same portion of the guide and over time it may begin to dislodge some of the guide material. In this embodiment, the receiving portion is modified to incorporate a more resilient material—in this example a stainless steel shim  710 —as a contact surface which is located at the base of the receiving chamber  1115 . By providing a contact surface at the base of the receiving chamber, the driver needle portion is directed—by the orientation of the guide channel  1320  (refer to  FIG.  5   ) into preferential contact with the contact surface. The material that is used in fabricating the contact surface is less likely to be damaged by the needle end portion and thus reduces the possibility of the integrity of the guide being compromised with reduced possibility of dislodged material being introduced into the body cavity during use. 
     The contact surface may be retained within the receiving portion in any one of a number of different ways.  FIG.  4    shows a particularly advantageous arrangement whereby the stainless steel shim is retained by a shoulder  745  on the inner wall of the guide and a pillar  740 . In this embodiment the pillar  740  is shown as an elongation of a screw receiving pillar, but it will be acknowledged that these two adjoined pillars could be formed as a single piece, that is if the screw position was adjusted, or they could be two separate entities. To allow for assembly a cap  720  is provided, which can be screwed into position with the screw once assembly is completed. It will further be appreciated by those skilled in the art that the same effect could be achieved a number of ways. For example, the cap  720  could be designed with clip features, such that the screw is not necessary to retain the cap. In another embodiment the side wall of the receiving portion could feature j shaped channel into which a j-shaped shim is placed. Alternately, the u-shaped inner surface as per  FIG.  2    could be modified at the top to add two bumps, which could be used to retain a u-shaped steel shim. Further, the shim could be biased, such that upon placement in the receiving portion, it exerts an outward force, which helps maintain its position. 
     Depending on the tolerances of the stainless steel shim  710  and its fit within the guide there may be an effective rattling of the component, which may be undesirable. Is such a scenario the bottom surface  745  of the receiving channel  1115  may be coated with a silicone fluid or the like, which will retain the stainless steel shim due to surface tension. 
     An advantage of the stainless steel shim in the guide, is that when the driver is passed through the guide and the sharp tip bottoms out on the stainless steel shim, an audible click is generated which will provide audible feedback in addition to the tactile feedback that is already generated by the contact of the two elements. The user is then provided with reassurance that the anchors have been successfully delivered through the abdominal wall. 
     Another feature of the guide of  FIG.  4    is the incorporation of a suture release slot  1060 . This slot allows the suture to be released from the guide. In using the guide of  FIG.  1   , once the first anchor is delivered, the trailing suture remains in the guide channel until the guide is removed completely over the trailing suture. The advantage of the suture release slot  1060  is that once the anchor is delivered, the suture can be pulled taut, and as the guide is pushed away from the tissue wall, the suture is released from the guide. The guide can then be rotated in situ for delivery of a second anchor on the opposing wall, without having to remove the guide from the defect. 
     An alternate embodiment would provide an additional slot  1900  in the foot portion of the guide. Such an arrangement is shown in  FIG.  10 E  and illustrates how such a slot  1900  could be used to receive a suture  610 . A larger diameter opening  1910  is provided at the base of the slot. This opening  1910  would allow the suture  610  to pass freely when pulled from either side. A narrowing in the slot is provided by raised shoulders  1905 A and  1905 B. Such a narrowing prevents the suture from being accidently released from the slot  1900  and allows the suture  610  to be easily loaded, by laying it across the slot and pulling it in a downward direction, in a manner similar to securing using a cleat. Such an arrangement could be advantageously used to deliver suture to an intra-abdominal space. The user could then use a conventional suture passer  2500  through the opening  1310  defining the entrance to the guide channel  1320  (previously referred to in  FIG.  5   ) to pick up the suture that is located within the landing region. Such an arrangement is evident from inspection of  FIG.  10 A  and advantageously provides a safe means of creating a closed loop closure as the receiving chamber  1115  of the guide protects from over insertion of the suture passer. 
     To use the device of  FIG.  10 A  with reference to  FIG.  10 B - FIG.  10 D : 
     a. The user loads suture  610  onto the guide  1140 . 
     b. The guide  1140  is then passed through a defect in the abdominal wall. 
     c. The suture grasper  2500  is passed through the guide and is manipulated to grasp the suture  610 . 
     d. Once the suture is held in the jaws  2600  of the grasper, it is retracted until the suture exits the opening  1310 . 
     e. As the suture loop  615 , is drawn further outside the body, the suture would pull completely through the opening. 
     f. The guide could then be removed from the defect and be reloaded with the suture. 
     g. The guide can them be repositioned in the defect on the opposite side, and step a-f be repeated. 
     h. The guide is removed from the defect leaving a loop of suture in the defect, which can be tied with an appropriate surgical knot. 
     One end of the suture,  611  for example could be presented with a stopper knot, which would prevent the suture pulling through the opening  1910  on the guide, which would ensure that the suture pulls free from one side only. An alternative arrangement would be to provide the opening  1910  without suture. This arrangement would be more secure in terms of preventing the suture from pulling out through the slot, but would be more time consuming in terms of loading. 
       FIG.  5    illustrates another feature of the guide of  FIG.  4    whereby the needle guide channel  835  features an internal ramp  755 . The benefit of such a feature is that it effects a reduction in the clearance within the channel, when the driver is delivered through, which has the effect of giving a more consistent bite through the tissue. This is an effect caused by the reduced diameter of the driver shaft  510 , as is seen in  FIG.  5   . An alternative arrangement is shown in  FIG.  6    where the guide channel features a reduced diameter portion  760  proximal to the proximal opening of the needle guide channel. In using this guide, the anchors would be loaded, firstly into the guide by pushing the proximal end of the anchor  235  into the guide exit  1330 , i.e. in a direction opposite to that in which they will ultimately be delivered into the tissue, and then using the suture (not shown) to pull the anchor into the step  765 . The driver is then presented through the opening  1310  of the guide and as it passes through, the anchor is picked up by the stepdown portion of the driver. 
     Further examples of reloading anchors onto drivers are shown in  FIGS.  7  and  8   , which may be used in combination with the guides of  FIGS.  1 - 5   . There is shown herein a reloader tool  900  which comprises a proximal opening  910 , an anchor receiving portion  920  and a suture cleat  940 . The anchor is loaded into the anchor receiving portion, and the trailing suture is secured in the cleat  940 . The driver  500  is passed through the proximal opening. The internal geometry (not shown) serves to align the driver such that the stepdown portion  515  will be centered on the anchor and pick it up, as it is advanced through the reloader tool  900 . The distal end of the anchor receiving portion  920  features a ramp  925 . As the driver advances this ramp provides resistance against forward motion of the anchor, allowing it to be picked up by the driver, and secondly as the driver is advanced the misalignment of the ramp forces the driver into the exit slot  930 . The suture cleat is designed such that the inside of the cleat is a circular profile and that as the anchor is advanced, the suture trails from the cleat. 
     The device  950  of  FIG.  8    comprises an obturator  980  and a guide  950 . The obturator  980 , which could be spring-loaded to facilitate a Veress needle type protected delivery—comprises a proximal handle  990  and a shaft  985  which are joined. The handle  990  allows the user to handle the obturator and remove it from the guide portion. The guide  950  comprises a proximal portion  959  joined to a shaft  960 . The shaft  960  terminates distally in a sharp tip  970 . When the obturator  980  is in place it serves to protect the sharp tip. The proximal portion  959  has a lead-in  955  to a lumen disposed through the proximal portion  959 , which further extends completely through the device via the shaft, through which an anchor  230 , such as that shown in previous embodiments may be introduced. The anchor can be pulled further into the lumen until the suture is as distal as it can be in the slot  965 . Finger grips  975  are provided on the external surface of the proximal portion  959 . These are illustrated as smooth, but could be textured to improve grip. The device could then be passed through an abdominal wall, or through a prosthetic material, such that the distal end is inside the abdominal space, interior to the inner abdominal wall or prosthetic material. The anchor can then be delivered by passing the obturator back though the guide. The anchor is pushed distally through the guide, until it exits in the intra-abdominal space. The guide and obturator can then be retracted leaving the anchor in situ. The remaining anchor can then be used in conjunction with other such anchors to approximate tissue or prosthetic material. 
     Another example of use of a guide  1140  in accordance with the present teaching is illustrated in  FIG.  9   . The guide  1140  interacts with a prosthetic device  1500 . The prosthetic device  1500  features an opening  1530  on the abdominal wall engaging side  1510 . The opening has a pair of straps  1540  and  1550  attached to the device  1500  and which can be used to manipulate the prosthetic device  1500 . The prosthetic device further comprises an organ contacting side  1520 , which in combination with  1510  defines an internal space in the device, which is accessed through the opening  1530 . In use the distal portion of the guide  1150  is inserted into the prosthetic device through the opening  1530  guide. Anchors can then be delivered through the guide  1140 , entering through the prosthetic material on the abdominal engaging portion  1510 . The delivered anchor(s) are then retained in the inner volume of the prosthetic device. This enables fixation of the prosthetic device in situ, whilst also allowing and facilitating closure of the defect. Whilst shown as having a solid geometrical form, it will be appreciated that the form of the prosthetic may vary and could equally be provided in a mesh form. 
     While all of the embodiments above illustrate a single delivery channel, it will be appreciated by those skill in the art, that a similar guide could be provided featuring multiple delivery channels, to allow for anatomical differences, for example abdominal wall thickness in obese and non-obese patients, wherein the angle of the guide channel is varied to achieve the desired outcome. 
     As detailed above, in accordance with aspects of the present teaching, the suture/anchor assembly may consist of a length of bioabsorbable suture attached to bioabsorbable anchor, provided for example in the form of a length of bioabsorbable tubing or molded geometry, and in one embodiment configured such that the assembly is t-shaped. The suture may be a braided or monofilament suture made from any application specific bioabsorbable or non-absorbable polymers. For fascial layer closure a USP size 0 suture is preferred. This material is ideally suited to an application where the suture maintains approximately 50% of its strength after two weeks. However it will be appreciated that the suture material may be changed depending on strength or mass loss requirements of the specific application. 
     While preferred arrangements have been described in an effort to assist in an understanding of the teaching of the present invention it will be appreciated that it is not intended to limit the present teaching to that described and modifications can be made without departing from the scope of the invention. 
     It will be appreciated that the exemplary arrangements or examples of devices have been described with reference to the Figures attached hereto. Where a feature or element is described with reference to one Figure, it will be understood that the feature or element could be used with or interchanged for features or elements described with reference to another Figure or example. The person of skill in the art, when reviewing the present teaching, will understand that it is not intended to limit the present teaching to the specifics of the illustrated exemplary arrangements as modifications can be made without departing from the scope of the present teaching. 
     The words comprises/comprising when used in this specification are to specify the presence of stated features, integers, steps or components but does not preclude the presence or addition of one or more other features, integers, steps, components or groups thereof