An endoscopic needle exchange system for use with a surgical needle, comprising: a) an endoscope having a proximal end, a distal end defining a circumference, a instrument channel with a first diameter and a distal end, the endoscope sized for insertion into a natural orifice of the mammalian body while being operated from outside the body; and b) a needle capture device, comprising, i) a flexible tubular member having a proximal end and a distal end, ii) a flexible shaft having a proximal end and a distal end, said shaft extending through said flexible tubular member, iii) a proximal handle to longitudinally displace said shaft and flexible tubular member relative to each other characterized by iv) a housing having a proximal end fixed to said distal end of said flexible tubular member, a distal end, an interior, an exterior surface, and an alternating arrangement of flights and spaces radially arrayed about said exterior surface, said flights dimensioned to be closely received within said distal end of said instrument channel so as to coaxially orient said housing with said instrument channel, and v) a capture mechanism within said interior of said housing having a first element coupled to said flexible shaft and a second element coupled to said flexible tubular member, wherein in a first configuration of said first and second elements said capture mechanism is adapted to receive and retain the needle presented into said distal end of said instrument channel, and in a second configuration of said first and second elements said capture mechanism is adapted to release the needle from the instrument channel. a) an endoscope having a proximal end, a distal end defining a circumference, a instrument channel with a first diameter and a distal end, the endoscope sized for insertion into a natural orifice of the mammalian body while being operated from outside the body; and b) a needle capture device, comprising, i) a flexible tubular member having a proximal end and a distal end, ii) a flexible shaft having a proximal end and a distal end, said shaft extending through said flexible tubular member, iii) a proximal handle to longitudinally displace said shaft and flexible tubular member relative to each other characterized by iv) a housing having a proximal end fixed to said distal end of said flexible tubular member, a distal end, an interior, an exterior surface, and an alternating arrangement of flights and spaces radially arrayed about said exterior surface, said flights dimensioned to be closely received within said distal end of said instrument channel so as to coaxially orient said housing with said instrument channel, and v) a capture mechanism within said interior of said housing having a first element coupled to said flexible shaft and a second element coupled to said flexible tubular member, wherein in a first configuration of said first and second elements said capture mechanism is adapted to receive and retain the needle presented into said distal end of said instrument channel, and in a second configuration of said first and second elements said capture mechanism is adapted to release the needle from the instrument channel. i) a flexible tubular member having a proximal end and a distal end, ii) a flexible shaft having a proximal end and a distal end, said shaft extending through said flexible tubular member, iii) a proximal handle to longitudinally displace said shaft and flexible tubular member relative to each other characterized by iv) a housing having a proximal end fixed to said distal end of said flexible tubular member, a distal end, an interior, an exterior surface, and an alternating arrangement of flights and spaces radially arrayed about said exterior surface, said flights dimensioned to be closely received within said distal end of said instrument channel so as to coaxially orient said housing with said instrument channel, and v) a capture mechanism within said interior of said housing having a first element coupled to said flexible shaft and a second element coupled to said flexible tubular member, wherein in a first configuration of said first and second elements said capture mechanism is adapted to receive and retain the needle presented into said distal end of said instrument channel, and in a second configuration of said first and second elements said capture mechanism is adapted to release the needle from the instrument channel.