Suturing device and methods of use thereof

Abstract

The present disclosure includes a suturing device including: a fixed arm having a fixed jaw including a first grasping slot configured to receive a needle; a movable arm coupled to a movable jaw including a second grasping slot configured to receive the needle, the movable arm configured to pivot relative to the fixed arm to pivot the movable jaw relative to the fixed jaw until the needle is received in the first grasping slot and the second grasping slot; and a needle transfer mechanism configured to grasp the needle in the first grasping slot or the second grasping slot. In some aspects, the suturing device includes a safety member configured to control when the movable arm moves. The present disclosure includes a loading apparatus including a loading slot configured to receive a fixed jaw and a slider configured to move the needle towards into the fixed jaw.

Description

SUTURING DEVICE AND METHODS OF USE THEREOFCROSS-REFERENCE TO REEATED APPLICATIONS

[0001] This application claims the benefit of and priority to U.S. Provisional Patent Application No. 63 / 452,301, filed March 15, 2023, Turkish Application No. 2023 / 002908, filed March 15, 2023, and Turkish Application No. 2023 / 002475, filed March 6, 2023, the contents of which are incorporated herein by reference in their entirety.FIELD

[0002] This disclosure relates to suturing devices used in surgical operations, a suture loading apparatus for loading a suture into a suturing device, and methods of their use.BACKGROUND

[0003] Urinary incontinence refers to the involuntary leakage or unintentional loss of urine. The disease comes in three different forms: stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence. The most common is stress urinary incontinence (SUI), which is the involuntary leakage of urine that happens during physical activities that increase abdominal pressure (stress) and / or puts pressure on the bladder, such as coughing, sneezing, laughing, heavy lifting, and exercising.

[0004] Abdominal colposuspension based on native tissue repair for Stress UI is based on elevation of the vaginal wall towards bilateral strong pelvic floor supportive structures such as Arcus Tendineus Fascia Pelvis (ATFP), iliopectineal ligament. However, native tissue repair is invasive and difficult because it is intensive and is a major surgery (abdominal). Transvaginal surgery is based on mesh repair for SUI. It involves the placement of tension- free mesh (sling). This method often involves placing artificial implants such as a synthetic sling or mesh.

[0005] Pelvic organ prolapse refers to the prolapse (drop) of pelvic organs from their normal position. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and rectum.

[0006] Surgical treatment of POP can be done through the abdomen or the vagina. Abdominal surgeries to repair POP can be done either based on native tissue repair or byplacing artificial mesh. Transvaginal surgeries too can be either done based on native tissue repair or by placing artificial mesh. Native tissue repair done through the vagina is based on the elevation of vaginal wall or cervix (if the patient’s uterus has been removed for another reason) towards strong pelvic floor supportive structures such as the Sacrospinous ligament, Sacro-uterine ligament, and Arcus Tendineus Fascia Pelvis (ATFP).

[0007] A number of procedures have been developed over time to address these issues. Current surgical treatment options of SUI include native tissue repair, such as abdominal colposuspension, a procedure in which the bladder neck is supported by sutures. Sling procedures can be used in which the support is provided with tissue either surgically removed from other parts of the patient’s body (autologous sling), or donated by another person (allograft sling) or animal (xenograft sling). Sling procedures can also be performed with materials such as surgical mesh (mesh sling). Sling procedures are done through the vagina as opposed to abdominal colposuspension. They can be performed using three incisions, in two ways: retropubic or transobturator. Other procedures include a “mini-sling” procedure which may be done with a single incision. The most common procedures for the treatment of SUI are abdominal colposuspension, which can present difficulties as it is performed through the abdomen, and mid-urethral sling procedures (MUS), which use a surgical mesh that is associated with safety concerns due to mesh erosion and related complications.

[0008] Vaginal Arco-Colposuspension (VACS) surgery introduces a minimally invasive, transvaginal, native tissue repair technique. Arcus Tendinous Fascia Pelvis (ATFP) which is more difficult to reach via abdominal route, can be easily palpated through the lateral vaginal wall, but the pubic part of ATFP, which requires sutures for VACS, remains behind the pubic bone, and its location does not seem to be suitable for suturing.

[0009] Thus, there is still a need for safe and effective procedures for urinary incontinence that are minimally invasive and use a native tissue repair technique.SUMMARY

[0010] The present disclosure relates to a suturing device, including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle; and a needle transfer mechanism, including: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured tochange length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle.

[0011] The present disclosure relates to a suturing system, including: a suturing device, including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle; and a needle transfer mechanism, including: a first grasping member positioned in the first jaw; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle; and an energy source coupled to the first wire and the second wire and configured to supply electric current to the first wire and the second wire.

[0012] The present disclosure relates to a method, including: opening a second jaw of a suturing device with respect to a first jaw of the suturing device, wherein: the first jaw includes a first grasping slot configured to receive a needle and a first grasping member configured to removably couple with the needle to retain the needle in the first grasping slot; the second jaw includes a second grasping slot configured to receive the needle and a second grasping member configured to removably couple with the needle to retain the needle in the second grasping slot; and the needle is coupled to the first grasping member and retained in the first grasping slot of the first jaw; closing the second jaw with respect to the first jaw, optionally wherein the device is positioned so that the target tissue is between the first jaw and the second jaw before closing the second jaw; and transferring the needle from the first grasping slot of the first jaw to the second grasping slot of the second jaw, wherein transferring the needle includes: supplying an electric current to a first wire coupled to the first grasping member to change a length of the first wire and uncouple the first grasping member from the needle.

[0013] The present disclosure relates to a transfer mechanism for a suturing device, including: a wire, wherein: the wire is coupled to a needle; the wire is coupled to an energy source configured to supply an electric current through the wire; the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the needle from a first position to a second position when electric current is supplied through the wire. In some embodiments, the present disclosure relates to a transfer mechanism, further including a potential energy member, wherein: the potential energy member is configured to transition between a first configuration and a second configuration; and the potential energy member is configured to move the needle from the second position to the first position when the potential energy member transitions from the second configuration to the first configuration.

[0014] The present disclosure relates to a transfer mechanism for a suturing device, including: a wire, wherein: the wire is coupled to a grasping member; the wire is coupled to an energy source configured to supply an electric current through the wire; the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the grasping member is configured to couple to a needle in the first position; and the grasping member is configured to uncouple from the needle in the second position. In some embodiments, the present disclosure relates to a transfer mechanism, further including a potential energy member, wherein: the potential energy member is configured to transition between a first configuration and a second configuration; and the potential energy member is configured to move the grasping member from the second position to the first position when the potential energy member transitions from the second configuration to the first configuration.

[0015] The present disclosure relates to a suturing device, including: a needle transfer mechanism; one or more image sensors comprising one or more optical wires extending through the suturing device, wherein the one or more image sensors are configured to generate image data of an operating site of the suturing device. The present disclosure relates to a suturing device, including: a needle transfer mechanism; and a fiber optic image sensor, such as a fiber optic camera including an optical wire extending through the suturing device, wherein the fiber optic camera is configured to generate image data of an operating site of the suturing device.

[0016] The present disclosure relates to a suturing device, including: a needle transfer mechanism; and one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device. The present disclosure relates to a suturing device, including: a needle transfer mechanism; and an electric field sensor positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

[0017] The present disclosure relates to a suturing device, including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle; and one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw. The present disclosure relates to a suturing device, including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle; and a piezo film positioned on a surface of at least one of the first jaw or the second jaw, wherein the piezo film is configured to vibrate the at least one of the first jaw or the second jaw.

[0018] The present disclosure relates to a suturing device, including: an elongate body; a needle; and a needle transfer mechanism including a wire coupled to the needle and coupled to an energy source, wherein: the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the needle when electric current is supplied through the wire.

[0019] The present disclosure relates to a suturing device including: a fixed arm integral with a fixed jaw including a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism including: a first grasping member configured to secure the needle in the first grasping slot and release the needle from the first grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member configured to secure the needle in the second grasping slot and release the needle from the second grasping slot, the firstgrasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire.

[0020] In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm. In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes a jaw joint located in the reference body, wherein the jaw joint is coupled to the movable jaw, and wherein the movable jaw is configured to pivot about the jaw joint and relative to the fixed jaw. In some embodiments, the present disclosure relates to a suturing device, wherein the suturing device further includes a connecting joint configured to link the movable arm and the movable jaw, wherein the movable arm is configured to move the connecting joint to cause the movable jaw to pivot about the jaw joint.

[0021] The present disclosure relates to a suturing device including: a fixed arm integral with a fixed jaw including a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism including first and second wires configured to secure the needle in the first grasping slot or the second grasping slot, the first and second wires configured to: change length in response to electric current supplied through the first and second wires, respectively; and control first and second grasping members to retain and release the needle from the first and second grasping slots.

[0022] The present disclosure relates to a suturing device including: a needle configured to include a channel for threading a suture therethrough; a fixed arm integral with a fixed jaw including a first grasping slot configured to receive the needle; a movable jaw movably coupled to a movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism including first and second needle securing members configured to secure the needle in the first grasping slot or the second grasping slot, the first and second needle securing members coupled to first and second wires and configured to engage one or more features on the needle to selectively retain and release theneedle from the first and second grasping slots in response to electric current supplied through the first and second wires.

[0023] The present disclosure relates to a suturing device including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle; and a needle transfer mechanism, including: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a first potential energy member, wherein the first potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the first grasping member; a second grasping member positioned in the second jaw; a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire; and a second potential energy member, wherein the second potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the second grasping member, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle.

[0024] The present disclosure relates to a suturing device including: a fixed arm integral with a fixed jaw including a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism including: a first grasping member configured to secure the needle in the first grasping slot and release the needle from the first grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a first potential energy member, wherein the first potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the first grasping member; a second grasping member configured to secure the needle in the second grasping slot and release the needle from the second grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a second wire coupled to the secondgrasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire; and a second potential energy member, wherein the second potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the second grasping member.

[0025] The present disclosure relates to a suturing device including: an elongate body; a fixed jaw body extending from the elongate body and including a linear guide; a fixed jaw fixedly coupled to and extending from the fixed jaw body; a movable jaw coupled to the fixed jaw body at the linear guide and configured to move linearly with respect to the fixed jaw in the linear guide; and a drive mechanism, including: a wire configured to move the movable jaw along the linear guide, wherein the wire is configured to change length in response to electric current supplied through the wire. In some embodiments, the present disclosure relates to a suturing device, wherein the drive mechanism further includes: a potential energy member, wherein: the wire is configured to move the movable jaw along the linear guide in a first direction; and the potential energy member is configured to move the movable jaw along the linear guide in a second direction opposite of the first direction.

[0026] The present disclosure relates to a suturing device including: an elongate body; a fixed jaw body extending from the elongate body and including a jaw joint; a fixed jaw fixedly coupled to and extending from the fixed jaw body; a movable jaw coupled to the fixed jaw body and configured to pivot with respect to the fixed jaw about the jaw joint; and a drive mechanism, including: a wire configured to rotate the movable jaw about the jaw joint, wherein the wire is configured to change length in response to electric current supplied through the wire. In some embodiments, the present disclosure relates to a suturing device, wherein the drive mechanism further includes: a potential energy member, wherein: the wire is configured to rotate the movable jaw about the jaw joint in a first direction; and the potential energy member is configured to rotate the movable jaw about the jaw joint in a second direction opposite of the first direction.

[0027] The present disclosure relates to a suturing device including: a needle; a first needle holding member including a first port configured to receive the needle; a second needle holding member in alignment with the first needle holding member including a second port configured to receive the needle; and a needle transfer mechanism at least partially positioned within the first needle holding member, including: a wire coupled to the needle, wherein: the wire is configured to change length in response to electric current supplied through the wire;and the needle transfer mechanism is configured to move the needle from the first port of the first needle holding member to the second port of the second needle holding member. In some embodiments, the present disclosure relates to a suturing device, wherein the first needle holding member and the second needle holding member are fixed relative to each other.

[0028] The present disclosure relates to a suturing device including: a first jaw including a first grasping slot configured to receive a needle; a second jaw including a second grasping slot configured to receive the needle, wherein the second jaw is movable with respect to the first jaw; and a needle transfer mechanism configured to secure the needle in the first grasping slot or the second grasping slot and release the needle from the first grasping slot or the second grasping slot, wherein the needle transfer mechanism includes a wire configured to change length in response to electric current supplied through the wire.

[0029] In some embodiments, the present disclosure relates to a suturing device, wherein the needle transfer mechanism includes: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw and selectively extendable in the second grasping slot; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle. In some embodiments, the present disclosure relates to a suturing device, wherein the first wire is configured to move the first grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the first grasping member is configured to couple to the needle in the first position; and the first grasping member is configured to uncouple from the needle in the second position. In some embodiments, the present disclosure relates to a suturing device, further including a first potential energy member, wherein: the first potential energy member is configured to transition between a first configuration and a second configuration; and the first potential energy member is configured to move the first grasping member from the second position to the first position when the first potential energy member transitions from the second configuration to the first configuration. In some embodiments, the presentdisclosure relates to a suturing device, wherein the second wire is configured to move the second grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the second grasping member is configured to couple to the needle in the first position; and the second grasping member is configured to uncouple from the needle in the second position. In some embodiments, the present disclosure relates to a suturing device, further including a second potential energy member, wherein: the second potential energy member is configured to transition between a first configuration and a second configuration; and the second potential energy member is configured to move the second grasping member from the second position to the first position when the second potential energy member transitions from the second configuration to the first configuration. In some embodiments, the present disclosure relates to a suturing device, further including an input, wherein the input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire. In some embodiments, the present disclosure relates to a suturing device, further including an input, wherein the input, upon being actuated once, is configured to cause the energy source coupled to the first wire and the second wire to de-energize the second wire and energize the first wire. In some embodiments, the present disclosure relates to a suturing device, further including an input, wherein the input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to: de-energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member not coupled to the needle prior to actuation of the input; and energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member coupled to the needle prior to actuation of the input. In some embodiments, the present disclosure relates to a suturing device, further including a first input and a second input, wherein: the first input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire; and the second input, upon being actuated once, is configured to cause the energy source coupled to the first wire and the second wire to de-energize the second wire and energize the first wire. In some embodiments, the present disclosure relates to a suturing device, further including: a first handle; a second handle; and a force sensor, wherein: the force sensor is configured to detect contact and closing force between the first handle and the second handle as the first handle and the second handle are closed; and the force sensor, upon detecting a threshold force, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire. In someembodiments, the present disclosure relates to a suturing device, wherein the force sensor, upon detecting the threshold force, is configured to cause the energy source to de-energize the second wire and energize the first wire. In some embodiments, the present disclosure relates to a suturing device, further including: a first handle; a second handle; and a force sensor, wherein: the force sensor is configured to detect contact and closing force between the first handle and the second handle as the first handle and the second handle are closed; the force sensor, upon detecting a threshold force, is configured to cause an energy source coupled to the first wire and the second wire to de-energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member not coupled to the needle prior to detecting the threshold force; and the force sensor, upon detecting the threshold force, is configured to cause the energy source coupled to the first wire and the second wire to energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member coupled to the needle prior to detecting the threshold force. In some embodiments, the present disclosure relates to a suturing device, further including: a fixed arm integral with the first jaw; and a movable arm movably coupled with the second jaw, the second jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw. In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm. In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes a jaw joint located in the reference body, wherein the jaw joint is coupled to the second jaw, and wherein the second jaw is configured to pivot about the jaw joint and relative to the first jaw. In some embodiments, the present disclosure relates to a suturing device, wherein the suturing device further includes a connecting joint configured to link the movable arm and the second jaw, wherein the movable arm is configured to move the connecting joint to cause the second jaw to pivot about the jaw joint. In some embodiments, the present disclosure relates to a suturing device, further including: a fixed jaw body including a linear guide; the first jaw fixedly coupled to and extending from the fixed jaw body; the second jaw coupled to the fixed jaw body at the linear guide and configured to move linearly with respect to the first jaw in the linear guide; and a drive mechanism, including: a wire configured to move the second jaw along the linear guide, wherein the wire is configured to change length in response to electric current supplied through the wire. In some embodiments, the present disclosure relates to a suturing device, wherein the drive mechanism further includes: a potential energy member, wherein: the wireis configured to move the second jaw along the linear guide in a first direction; and the potential energy member is configured to move the second jaw along the linear guide in a second direction opposite of the first direction. In some embodiments, the present disclosure relates to a suturing device, further including: a fixed jaw body including a jaw joint; the first jaw fixedly coupled to and extending from the fixed jaw body; the second jaw coupled to the fixed jaw body and configured to pivot with respect to the first jaw about the jaw joint; and a drive mechanism, including: a wire configured to rotate the second jaw about the jaw joint, wherein the wire is configured to change length in response to electric current supplied through the wire. In some embodiments, the present disclosure relates to a suturing device, wherein the drive mechanism further includes: a potential energy member, wherein: the wire is configured to rotate the second jaw about the jaw joint in a first direction; and the potential energy member is configured to rotate the second jaw about the jaw joint in a second direction opposite of the first direction. In some embodiments, the present disclosure relates to a suturing device, further including: a fixed arm integral with the first jaw; a first handle coupled to a proximal end of the fixed arm; a movable arm movably coupled with the second jaw, the second jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a second handle coupled to a proximal end of the movable arm. In some embodiments, the present disclosure relates to a suturing device, further comprising a single handle. In some embodiments, the present disclosure relates to a suturing device, further including: a fiber optic camera including an optical wire extending through the suturing device, wherein the fiber optic camera is configured to generate image data of an operating site of the suturing device. In some embodiments, the present disclosure relates to a suturing device, further including: an electric field sensor positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device. In some embodiments, the present disclosure relates to a suturing device, further including a piezo film positioned on a surface of at least one of the first jaw or the second jaw, wherein the piezo film is configured to vibrate the at least one of the first jaw or the second jaw.

[0030] The present disclosure relates to a suturing device including: a fixed arm integral with a fixed jaw including a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; a needle transfer mechanism including first and second plates configured to secure the needle in the first grasping slot or the second grasping slot andrelease the needle from the first grasping slot or the second grasping slot, the first and second plates configured to selectively engage the needle while the needle is positioned in the first grasping slot or the second grasping slot; and at least one of a fiber optic camera, an electric field sensor, or a piezo film.

[0031] In some embodiments, the present disclosure relates to a suturing device, wherein: the first plate includes a first control bar configured to advance a first grasping member towards a first receptacle of the needle disposed in the first grasping slot to grasp the needle in the first grasping slot or retract the first grasping member from the first receptacle to release the needle from the first grasping slot; and the second plate includes a second control bar configured to advance a second grasping member towards a second receptacle of the needle disposed in the second grasping slot to grasp the needle in the second grasping slot or retract the second grasping member from the second receptacle to release the needle from the second grasping slot. In some embodiments, the present disclosure relates to a suturing device, further including a lever configured to move among: a first position to advance the first control bar to grasp the needle in the first grasping slot and retract the second control bar to release the needle from the second grasping slot, a second position to retract the first control bar to release the needle from the first grasping slot and retract the second control bar to release the needle from the second grasping slot, and a third position to retract the first control bar to release the needle from the first grasping slot and advance the second control bar to grasp the needle in the second grasping slot. In some embodiments, the present disclosure relates to a suturing device, further comprising a cover partially disposed over the lever, the cover comprising indicators corresponding to movements of the lever to the first position, the second position, and the third position. In some embodiments, the present disclosure relates to a suturing device, further including a switching joint coupled to the first control bar and the second control bar. In some embodiments, the present disclosure relates to a suturing device, wherein the lever is coupled to the switching joint, wherein the lever is configured to rotate the switching joint to move the first control bar and the second control bar. In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm. In some embodiments, the present disclosure relates to a suturing device, wherein the fixed arm further includes a jaw joint located in the reference body, wherein the jaw joint is coupled to the movable jaw, and wherein the movable jaw is configured to pivot about the jaw joint andrelative to the fixed jaw. In some embodiments, the present disclosure relates to a suturing device, wherein the suturing device further includes a connecting joint configured to link the movable arm and the movable jaw, wherein the movable arm is configured to move the connecting joint to cause the movable jaw to pivot about the jaw joint. In some embodiments, the present disclosure relates to a suturing device, further including: a fiber optic camera including an optical wire extending through the suturing device, wherein the fiber optic camera is configured to generate image data of an operating site of the suturing device. In some embodiments, the present disclosure relates to a suturing device, further including: an electric field sensor positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device. In some embodiments, the present disclosure relates to a suturing device, further including a piezo film positioned on a surface of at least one of the first jaw or the second jaw, wherein the piezo film is configured to vibrate the at least one of the first jaw or the second jaw.

[0032] The present disclosure relates to a suturing method, including: forming an incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a first suturing device inside a pelvic cavity and adjacent to a first target tissue through the incision, the first target tissue being a first arcus tendinous fascia pelvis (ATFP) in the pelvic cavity; placing, using the first suturing device, at least one suture in the first ATFP; placing at least one suture in the vesicovaginal fascia, the at least one suture in the vesicovaginal fascia connected to the at least one suture in the first ATFP; and pulling the at least one suture in the first ATFP and the at least one suture in the vesicovaginal fascia to form a loop, thereby bringing the vaginal wall closer to the first ATFP.

[0033] In some embodiments, the present disclosure relates to a method, wherein pulling the at least one suture in the ATFP and the at least one suture in the vesicovaginal fascia results in lifting the vaginal wall, the bladder neck, and urethra. In some embodiments, the present disclosure relates to a method, further including: positioning the suturing device inside the pelvic cavity and adjacent to a second target tissue through the incision, the second target tissue being a second ATFP in the pelvic cavity; placing at least one suture in the second ATFP; placing at least one suture in the vesicovaginal fascia, the at least one suture in the vesicovaginal fascia connected to the at least one suture in the second ATFP; and pulling the at least one suture in the second ATFP and the at least one suture in the vesicovaginal fascia to form a loop, thereby bringing the vaginal wall closer to the second ATFP. In someembodiments, the present disclosure relates to a method, wherein the anatomical position of at least one of the vaginal wall, bladder neck or urethra in the pelvic cavity is restored. In some embodiments, the present disclosure relates to a method, wherein the anatomical position of each of the vaginal wall, bladder neck and urethra in the pelvic cavity is restored. In some embodiments, the present disclosure relates to a method, wherein the physiological function of at least one of the vaginal wall, bladder neck or urethra in the pelvic cavity is restored. In some embodiments, the present disclosure relates to a method, wherein the physiological function of each of the vaginal wall, bladder neck and urethra in the pelvic cavity is restored. In some embodiments, the present disclosure relates to a method, wherein the at least one suture is formed from at least one of a thread, a fiber, a filament, and a wire. In some embodiments, the present disclosure relates to a method, wherein the at least one suture is formed from an absorbable material. In some embodiments, the present disclosure relates to a method, wherein the at least one suture is formed from a non-absorbable material. In some embodiments, the present disclosure relates to a method, wherein the at least one suture in the first ATFP or the second ATFP is placed in an anteroposterior part of the first ATFP or the second ATFP. In some embodiments, the present disclosure relates to a method, wherein the at least one suture in the first ATFP or the second ATFP is placed in the junction of pubic ramus and symphysis pubis. In some embodiments, the present disclosure relates to a method, wherein the at least one suture in the first ATFP or the second ATFP includes a first suture and a second suture, wherein the first suture is placed in an anteroposterior part of the first ATFP or the second ATFP, and the second suture is placed in a mediolateral pubic part of the first ATFP or the second ATFP, 0.5 to 1 cm distance posteroinferior to the first suture. In some embodiments, the present disclosure relates to a method, wherein, after forming the incision in the vaginal wall and before positioning the device inside the pelvic cavity, the method further includes forming a dissection from over the vesicovaginal fascia towards the junction of the pubic ramus and symphysis pubis. In some embodiments, the present disclosure relates to a method, wherein the restoration is performed solely using the sutures without a mesh. In some embodiments, the present disclosure relates to a method, wherein, when the vesicovaginal fascia is approximated to ATFPs bilaterally, the connection between pelvic floor structures and urethra and bladder neck is restored. In some embodiments, the present disclosure relates to a method, wherein the at least one suture in the vesicovaginal fascia is placed with a second suturing device. In some embodiments, the present disclosure relates to a method, further including palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

[0034] The present disclosure relates to a suturing method, including: forming a transverse incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a suturing device inside a pelvic cavity and adjacent a target tissue through the incision, the target tissue being a sacrospinous ligament in the pelvic cavity; placing a plurality of sutures in the target tissue; placing a plurality of sutures in the cervix uteri or the vaginal cuff; and pulling the plurality of sutures to form a loop with the sutures passed on the sacrospinous ligament and the cervix uteri or vaginal cuff to correct apical prolapse.

[0035] The present disclosure relates to a suturing method, including: forming an incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a suturing device inside a pelvic cavity through the incision, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw, the target tissue being each of the arcus tendinous fasciae pelvis (ATFP) in the pelvic cavity; placing a plurality of sutures in the target tissue, the plurality of sutures being placed in each arcus tendinous fasciae pelvis (ATFP); placing a plurality of sutures in the vesicovaginal fascia; and optionally pulling the plurality of sutures in any order to form a loop with the sutures passed on ATFP and vesicovaginal fascia to bring the vaginal wall closer to the ATFP at each side and to lift the vaginal wall, the bladder neck and urethra to restore their anatomical and physiological positions in the pelvic cavity.

[0036] In some embodiments, the present disclosure relates to a method, further including forming a dissection from over the vesicovaginal fascia towards the junction of the pubic ramus and symphysis pubis. In some embodiments, the present disclosure relates to a method, further including palpating a tissue to determine a location of the target tissue inside the pelvic cavity. In some embodiments, the present disclosure relates to a method, further including pulling the suturing device away from the target tissue to create a distance between the suturing device and the target tissue to open the movable jaw relative to the fixed jaw. In some embodiments, the present disclosure relates to a method, wherein the suturing device further includes: a fixed jaw integral with a distal end of the fixed arm and including a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw. In some embodiments, the present disclosure relates to a method, wherein thedistal ends of the fixed and movable arms are angled such that the distal end accurately reaches the target tissue in the pelvic cavity to be sutured via a vaginal incision. In some embodiments, the present disclosure relates to a method, wherein the suturing device further includes: a fixed jaw integral with a distal end of the fixed arm and including a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to move linearly relative to the fixed arm.

[0037] The present disclosure relates to a suturing method, including: positioning a suturing device inside a pelvic cavity of a patient through an incision in a vaginal wall, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw, the target tissue being arcus tendinous fasciae pelvis (ATFP); and forming a Z- suture with the suturing device to place a plurality of sutures in the target tissue. In some embodiments, the present disclosure relates to a method, further including palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

[0038] The present disclosure relates to a suturing method, including: positioning a suturing device inside a pelvic cavity of a patient, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw; and providing treatment of pelvic organ prolapse by suturing the target tissue using the suturing device to place a plurality of sutures in the target tissue to suture the target tissue to the apical vaginal wall or cervix uteri, the target tissue being in the form of a ligament in the pelvic cavity such that suturing the ligament to the apical vaginal wall or cervix uteri provides vaginal apex elevation. In some embodiments, the present disclosure relates to a method, further including palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

[0039] The present disclosure relates to a suturing method, including: positioning a suturing device inside a pelvic cavity of a patient through an incision in a vaginal wall, the suturing device including a movable jaw and a fixed jaw and a needle; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw; and actuating the movable jaw relative to the fixed jaw such that the movable jaw moves towards the fixed jaw to move a needle positioned in at least one of the movable jaw and the fixed jaw through the target tissue to apply a suture to the targettissue; optionally wherein the suturing device is sized and shaped to be received in the pelvic cavity through the vaginal wall in order to position sutures to lift the vaginal wall, the bladder neck and urethra to restore their anatomical and physiological positions in the pelvic cavity.

[0040] In some embodiments, the present disclosure relates to a method, further including palpating a tissue to determine a location of the target tissue inside the pelvic cavity. In some embodiments, the present disclosure relates to a method, wherein the suturing device further includes: a fixed jaw integral with a distal end of the fixed arm and including a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm including a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference location on the fixed arm and relative to the fixed jaw while the fixed jaw remains immovable. In some embodiments, the present disclosure relates to a method, wherein the distal end of the fixed and movable arms are angled such that the distal end reaches accurately the target tissue in the pelvic cavity to be sutured via the vaginal wall.

[0041] The present disclosure relates to a suturing device, including: a handle; an elongate arm connected to the handle at a proximal end thereof and having a first movable jaw and a second fixed jaw positioned on a distal end thereof, the first jaw being movable and comprising a first grasping slot configured to receive a needle and the second jaw being fixed and comprising a second grasping slot configured to receive the needle; and a mandrel mechanism configured to connect the handle to the elongate arm such that the first and second jaws on the distal end of the arm are rotatable about a longitudinal axis of the arm to allow the first and second jaws to assume any angular position while the handle remains fixed.

[0042] In some embodiments, the mandrel mechanism comprises a user activated button configured to move a spring-loaded pin positioned inside the mandrel mechanism to one of at least one recess positioned along an angular path of the mandrel mechanism. In some embodiments, the position of the pin inside one of the at least one recess is configured to set an angular position of the first and second jaws.

[0043] In some embodiments, the suturing device further comprises a lever mechanism configured to move the first jaw relative to the second jaw on a linear guide. In some embodiments, the lever mechanism has a distal position in which the first and second jaws are fully closed and a proximal position in which the first and second jaw are fully open.

[0044] In some embodiments, the suturing device further comprises a needle transfer mechanism configured to transfer a needle between a first grasping slot in the first jaw and a second grasping slot in the second jaw for applying sutures to a target tissue. In some embodiments, the needle transfer mechanism comprises: a toggle switch configured to move between a distal position and a proximal position transferring the needle between the first jaw and the second jaw using a first cable and a second cable; wherein a distal position of the toggle switch transfers the needle from the first jaw to the second jaw by pulling on the first cable, and wherein the proximal position of the toggle switch transfers the needle from the second jaw to the first jaw by pulling on the second cable.

[0045] In some embodiments, the suturing device further comprises one or more image sensors comprising one or more optical wires extending through the suturing device, wherein the one or more image sensors are configured to generate image data of an operating site of the suturing device. In some embodiments, the suturing device further comprises one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device. In some embodiments, the suturing device further comprises one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw.

[0046] In some embodiments, the suturing device further comprises dual-action needle unload button positioned on a proximal end of the handle, the dual-action needle unload button being configured to unload the needle while the first and second jaws are open.

[0047] The present disclosure relates to a suturing device, comprising: a handle; and an elongate arm connected to the handle at a proximal end thereof and having first and second jaws positioned on a distal end thereof, the first jaw comprising a first grasping slot configured to receive a needle and the second jaw comprising a second grasping slot configured to receive the needle, the first and second jaws having a fixed aperture therebetween; wherein the distal end of the arm is angled relative to the proximal end such that the distal end is configured to reach a target tissue to be sutured.

[0048] In some embodiments, the first and second jaws are rotated between 60 degrees and 90 degrees relative to the elongate arm.

[0049] In some embodiments, the suturing device further comprises one or more image sensors comprising one or more optical wires extending through the suturing device, whereinthe one or more image sensors are configured to generate image data of an operating site of the suturing device. In some embodiments, the suturing device further comprises one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device. In some embodiments, the suturing device further comprises one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw.

[0050] The present disclosure relates to a suturing needle, comprising: an elongate body with a proximal end and a distal end; a first circumferential slot positioned at the proximal end of the elongate body and a second circumferential slot positioned at the distal end of the elongate body, the first and second circumferential slots being configured to interface with a suturing device; and a thread slot formed in a middle portion of the elongate body between the proximal and distal ends of the elongate body, the thread slot being configured to receive a thread; wherein the thread is forcibly deformed into the thread slot creating a desired holding force between the suturing needle and the thread to join the thread to the suturing needle.

[0051] In some embodiments, the thread slot has a cross-sectional geometry that is at least one of rectangular, triangular, slanted, straight, linear, or circumferential.BRIEF DESCRIPTION OF THE DRAWINGS

[0052] The present disclosure is further described in the detailed description which follows, in reference to the noted plurality of drawings by way of non-limiting examples of exemplary embodiments, in which like reference numerals represent similar parts throughout the several views of the drawings, and wherein:

[0053] FIG. 1 depicts a cross-sectional view of a suturing device, according to some embodiments herein;

[0054] FIG. 2 depicts a cross-sectional view of a suturing device, according to some embodiments herein;

[0055] FIGS. 3 A and 3B depict an embodiment of a suturing device, according to some embodiments herein;

[0056] FIGS. 4A and 4B depict an embodiment of grasping slots of a suturing device, according to some embodiments herein;

[0057] FIGS. 5 A, 5B, 5C, and 5D depict an embodiment of a suturing device including movement of a movable arm and a movable jaw and transferring a needle, according to some embodiments herein;

[0058] FIGS. 6 A, 6B, and 6C depict an embodiment of a suturing device including joints for facilitating movement of a movable arm and a movable jaw, according to some embodiments herein;

[0059] FIG. 7A depicts a concave needle for a suturing device, according to some embodiments herein;

[0060] FIGS. 7B, 7C, 7D, and 7E depict a straight needle for a suturing device, according to some embodiments herein;

[0061] FIGS. 7F, FIG. 7G, FIG. 7H, and FIG. 71 depict an embodiment of a needle having an open channel feature -based joining of needle and thread, according to some embodiments herein;

[0062] FIGS. 7J, 7K, 7L, and 7M depict cross-sectional views of a suturing device showing an embodiment of a needle transfer mechanism, according to some embodiments herein;

[0063] FIG. 7MM depicts a cross-sectional view of a suturing device showing an embodiment of a needle transfer mechanism, according to some embodiments herein;

[0064] FIG. 7N depicts a cross-sectional view of a suturing device showing an embodiment of a needle transfer mechanism, according to some embodiments herein;

[0065] FIGS. 70 and 7P depict cross sectional views of a needle transfer mechanism, according to some embodiments herein;

[0066] FIGS. 8 A and 8B depict a suturing device including a user interface, according to some embodiments herein;

[0067] FIG. 8C depicts a suturing device and a loading device, according to some embodiments herein;

[0068] FIGS. 9A and 9B depict an external unit for coupling to a suturing device, according to some embodiments herein;

[0069] FIGS. 10A, 10B, and 10C depict embodiments of a suturing device including a force sensor, according to some embodiments herein;

[0070] FIGS. 11A and 11B depict a suturing device having an attachment members, according to some embodiments herein;

[0071] FIG. 12A and FIG. 12B depict embodiments of shapes of suturing devices, according to some embodiments herein;

[0072] FIGS. 13 A and 13B depict a suturing device, according to some embodiments herein;

[0073] FIGS. 14A, 14B, 14C, 14D, and 14E depict flowcharts of representative methods of operation a suturing device, according to some embodiments herein;

[0074] FIGS. 15 A, 15B, and 15C depict a concave needle, according to some embodiments herein;

[0075] FIGS. 16A, 16B, 16C, and 16D depict a suturing device, according to some embodiments herein;

[0076] FIGS. 17A, 17B, 17C, and 17D depict a straight needle, according to some embodiments herein;

[0077] FIGS. 18 A, 18B, 18C, and 18D depict embodiments of a suturing device and linear movement of a movable jaw relative to a fixed jaw, according to some embodiments herein;

[0078] FIG. 19A depicts a partially exploded view of a suturing device, according to some embodiments herein;

[0079] FIG. 19B depicts a partially exploded view of a suturing device and actuator, according to some embodiments herein;

[0080] FIG. 20A depicts a transparent view of a fixed jaw body of a suturing device, according to some embodiments herein;

[0081] FIG. 20B depicts a cross sectional view of the fixed jaw body, jaws, and actuators of a suturing device, according to some embodiments herein;

[0082] FIGS. 20C, 20D, 20E, and 20F depict a drive mechanism for moving a movable jaw linearly, according to some embodiments herein;

[0083] FIG. 21 depicts a transparent view of a suturing device, according to some embodiments herein;

[0084] FIGS. 22A, 22B, and 22C depict a suturing device having an optical camera, according to some embodiments herein;

[0085] FIGS. 23 A and 23B depict a suturing device having an electric field sensor, according to some embodiments herein;

[0086] FIGS. 24A and 24B depict a foot pedal for use with a suturing device, according to some embodiments herein;

[0087] FIG. 25 depicts a piezo film on a jaw of a suturing device, according to some embodiment herein;

[0088] FIG. 26A depicts a suturing device, according to some embodiments herein;

[0089] FIG. 26B depicts a cross-sectional view of the suturing device of FIG. 26A, according to some embodiments herein;

[0090] FIG. 26C depicts an embodiment of a suturing device, according to some embodiments herein;

[0091] FIGS. 27 A and 27B depict a suturing device, according to some embodiments herein; and

[0092] FIGS. 28A, 28B, 28C, and 28D depict a drive mechanism for rotating a movable jaw with respect to a fixed jaw, according to some embodiments herein.

[0093] FIG. 29A and FIG. 29B depict an embodiment of the suturing device.

[0094] FIG. 30A and FIG. 30B depict an embodiment of the grasping slots of the suturing device.

[0095] FIG. 31A and FIG. 3 IB depict an embodiment of the suturing device including movement of the movable arm and the movable jaw while the needle is secured in the fixed jaw.

[0096] FIG. 31C and FIG. 3 ID depict an embodiment of the suturing device including the needle transfer mechanism transferring the needle.

[0097] FIG. 3 IE depict an embodiment of the suturing device including movement of the movable arm and the movable jaw while the needle is secured in the movable jaw.

[0098] FIG. 32A, FIG. 32B, FIG. 32C depict an embodiment of the suturing device including joints for facilitating movement of the movable arm and the movable jaw.

[0099] FIG. 33A depicts an embodiment of a concave needle for the suturing device.

[0100] FIG. 33B, FIG. 33C, FIG. 33D, and FIG. 33E depict an embodiment of a straight needle for the suturing device.

[0101] FIG. 33F, FIG. 33G, FIG. 33H, FIG. 331 depict an embodiment of a needle having an open channel feature-based joining of needle and thread.

[0102] FIG. 33J depicts an embodiment of the suturing device including mechanisms for securing and releasing the needle.

[0103] FIG. 33K, FIG. 33L, and FIG. 33M depict an exploded view of an embodiment of the control bars and the grasping members.

[0104] FIG. 33N, FIG. 330, and FIG. 33P depicts an embodiment of the suturing device including mechanisms for securing and releasing the needle.

[0105] FIG. 34A, FIG. 34B, and FIG. 34C depict an embodiment of the suturing device including the stopper in an activated position.

[0106] FIG. 35A and FIG. 35B depict an embodiment of the suturing device including the activated stopper and the safety member preventing movement of the movable arm and the movable jaw when the needle is unsecured.

[0107] FIG. 36A and FIG. 36B depict an embodiment of the suturing device including the activated stopper allowing movement of the movable arm and the movable jaw when the needle is secured in the first grasping slot.

[0108] FIG. 36C and FIG. 36D depict an embodiment of the suturing device including the activated stopper allowing movement of the movable arm and the movable jaw when the needle is secured in the second grasping slot.

[0109] FIG. 37A depicts an embodiment of the suturing device including the stopper transitioning from an active position to a deactivated position.

[0110] FIG. 37B, and FIG. 37C depict exploded views of the stopper and the movable arm.

[0111] FIG. 37D and FIG. 37E depict an embodiment of the suturing device including the stopper in the deactivated position.

[0112] FIG. 38A and FIG. 38B depict an embodiment of the suturing device including the stopper in the deactivated position to allow the movable arm to move even when the needle is unsecured.

[0113] FIG. 39A depicts an exploded view of an embodiment of the suturing device.

[0114] FIG. 39B and FIG. 39C depict an embodiment of the suturing device with an attachment member.

[0115] FIG. 40A and FIG. 40B depict embodiments of shapes of suturing devices.

[0116] FIG. 41 A and FIG. 4 IB depict an embodiment of the suturing device.

[0117] FIG. 41C depicts an exploded view of an embodiment of the suturing device.

[0118] FIG. 42A, FIG. 42B, and FIG. 42C depict an embodiment of the loading apparatus and the needle.

[0119] FIG. 43 depicts a back view of an embodiment of the loading apparatus.

[0120] FIG. 44 depicts an embodiment of the loading apparatus with thread.

[0121] FIG. 45 depicts an embodiment of the suturing device loaded with thread from the loading apparatus.

[0122] FIG. 46 depicts a flow chart of a method for using the suturing device and the loading apparatus.

[0123] FIG. 47 depicts an embodiment of the suturing device loaded onto the loading apparatus.

[0124] FIGS. 48A-48I depict use of the loading apparatus to load a suture into the suturing device.

[0125] FIG. 49 depicts the suturing device securing the needle loaded by the loading apparatus.

[0126] FIG. 50 depicts an embodiment of a suturing device, according to some embodiments herein.

[0127] FIGS. 51 A, 51B, 51C, and 5 ID depict an embodiment of a suturing device showing a mandrel mechanism for rotating opposed jaws, according to some embodiments herein.

[0128] FIGS. 52A, 52B, 52C, 52D, 52E, and 52F depict an embodiment of a suturing device with a lever mechanism for opening and closing of the jaws, according to some embodiments herein.

[0129] FIGS. 53A, 53B, 53C, 53D, 53E, and 53F depict an embodiment of a suturing device with a toggle switch for the purpose of needle transfer between the jaws, according to some embodiments herein.

[0130] FIGS. 54A, 54B, 54C, 54D, 54E, 54F, 54G, and 54H depict an embodiment of a suturing device with a dual-action needle unload button, according to some embodiments herein.

[0131] FIGS. 55A, 55B, 55C, 55D, and 55E, depict an embodiment of a suturing device with a needle to be used with the device is shown in FIG. 50, according to some embodiments herein.

[0132] FIGS. 56A, 56B, 56C, and 56D depict an embodiment of a suturing device with a needle transfer mechanism, according to some embodiments herein.

[0133] FIG. 57 depicts an embodiment of a suturing device, according to some embodiments herein.

[0134] FIG. 58A, FIG. 58B, FIG. 58C, FIG. 58D, FIG. 58F, FIG. 58G, and FIG. 58H depict the suturing device maneuvering in the cavity.

[0135] FIG. 58E depicts an embodiment of an operator holding the suturing device for palpating during suturing operations.

[0136] FIG. 59 A and FIG. 59B depicts an embodiment of a mini sling.

[0137] FIG. 60 depicts a close-up view of an embodiment of a mini sling including adjustment sutures.

[0138] FIG. 61 depicts an embodiment of the sling loader for the mini sling.

[0139] FIG. 62 depicts an embodiment of the mini sling placed on the sling loader.

[0140] FIGS. 63 A, 63B, 63C, 63D, 63E, 63F, 63G, 63H, 631, and 63 J depict an embodiment of inserting the mini sling.

[0141] FIG. 64A illustrates an exemplary schematic of a pelvic cavity.

[0142] FIGS. 64B and 64C illustrate an exemplary embodiment of a plurality of sutures placed in the pelvic cavity representing a VACS procedure.

[0143] While the above-identified drawings set forth presently disclosed embodiments, other embodiments are also contemplated, as noted in the discussion. This disclosure presents illustrative embodiments by way of representation and not limitation. Numerous other modifications and embodiments can be devised by those skilled in the art which fall within the scope and spirit of the principles of the presently disclosed embodiments.DETAILED DESCRIPTION

[0144] The present disclosure includes improved suturing devices and methods of their use. The suturing device can be inserted into a cavity to reach a tissue to be sutured.

[0145] In some embodiments, a suturing device, suture loader, tension-free mid-urethral sling, and methods of their use are provided. The suture loader can load the threaded needle into the suturing device. The suturing device can be inserted into a cavity to reach a tissue to be sutured. The suturing device can include a fixed jaw and a movable jaw between which the tissue is placed for suturing. The fixed jaw stays in position while the movable jaw moves the threaded needle to suture the tissue. The suturing device includes a needle transfer mechanism that passes the needle between the jaws while suturing the tissue. A stopper and a safety member can control the movement of the movable jaw to prevent the needle from falling out when the needle is transferred between the jaws. When the suturing is complete, the suturing device can be removed from the cavity with the needle.

[0146] Any of the embodiments of suturing devices described herein can be in various sizes, shapes, and angles that are optimized based on the anatomy for which the suturing devices are to be used. The suturing devices can have sizes and angles optimized for the repair of pelvic floor disorders safely due to positional accuracy and in a minimally invasive way. The suturing devices can have sizes and angles optimized for minimally invasive usage in deep, narrow, and invisible to naked eye operating sites. The size and angles of the devices can be selected according to the target tissue each device is designed to reach for suturing and according to the pathway each device needs to travel in order to reach the target tissue. For example, the pathway can have obstacles such as hard-bony tissues and soft tissues. The sizes and angles can ensure that the surgical methods for using the suturing devices can maneuver the suturing devices through the pathway such that the devices are delivered to their target tissue in the least invasive way. For example, the area of the pathway can be in the pelvic cavity, which can be very similar from patient to patient with minimal standard deviation. As such, the calculation can be accurate across patients even though they might have different bodily parameters (e.g., height, weight, etc.). Any of the suturing devices described herein can also have a length such that during operation of the suturing device, the handle can be positioned outside the cavity while the length defines a portion of the suturing device that can be positioned inside the cavity. For example, the suturing devices can have a length and angles for transvaginal approaches or procedures.

[0147] The terms “distal” and “proximal” may be used herein to describe the relative positioning of one or more elements. “Distal” is in the direction of, or nearest to, an operating site within a patient. “Proximal” is in the opposite direction of the distal direction.

[0148] In some embodiments, the suturing devices described herein include a needle for passing through a tissue of interest. In some embodiments, the suturing devices described herein include mechanisms for moving or acting on a needle. Such mechanisms may be referred to as “needle transfer mechanisms.” For instance, referring to FIG. 1, a suturing device 100 is depicted. The suturing device 100 generally includes an elongate body 102 and a needle transfer mechanism 112. In some embodiments, a needle 104 is configured to extend from the elongate body 102 to suture a tissue 120. In some embodiments, the needle transfer mechanism 112 includes a muscle wire 108 coupled to the needle 104. In some embodiments, the muscle wire 108 is directly coupled to the needle 104. In some embodiments, the muscle wire 108 is indirectly coupled to the needle 104 (e.g. through one or more components positioned between the muscle wire 108 and the needle 104). In some embodiments, the muscle wire 108 can extend proximally through at least a portion of the elongate body 102. In some embodiments, the muscle wire 108 can be coupled to an energy source 110 configured to supply an electric current to the muscle wire 108. In some embodiments, the needle transfer mechanism 112 includes a potential energy member 106. The potential energy member 106 can be coupled to the needle 104. In some embodiments, the potential energy member 106 can be directly coupled to the needle 104. In some embodiments, the potential energy member 106 is indirectly coupled to the needle 104 (e.g. through one or more components positioned between the potential energy member 106 and the needle 104). In some embodiments, the potential energy member 106 is otherwise positioned such that the potential energy member 106 can apply a force on the needle 104.

[0149] Still referring to FIG. 1, in some embodiments, the muscle wire 108 can be configured to change length based on electric current being supplied through the muscle wire 108. For instance, the muscle wire 108 can shorten when the energy source 110 supplies electric current to the muscle wire 108, and the muscle wire 108 can return to an original extended length when the electric current is no longer supplied to the muscle wire 108. In some embodiments, when the muscle wire 108 is shortened, the muscle wire 108 can apply a pulling force or pushing force on the needle 104 (directly or indirectly, e.g. through one or more intervening components) to move the needle 104. In some embodiments, the potential energy member 106 can move from a first shape or configuration to a second shape or configuration when the muscle wire 108 shortens. In the second shape or configuration, the potential energy member 106 can store energy. When the muscle wire 108 lengthens, the potential energy member 106 can release the stored energy and return to its first shape orconfiguration, and in doing so apply a pushing force or pulling force on the needle 104 (directly or indirectly, e.g. through one or more intervening components) to move the needle 104.

[0150] Referring to FIG. 2, a suturing device 200 is depicted. The suturing device 200 can include an elongate body 202. In some embodiments, a first jaw 204 and a second jaw 206 extend from the elongate body 202 toward a tissue 220 to be sutured. The first jaw 204 and the second jaw 206 can be configured to pass a needle 208 of the suturing device 200 between the jaws 204, 206. The suturing device 200 can include a needle transfer mechanism 230. In some embodiments, the needle transfer mechanism 230 can include a first grasping member 232 in the first jaw 204 that can move to grasp or release the needle 208. In some embodiments, the needle transfer mechanism 230 includes a muscle wire 234 coupled to the first grasping member 232. In some embodiments, the muscle wire 234 is directly coupled to the first grasping member 232. In some embodiments, the muscle wire 234 is indirectly coupled to the first grasping member 232 (e.g. through one or more components positioned between the muscle wire 234 and the first grasping member 232). In some embodiments, the muscle wire 234 can extend proximally through at least a portion of the elongate body 202. In some embodiments, the muscle wire 234 can be coupled to an energy source 210 configured to supply an electric current to the muscle wire 234. In some embodiments, the needle transfer mechanism 230 includes a potential energy member 236. The potential energy member 236 can be coupled to the first grasping member 232. In some embodiments, the potential energy member 236 can be directly coupled to the first grasping member 232. In some embodiments, the potential energy member 236 is indirectly coupled to the first grasping member 232 (e.g. through one or more components positioned between the potential energy member 236 and the first grasping member 232). In some embodiments, the potential energy member 236 is otherwise positioned such that the potential energy member 236 can apply a force on the first grasping member 232.

[0151] Still referring to FIG. 2, in some embodiments, the muscle wire 234 can be configured to change length based on electric current being supplied through the muscle wire 234. For instance, the muscle wire 234 can shorten when the energy source 210 supplies electric current to the muscle wire 234, and the muscle wire 234 can return to an original extended length when the electric current is no longer supplied to the muscle wire 234. In some embodiments, when the muscle wire 234 is shortened, the muscle wire 234 can apply apulling force or pushing force on the first grasping member 232 (directly or indirectly, e.g. through one or more intervening components) to move the first grasping member 232. In some embodiments, the potential energy member 236 can move from a first shape or configuration to a second shape or configuration when the muscle wire 234 shortens. In the second shape or configuration, the potential energy member 236 can store energy. When the muscle wire 234 lengthens, the potential energy member 236 can release the stored energy and return to its first shape or configuration, and in doing so apply a pushing force or pulling force on the first grasping member 232 (directly or indirectly, e.g. through one or more intervening components) to move the first grasping member 232.

[0152] Still referring to FIG. 2, the needle transfer mechanism 230 can also include a second grasping member 242 in the second jaw 206, a muscle wire 244 coupled to the second grasping member 242 (directly or indirectly) and the energy source 210, and a potential energy member 246 coupled to the second grasping member 242 (directly or indirectly), or otherwise positioned to apply a force on the second grasping member 242. The muscle wire 244 and the potential energy member 246 can operate similarly to the muscle wire 234 and the potential energy member 236 to move the second grasping member 242. Movement of the first grasping member 232 and the second grasping member 242 can control the passing of the needle 208 between the jaws 204 and 206 to suture the tissue 220.

[0153] Even though the device shown in FIG. 2 has a relatively straight elongate body, a portion of a distal end of the elongate body can be angled relative to the rest of the elongate body. For example, an angle of the distal end of the elongate body relative to the rest of the elongate body can be at an angle ranging from approximately 10 to 20 degrees. For example, the elongate body can have a distal portion that extends relative a proximal portion at an angle of about 16 degrees. For example, the elongate body can have a distal portion that extends relative a proximal portion at an angle of 15.88 degrees. It is contemplated that the suturing devices can be modified to modify the sizes, shapes, and angles to optimize the suturing device for specific cavities and operations.

[0154] Now referring generally to FIG. 3 A and FIG. 3B, in some embodiments, the suturing device 2001A can be scissor- shaped and ergonomically sized to reach target tissues in a tight space. The suturing device 2001A can include a fixed arm 2007 integral with a fixed jaw 2005. In some embodiments, a distal end of the fixed arm 2007 includes the fixed jaw 2005. The suturing device 2001 A can include a movable arm 2008 coupled to a movable jaw 2006.

[0155] The fixed jaw 2005 and the movable jaw 2006 can both release and grasp a needle, and the suturing device 2001 A can also include a needle transfer mechanism 2004 to transfer the needle between the fixed jaw 2005 and the movable jaw 2006. The needle transfer mechanism 2004 is described in detail further below.

[0156] In some embodiments, the suturing device 2001A can include a first handle 2002A coupled to the movable arm 2008 and a second handle 2002B coupled to the fixed arm 2007. The handle 2002A and the handle 2002B can aid the user in moving the movable arm 2008 relative to the fixed arm 2007. The handle 2002A and the handle 2002B can be disposed at the end of the suturing device 2001 A that remains outside of the patient cavity during the operation such that the operator can control the suturing device 2001A. The handle 2002A and the handle 2002B can be disposed at a proximal end of the suturing device 2001A.

[0157] FIG. 4A and FIG. 4B depict an embodiment of the suturing device 2001A. In some embodiments, the fixed jaw 2005 includes a first grasping slot 2103 that can receive the needle 2201 (further described in reference to FIGS. 7A-7I). In some embodiments, the movable jaw 2006 includes a second grasping slot 2104 that can receive the needle 2201. In some embodiments, the grasping slots are channels sized and shaped to receive the needle. For example, the grasping slots can define a round channel or a round hole for receiving and grasping the needle.

[0158] Referring to FIGS. 3A-4B, in some embodiments, the needle transfer mechanism 2004 can transfer the needle between the first grasping slot 2103 and the second grasping slot 2104. To that end, the needle transfer mechanism 2004 can secure the needle in the first grasping slot 2103 and / or the second grasping slot 2104, and / or release the needle from the first grasping slot 2103 or the second grasping slot 2104.

[0159] FIGS. 5A-5D show an embodiment of a mechanism for moving the movable arm 2008 to pivot relative to the fixed arm 2007 to pivot the movable jaw 2006 relative to the fixed jaw 2005. As shown in FIGS. 5A and 5B, the movable arm 2008 can have an arm movement 2105 along which the movable arm 2008 pivots away or towards the fixed arm 2007. For example, the arm movement 2105 can be caused by a surgeon’s manual movement of handle 2002A to open and close the device 2001 A. This control can be advantageous while operating in invisible areas to make sure that movement of the device 2001A can be under theoperator’s control. In some embodiments, the arm movement 2105 can be caused by additional potential energy members such as a spring.

[0160] In some embodiments, the fixed arm 2007 can remain immovable relative to the movable arm 2008 while the movable arm 2008 moves. The movable arm 2008 can pivot relative to the fixed arm 2007 to pivot the movable jaw 2006 relative to the fixed jaw 2005. The movement of the movable arm 2008 relative to the fixed arm 2007 can enable the movable jaw 2006 to have a jaw movement 2107 along which the movable jaw 2006 can pivot away or towards the fixed jaw 2005. The fixed jaw 2005 can remain immovable relative to the movable jaw 2006 while the movable jaw 2006 moves. In some embodiments, the movable arm 2008 and the movable jaw 2006 move relative to the fixed arm 2007. In some embodiments, the movable arm 2008 and the movable jaw 2006 move relative to the fixed jaw 2005. In some embodiments, the movable arm 2008 and the movable jaw 2006 move relative to each other. In some embodiments, the fixed arm 2007 and the fixed jaw 2005 do not move. In some embodiments, the fixed jaw 2005 cannot move independently of the fixed arm 2007. In some embodiments, the fixed jaw 2005 cannot move independently of the fixed arm 2007 because the fixed arm 2007 is integral with the fixed jaw 2005.

[0161] The fixed jaw 2005 can make it easier to work safely in narrow spaces because having the fixed jaw 2005 remain stationary with respect to the target tissue allows the sutures to be placed while staying in a safe area. For example, when an operator moves the movable jaw 2006 relative to the fixed jaw 2005, the operator would know the location of the fixed jaw 2005. When the target tissue is referenced with the fixed jaw 2005 at an operating place that is difficult to see or not visible at all, the fixed jaw 2005 enables the suture to pass through the targeted tissue. The fixed jaw 2005 and the movable jaw 2006 can come together at a constant or predictable location with respect to the tissue such that the location and distance do not need to be predicted continuously to center the tissue. Thus, the fixed jaw 2005 enables suturing in areas that are difficult to see.

[0162] As shown in FIG. 5B, in some embodiments, the movable arm 2008 can be pivoted relative to the fixed arm 2007 to pivot the movable jaw 2006 relative to the fixed jaw 2005. The movable arm 2008 can pivot the movable jaw 2006 relative to the fixed jaw 2005 until the needle 2201 is received in both the first grasping slot 2103 and the second grasping slot 2104 to exchange the needle 2201 between the first grasping slot 2103 and the second grasping slot 2104.

[0163] Referring to FIGS. 5A-5D, the needle transfer mechanism 2004 can control the securing and releasing of both the first grasping slot 2103 and the second grasping slot 2104. The needle transfer mechanism 2004 can receive one or more inputs or commands to control the securing and releasing of the first grasping slot 2103 and the second grasping slot 2104. For instance, in a first state, the needle 2201 can be secured in the first grasping slot 2103 of the fixed jaw 2005. As shown in FIG. 5A, when the movable arm 2008 is moving or open, the needle transfer mechanism 2004 can grasp of the needle 2201 in the fixed jaw 2005 while keeping the grasping inactive in the movable jaw 2006. As shown in FIG. 5B, when the movable arm 2008 is adjacent to the fixed arm 2007, the needle transfer mechanism 2004 can grasp the needle 2201 in the fixed jaw 2005 while keeping the grasping inactive in the movable jaw 2006.

[0164] As shown in FIG. 5C, the needle transfer mechanism 2004 can secure the needle 2201 in the second grasping slot 2104 and subsequently release the needle 2201 from the first grasping slot 2103. That is, in FIG. 5C, the needle transfer mechanism 2004 can grasp the needle 2201 in the movable jaw 2006 while keeping the grasping inactive in the fixed jaw 2005. As shown in FIG. 5D, when the movable jaw 2006 pivots away from the fixed jaw 2005 by the movement of the movable arm 2008, the needle 2201 is secured in the movable jaw 2006, thus completing the transfer of the needle between the fixed jaw 2005 and the movable jaw 2006. As shown in FIG. 5D, when the movable arm 2008 is moving or open, the needle transfer mechanism 2004 can grasp the needle 2201 in the movable jaw 2006 while keeping the grasping inactive in the fixed jaw 2005.

[0165] Referring generally to FIGS. 5A-5D, in some embodiments, the needle transfer mechanism 2004 of the suturing device 2001A can include a cover 2108 partially disposed over at least portions of the needle transfer mechanism 2004. In some embodiments, as will be discussed in further detail below, the cover 2108 can include one or more buttons for receiving user input or commands. In some embodiments, as will be discussed in further detail below, the cover 2108 can include one or more indicators corresponding to the operating state, either active (e.g. grasping) or inactive (e.g. not grasping), of the needle transfer mechanism 2004 in the movable jaw 2006 and / or the fixed jaw 2005.

[0166] FIGS. 6A-6C depict an embodiment mechanism of the suturing device 2001 A for the movement of the movable arm 2008 relative to the fixed arm 2007 to enable the movable jaw 2006 to have the jaw movement 2107 along which the movable jaw 2006 pivots away ortowards the fixed jaw 2005. In some embodiments, the fixed arm 2007 can include an arm joint 2101 to couple the fixed arm 2007 to the movable arm 2008. For example, the arm joint2101 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the arm joint 2101 enables the movement of the movable arm 2008 relative to the fixed arm 2007. For example, the movable arm 2008 can pivot about the arm joint 2101 and relative to the fixed arm 2007. In some embodiments, the arm joint 2101 can allow the movable arm 2008 to pivot relative to the fixed arm 2007 in one degree of freedom. In some embodiments, the arm joint 2101 can restrict some movement of the movable arm 2008, such as to prevent the movable arm 2008 from breaking or exerting excessive force on the movable jaw 2006, the slots, or any other component described herein.

[0167] In some embodiments, the fixed arm 2007 includes a jaw joint 2100. In some embodiments, the fixed jaw 2005 includes the jaw joint 2100. The jaw joint 2100 is coupled to the movable jaw 2006 so that the movable jaw 2006 can pivot relative to the fixed jaw 2005. For example, the jaw joint 2100 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the movable jaw 2006 can pivot about the jaw joint 2100 and relative to the fixed jaw 2005. In some embodiments, the jaw joint 2100 can allow the movable jaw 2006 to pivot relative to the fixed jaw 2005 in one degree of freedom. In some embodiments, the jaw joint 2100 can restrict some movement of the movable jaw 2006, such as to prevent the movable jaw 2006 from breaking or exerting excessive force on the fixed jaw 2005, the slots, or any other component described herein.

[0168] In some embodiments, the suturing device 2001A further includes a connecting joint2102 coupled to the movable arm 2008 and the movable jaw 2006. The connecting joint 2102 can be positioned between the jaw joint 2100 and the arm joint 2101 such that the jaw joint 2100 and the arm joint 2101 are decoupled and mechanically independent from each other. The connecting joint 2102 can allow movement of the movable arm 2008 to pivot the movable jaw 2006. For example, the connecting joint 2102 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the movable arm 2008 can physically move the connecting joint 2102 to cause the movable jaw 2006 to pivot about the jaw joint 2100. Movement of the movable arm 2008 can move the connecting joint 2102 to pivot the movable jaw 2006 about the jaw joint 2100. For example, as shown in FIG. 6B and FIG. 6C, movement of the movable arm 2008 awayfrom the fixed arm 2007 causes the connecting joint 2102 to move across the width of the fixed arm 2007. The connecting joint 2102 pulls on the movable jaw 2006, which causes the movable jaw 2006 to pivot about the jaw joint 2100 and away from the fixed jaw 2005.

[0169] In some embodiments, the connecting joint 2102 can restrict some movement of the movable jaw 2006 and the movable arm 2008, such as to prevent them from disconnecting or exerting excessive force on the slots or any other component described herein. For example, the connecting joint 2102 can be restricted to movements along the width of the fixed arm 2007, which would prevent excessive movements of the movable jaw 2006 and the movable arm 2008. In some embodiments, the part of the fixed arm 2007 between the jaw joint 2100 and the arm joint 2101 can remain in a fixed position while the movable jaw 2006 moves inside the pelvic cavity and the movable arm 2008 moves outside the vaginal cavity. Such movements can advantageously reduce the profile of the movable jaw 2006 and the movable arm 2008.

[0170] In some embodiments, the suturing device 2001 A can be comprised of 3 rigid metal parts (e.g., (1) fixed arm 2007 integral with the fixed jaw 2005, (2) the movable arm 2008, and (3) the movable jaw 2006) that are attached to each other with the three joints 2100, 2101, and 2102. In some embodiments, the fixed arm can at least partially define a reference body comprising the jaw joint 2100 and arm joint 2101. The movable jaw 2006 and the movable arm 2008 can move with respect to each other and the fixed arm 2007 and fixed jaw 2005 in 2D plane about the reference body. In some embodiments, the movable arm 2008 pivots about the arm joint 2101 and relative to the reference body. In some embodiments, the movable jaw 2006 pivots about the jaw joint 2100 and relative to the reference body.

[0171] For example, during the operation of the suturing device 2001 A inside the pelvic cavity, in order to perform the stitching at the correct location, the fixed arm 2007, whose outer contour can be designed accordingly, can be aligned with the specific area of the pelvic cavity and becomes fixed with respect to this specific area of the pelvic cavity while the jaw joint 2100, the arm joint 2101, and the connecting joint 2102 enable the operator to move the handle 2002A to move the movable arm 2008 to move the movable jaw 2006. By keeping the fixed arm 2007 fixed in position, the jaws 2005 and 2006 can be correctly positioned for suturing.

[0172] FIGS. 7A-7I, 15A-15C, and 17A-17D depict embodiments of the needle 2201. The needle 2201A, the needle 2201B, the needle 2201C, the needle 2201D, and the needle 2201E (generally referred to as needle 2201) can include a first receptacle 2207 A and a second receptacle 2207B. The receptacles 2207A, 2207B can be notches, holes, recesses, cutouts, indents, catches or other features in the surface of the needles 2201A-E that allow the needle 2201A-E to be grasped in the first grasping slot 2103 and / or the second grasping slot 2104, as discussed further below. The position of the first receptacle 2207A and the second receptacle 2207B on the needle 2201 enable the needle 2201 to be grasped within the first grasping slot 2103 or the second grasping slot 2104, or both. For example, the first receptacle 2207A can be grasped and coupled to the fixed jaw 2005 and the second receptacle 2207B can be grasped and coupled to the movable jaw 2006.

[0173] As shown in FIG. 7A, the needle 2201 can be a needle 2201A that has a concave shape. FIG. 7B, FIG. 7C, FIG. 7D, and FIG. 7E depict an embodiment of a needle 2201B that has a straight shape. In some embodiments, the needle 2201A and the needle 2201B can include a hole 2208. In some embodiments, the hole 2208 can be used for needle-thread joining by drilling a hole in the needle 2201A or the needle 2201B, inserting a thread (e.g. a thread 2301) into the hole 2208, and deforming the hole 2208 with the help of a suitable die geometry attached to a press. In some embodiments, the needle 2201 and the thread can be joined by using a proper adhesive instead of deforming the hole 2208.

[0174] FIG. 7F, FIG. 7G, FIG. 7H, and FIG. 71 depict an embodiment of a needle 2201C that includes a channel 2209. The channel 2209 can be an open channel feature-based joining of the needle 2201 and thread 2301. The channel 2209 can be opened in the needle 2201C, a thread 2301 can be placed within the channel 2209, and the channel 2209 can be deformed onto the thread 2301 with the help of a suitable die geometry attached to a press. In some embodiments, the needle 2201 and the thread 2301 can be joined by using a proper adhesive instead of deforming the channel 2209.

[0175] FIGS. 15A-15C depict an embodiment of a needle 2201D that has a concave shape and holes as the first receptacle 2207A and the second receptacle 2207B. The receptacles 2207 A and 2207B can include countersink features on the front of the receptacles 2207 A and 2207B. The countersink features can enable the grasping members to grasp the needle 2201D with greater precision. FIGS. 17A-17D depict an embodiment of a straight needle 2201E with holes as the first receptacle 2207A and the second receptacle 2207B. The receptacles 2207 A-B of the needle 2201E include countersink features on the front of the receptacles 2207A and 2207B.

[0176] Referring now to one or more of FIG. 7J, FIG. 7K, FIG. 7L, FIG. 7M, FIG. 7MM, FIG. 7N, FIG. 70, and FIG. 7P, embodiments of the needle transfer mechanism 2004 of the suturing device 2001A are depicted. The needle transfer mechanism 2004 can enable the needle 2201 be retained in or released from the jaws 2005 and 2006 with the help of muscle wires (e.g., the first muscle wire 2027A and the second muscle wire 2027B). In some embodiments, the muscle wires 2027A and 2027B can be shape memory alloy wires. In some embodiments, the muscle wires 2027A and 2027B can be made of one or more materials such that the muscle wires 2027A, 2027B transition from a baseline length to a transformed length when an electric current is passed through the muscle wires 2027A, 2027B, and such that the muscle wires 2027A, 2027B transition from the transformed length to the baseline length once the muscle wires 2027A, 2027B are cut off from a flow of electric current (i.e. the flow of current through the muscle wires is stopped). In some embodiments, the baseline length can be longer than the transformed length. That is, in some embodiments, the muscle wires 2027A, 2027B shorten in length when an electric current is passed through the muscle wires 2027A, 2027B. In some embodiments, the muscle wires 2027A, 2027B are made of nitinol smart material.

[0177] In some embodiments, the first muscle wire 2027A and the second muscle wire 2027B can be positioned in the fixed arm 2007. In some embodiments, the first muscle wire 2027A and the second muscle wire 2027B extend within respective channels in the fixed arm 2007. For instance, the first muscle wire 2027A can extend within a first channel 2028A, and the second muscle wire 2027B can extend within a second channel 2028B. The first channel 2028A and the second channel 2028B can be separated by a divider 2030. The divider 2030 can prevent short circuiting of the first muscle wire 2027A and / or the second muscle wire 2027B. In some embodiments, the first muscle wire 2027A extends within a channel through the fixed jaw 2005. In some embodiments, the second muscle wire 2027B extends within a channel through the movable jaw 2006.

[0178] In some embodiments, electrical connectors 2029A and 2029B can be positioned on the proximal ends of the muscle wires 2027A, 2027B (i.e., the ends nearest the handle of the suturing device 2001A). A first electrical connector 2029A can be positioned on the proximal end of the first muscle wire 2027A, and a second electrical connector 2029B can bepositioned on the proximal end of the second muscle wire 2027B. Each electrical connector 2029A, 2029B can electrically couple the respective muscle wire 2027A, 2027B that the electrical connector 2029A, 2029B is positioned on with an energy source, as described in further detail below. In some embodiments, the electrical connectors 2029A, 2029B can couple the proximal ends of the first muscle wire 2027A and second muscle wire 2027B to first points of respective conductor wires (passing through a cable 2602 (FIG. 6A) for instance) coupled to an energy source, and therefore can supply electric current to the proximal ends of the muscle wires 2027A, 2027B. In some embodiments, the electrical connectors 2029A, 2029B can be positioned in a recess 2031 that includes a first opening 2032A into the first channel 2028A and a second opening 2032B into the second channel 2028B. The electrical connectors 2029A, 2029B and the openings 2032A, 2032B can be sized such that electrical connectors 2029 A, 2029B cannot traverse the openings and move distally (i.e. in the direction of the jaws) into the channels 2028A, 2028B. Therefore, the proximal ends of the muscle wires 2027A, 2027B including the electrical connectors 2029A, 2029B can be held predominantly stationary in the recess 2031 when the muscle wires 2027A, 2027B transition to their transformed length (i.e., shorten from their baseline lengths). In other words, the electrical connectors 2029 A, 2029B can anchor the proximal ends of the muscle wires 2027A, 2027B as current is passed through the muscle wires 2027A, 2027B. Therefore, the transition in length of the muscle wires 2027A, 2027B results in movement at the distal end (e.g. in the direction of the jaws) of the muscle wires 2027A, 2027B. In some embodiments, the divider 2030 can extend at least partially through the recess 2031 to separate the first electrical connector 2029A from the second electrical connector 2029B .

[0179] In some embodiments, the distal ends of the muscle wires 2027A, 2027B can be coupled to pull wires 2021A and 2021B, respectively. The distal end of the first muscle wire 2027 A can be coupled to a first pull wire 2021 A via a first ferrule 2026 A, or connector, and the distal end of the second muscle wire 2027B can be coupled to the second pull wire 202 IB via a second ferrule 2026B. In some embodiments, the first ferrule 2026A and the second ferrule 2026B can be crimped to couple the distal end of the first muscle wire 2027A to the first pull wire 2021 A and the distal end of the second muscle wire 2027B to the second pull wire 202 IB. In some embodiments, the ferrules 2026A, 2026B can couple the distal ends of the first muscle wire 2027A and second muscle wire 2027B to distal points of respective insulated conductor wires 2033A, 2033B coupled to the energy source. The first insulatedconductor wire 2033A can pass through a first opening 2032A in the wall that defines the distal end of the recess 2031 and through the first channel 2028A to be coupled to the distal end of the first muscle wire 2027A at the ferrule 2026A to supply electric current to the distal end of the first muscle wire 2027A. The second insulated conductor wire 2033B can pass through a second opening 2032B in the wall that defines the distal end of the recess 2031 and through the second channel 2028B to be coupled to the distal end of the second muscle wire 2027B at the ferrule 2026B to supply electric current to the distal end of the second muscle wire 2027B. In some embodiments, a first seal ring 2025A can be positioned at a distal end of the first channel 2028A, which the first pull wire 2021 A extends through, and a second seal ring 2025B can be positioned at a distal end of the second channel 2028B, which the second pull wire 202 IB extends through. The seal rings 2025A, 2025B can prevent blood or other fluid from entering the channels 2028A, 2028B and contacting the muscle wires 2027A, 2027B. Therefore, the seal rings 2025A, 2025B can assist in preventing short circuiting.

[0180] In some embodiments, the first pull wire 2021 A can extend through at least a portion of the fixed jaw 2005, and the second pull wire 202 IB can extend through at least a portion of the movable jaw 2006. In some embodiments, the distal end of the first pull wire 2021 A can be coupled to a first grasping member 2024A positioned in the fixed jaw 2005, and the distal end of the second pull wire 202 IB can be coupled to a second grasping member 2024B positioned in the movable jaw 2006. Geometric features, such as the feature 2020B can be used to route the pull wires, such as the pull wire 202 IB in FIG. 7M, in an optimal route through the suturing device 2001 A and jaw. The pull wires 2021 A, 202 IB can be non- conductive to provide insulation between the fixed jaw 2005 (and components therein) and the movable jaw 2006 (and components therein) and the muscle wires 2027A, 2027B. Therefore, in embodiments, the non-conductive pull wires 2021 A, 202 IB can prevent short circuiting as the result of blood or tissue contact with the muscle wires 2027A, 2027B, for instance.

[0181] It should be appreciated that in some embodiments, the muscle wires 2027A, 2027B can be directly coupled to the grasping members 2024A, 2024B. In some embodiments, the muscle wires 2027A, 2027B can be indirectly coupled to the grasping members 2024A, 2024B through one or more components (e.g., the pull wires 2021A, 2021B) between the muscle wires 2027A, 2027B and the grasping members 2024A, 2024B.

[0182] The needle 2201 can be grasped and retained in the fixed jaw 2005 by the first grasping member 2024 A, and the needle 2201 can be grasped and retained in the movable jaw 2006 by the second grasping member 2024B. More specifically, the first grasping member 2024 A can retain the needle 2201 in the fixed jaw 2005 when the first grasping member 2024A is pressed into the first receptacle 2207A or the second receptacle 2207B of the needle 2201, and the second grasping member 2024B can retain the needle 2201 in the movable jaw 2006 when the second grasping member 2024B is pressed into the first receptacle 2207 A or the second receptacle 2207B of the needle 2201. The first grasping member 2024A and the second grasping member 2024B can removably couple with the needle 2201. The first grasping member 2024A and the second grasping member 2024B can be pins, clips, projections, or any other member sized to be pressed into the first receptacle 2207 A and / or second receptacle 2207B.

[0183] In some embodiments, the needle transfer mechanism 2004 can include a first spring 2022A and a second spring 2022B. The first spring 2022A can be positioned around and coupled to the first grasping member 2024 A in the fixed jaw 2005. The second spring 2022B can be positioned around and coupled to the second grasping member 2024B in the movable jaw 2006. In some embodiments, the springs 2022A, 2022B can be retained in the fixed jaw 2005 and the movable jaw 2006, respectively, by machine elements that can include rings, pins, etc. or structural features such as protrusions. For instance, the second spring 2022B can be retained in the movable jaw 2006 by the machine element 2023B.

[0184] It should be appreciated that in some embodiments, the springs 2022A, 2022B can be directly coupled to the grasping members 2024A, 2024B. In some embodiments, the springs 2022A, 2022B can be indirectly coupled to the grasping members 2024A, 2024B through one or more components between the springs 2022A, 2022B and the grasping members 2024A, 2024B. In some embodiments, the springs 2022A, 2022B need not be directly or indirectly coupled to the grasping members 2024A, 2024B. The springs 2022A, 2022B (and other potential energy members discussed herein) can be otherwise situated such that the springs 2022A, 2022B can exert a force on the grasping members 2024A, 2024B and / or vice versa. For instance, the spring 2022A, grasping member 2024A (including a feature 2024 AA of the grasping member 2024 A), and machine elements 2023 may each be sized such that the distal end of the spring 2022A is maintained in contact with at least a portion of the grasping member 2024A (such as the feature 2024AA) or other elements incontact with the grasping member 2024A (e.g. elements situated between the spring 2022A and the grasping member 2024A) such that the spring 2022A can apply a distal force on the grasping member 2024A. Similarly, the spring 2022A, grasping member 2024A (including the feature 2024 AA of the grasping member 2024 A), and machine elements 2023 may each be sized such that the distal end of the spring 2022A is maintained in contact with at least a portion of the grasping member 2024A (such as the feature 2024AA) or other elements in contact with the grasping member 2024A (e.g. elements situated between the spring 2022A and the grasping member 2024A) such that the grasping member 2024A can apply a proximal force on the spring 2022 A.

[0185] The muscle wires 2027 A, 2027B can transition between their baseline and transformed lengths independently within their respective channels 2028 A, 2028B. In some embodiments, the first muscle wire 2027A can be in or transition to its baseline or extended length, in which the first grasping member 2024A is advanced towards the first grasping slot2103 and towards the first receptacle 2207 A or the second receptacle 2207B of the needle 2201 disposed in the first grasping slot 2103 to secure the needle 2201 in the first grasping slot 2103. In some embodiments, the first muscle wire 2027A can be in or transition to its transformed length, which is shorter than the baseline length, causing the first grasping member 2024A to retract from the first grasping slot 2103 and the first receptacle 2207A or the second receptacle 2207B to release the needle 2201 from the first grasping slot 2103.

[0186] In some embodiments, the second muscle wire 2027B can be in or transition to its baseline or extended length, in which the second grasping member 2024B is advanced towards the second grasping slot 2104 and towards the first receptacle 2207A or the second receptacle 2207B of the needle 2201 disposed in the second grasping slot 2104 to secure the needle 2201 in the second grasping slot 2104. In some embodiments, the second muscle wire 2027B can be in or transition to its transformed length, which is shorter than the baseline length, causing the second grasping member 2024B to retract from the second grasping slot2104 and the first receptacle 2207 A or the second receptacle 2207B to release the needle 2201 from the second grasping slot 2104.

[0187] For example, and for illustrative purposes only with respect to the first muscle wire 2027A, the first muscle wire 2027A can be shortened (i.e., transition to its transformed length) in the first channel 2028A, causing the distal end of the first muscle wire 2027A to move proximally in the first channel 2028A. Therefore, the first muscle wire 2027A can exerta force in the proximal direction on the pull wire 2021 A and first grasping member 2024A, causing the first grasping member 2024A to retract from the first grasping slot 2103 and the first receptacle 2207 A or the second receptacle 2207B of the needle 2201 to release the needle 2201 from the first grasping slot 2103. In some embodiments, the proximal motion, or retraction, of the first grasping member 2024A causes the first spring 2022A to fully compress to a loaded state. FIG. 7P depicts the first grasping member 2024A retracted from the first grasping slot 2103 and the full compression of the first spring 2022A. As mentioned above, the first muscle wire 2027A can be shortened when an electric current is passed through the first muscle wire 2027A.

[0188] When the electric current is cut off from the first muscle wire 2027A, or no longer passed through the first muscle wire 2027A, the first muscle wire 2027A transitions to its baseline length, causing the distal end of the first muscle wire 2027A to move distally in the first channel 2028A Once the electric current is cut off from the first muscle wire 2027A, eliminating the proximal retraction force on the distal end of the muscle wire 2027A, the pull wire 2021 A, and the first grasping member 2024A, the first spring 2022A transitions from its loaded state to a semi-compressed state (shown in FIG. 70), providing distal force on the first grasping member 2024A, pull wire 2021 A, and first muscle wire 2027A. Therefore, the transitioning to the semi-compressed state of the first spring 2022A causes advancement of the first grasping member 2024A towards the first grasping slot 2103. As shown in FIG. 70, when the first muscle wire 2027A is in its baseline length and the first grasping member 2024 A is moved distally toward and / or through the first grasping slot 2103, the first spring 2022A can be maintained in a semi-compressed state by machine elements (such as the machine element 2023B discussed with respect to the second muscle wire 2027B). In its semi-compressed state, the first spring 2022 A can provide and maintain a distal force on the first grasping member 2024 A such that the first grasping member 2024 A is pressed into the first receptacle 2207 A or the second receptacle 2207B of the needle 2201 with sufficient force to grasp and retain the needle 2201.

[0189] The first grasping member 2024A can be selectively transitioned between the positions depicted in FIGS. 70 and 7P, to grasp or release the needle 2201 in the jaw 2005, for instance, based on the selective application of electric current to the first muscle wire 2027A, and therefore by selective lengthening or shortening of the first muscle wire 2027A.

[0190] While the first muscle wire 2027A was discussed in detail above, it should be appreciated that the second muscle wire 2027B, along with the second pull wire 202 IB and the second grasping member 2024B, can be similarly operated. In some embodiments, the first muscle wire 2027A and the second muscle wire 2027B can be independently operated.

[0191] Referring to FIG. 8 A and 8B, a user interface 2605 for controlling the needle transfer mechanism 2004 is depicted. In some embodiments, the user interface 2605 includes a circuit board and microcontroller embedded within the suturing device 2001A. In some embodiments, the user interface 2605 can include one or more inputs 2604 for controlling operation of the needle transfer mechanism 2004 and / or other components of the suturing device 2001A. The one or more inputs 2604 can include an input 2604A, that can be a button. In some embodiments, the user interface can include more than one button. While buttons are particularly discussed herein as the one or more inputs, it should be appreciated that the inputs of the user interface 2605 can include any user-manipulatable elements including switches, dials, knobs, etc. The one or more inputs 2604 can be positioned along a surface of the suturing device 2001A for access by a user. The one or more inputs 2604 allow for user control of the needle transfer mechanism 2004, and particularly control of the first and second muscle wires 2027A, 2027B. The one or more inputs 2604 can allow for separate energization of the first muscle wire 2027A and the second muscle wire 2027B (i.e. the first muscle wire 2027A can be energized while the second muscle wire 2027B is de-energized, and vice versa). In some embodiments, the one or more inputs 2604 can allow for dependent energization of the first muscle wire 2027A and the second muscle wire 2027B (i.e. energization of one muscle wire 2027A, 2027B automatically results in the de-energization of the other muscle wire 2027A, 2027B). In some embodiments, the one or more inputs 2604 can allow for independent energization of the first muscle wire 2027A and the second muscle wire 2027B (i.e. energization of one muscle wire 2027A, 2027B does not automatically results in the de-energization of the other muscle wire 2027A, 2027B). In some embodiments, the one or more inputs 2604 can control a power source, which in some embodiments can be a battery or an adaptor, coupled to the user interface 2605 and / or the user interface 2705 (FIG. 9A) and supplying power for one or more outputs 2606 of the user interface 2605 and / or one or more outputs 2713 (FIG. 9A) of the user interface 2705, as described in further detail below. In some embodiments, the power source can be internal the suturing device 2001A. For instance, in some embodiments, the power source can be positioned within the cover 2108. In some embodiments, the power source can be external to the suturing deviceand coupled to the user interface 2605 via one or more electrical connectors extending from the suturing device 2001 A (through the second handle 2002B, for instance) to the power source.

[0192] In some embodiments, the user interface 2605 can include one or more outputs 2606 for indicating information on the operation of the suturing device 2001A, such as on power status, operation of the needle transfer mechanism 2004, error conditions (low battery), etc. The outputs 2606 can include a first indicator 2606A and a second indicator 2606B. The indicators can be LED lights, microphones, buzzers, etc. The first and second indicators 2606A and 2606B can provide visual, audial, and / or haptic outputs, for instance, that indicate to a user information on the operation of the suturing device 2001A and the needle transfer mechanism 2004 (for instance, the first indicator 2606A can indicate that the needle is grasped in the fixed jaw 2005, and the second indicator 2606B can indicate that the needle is grasped in the movable jaw 2006). While two indicators 2606A and 2606B are depicted, it should be appreciated that the suturing device 2001 A can include more or fewer indicators or outputs 2606. The one or more outputs 2606 can be coupled to a surface of the suturing device 2001A for interaction (e.g., visual, audial, haptic, etc.) with a user.

[0193] The user interface 2605 elements (e.g. the inputs 2604 and the outputs 2606) can be positioned anywhere along the suturing device 2001A. In some embodiments, the user interface 2605 elements can be positioned on the cover 2108. In some embodiments, the user interface 2605 elements can be positioned along the suturing device 2001A such that the user interface 2605 elements are visible and / or accessible during use of the suturing device 2001A. In some embodiment, the user interface 2605 elements can be positioned on the suturing device 2001A such that the user interface 2605 elements remain outside of a patient cavity during operation.

[0194] Referring now to FIGS. 8 A, 8B, 9 A, and 9B, the supply of electric current to the first muscle wire 2027A and the second muscle wire 2027B will be discussed. In some embodiments, the suturing device 2001 A includes a cable 2602 extending from the suturing device 2001A. In some embodiments, the cable 2602 extends from the second handle 2002B coupled to the fixed arm 2007. In some embodiments, the cable 2602 extends from a port 2600 in the second handle 2002B. In some embodiments, the cable 2602 includes two separate electrical leads or conductor wires inside the cable, each of the leads coupled to one of the first muscle wire 2027A or the second muscle wire 2027B. In some embodiments,multiple cables can extend from the second handle 2002B, each of the cables electrically coupled to one of the first muscle wire 2027A or the second muscle wire 2027B. In some embodiments, the cable 2602 can couple to an external unit 2700, which can include an energy source. Particularly, in some embodiments, the cable 2602 can couple to the energy source of the external unit 2700 via a socket 2706 and cable 2708 extending from the external unit 2700 at a port 2710. In some embodiments, the external unit 2700 includes a battery pack and analog and / or digital circuitry coupled to the user interface elements 2604, 2606 of the suturing device 2001A. The analog and / or digital circuitry allows for user-manipulation of the one or more inputs 2604 to control operation of the suturing device 2001 A and / or the external unit 2700. That is, in some embodiments, the cable 2602 and the cable 2708 allow for control signals from the one or more inputs 2604 of the user interface 2605 of the suturing device 2001A to be communicated to the external unit 2700.

[0195] In some embodiments, the external unit 2700 includes a user interface 2705. In some embodiments, the user interface 2705 can include one or more inputs 2711. In some embodiments, the user interface 2705 can include one or more outputs 2713 to indicate operation of the suturing device 2001 A and / or the external unit 2700 (e.g. operation of the energy source of the external unit 2700) to the user. In some embodiments, the one or more inputs 2711 of the user interface 2705 can be actuated in addition to or instead of the one or more inputs 2604 of the user interface 2605. In some embodiments, the one or more inputs 2711 of the user interface 2705 can be actuated to control the same functionalities described in relation to the one or more inputs 2604 of the user interface 2605 described above. In some embodiments, the one or more inputs 2711 of the user interface 2705 can be actuated to control different or separate functionalities than those described in relation to the one or more inputs 2604 of the user interface 2605 above. In some embodiments, the one or more outputs 2713 of the user interface 2705 can indicate the same indications described in relation to the one or more outputs 2606 of the user interface 2605 above. In some embodiments, the one or more outputs 2713 of the user interface 2705 can indicate different or separate indications on the operation of the suturing device 2001A and / or the external unit 2700 than those described in relation to the one or more outputs 2606 of the user interface 2605 above. The analog and / or digital circuitry of the external unit 2700 allows for user-manipulation of the one or more inputs 2711 to control operation of the suturing device 2001 A and / or the external unit 2700. That is, in some embodiments, the cable 2602 and the cable 2708 allow for controlsignals from the one or more inputs 2711 of the user interface 2705 of the external unit 2700 to be communicated to the suturing device 2001A.

[0196] The inputs 2711 of the user interface 2705 can be buttons, switches, dials, knobs, etc. The one or more outputs 2713 of the user interface 2705 can be LED lights, microphones, buzzers, etc. The one or more inputs 2711 and / or the one or more outputs 2713 can be positioned along a surface of the external unit 2700 for access by a user. In some embodiments, the one or more inputs 2711 of the user interface 2705 can control a power source, which in some embodiments can be a battery or an adaptor, coupled to the user interface 2705 and / or the user interface 2605 and supplying power for one or more outputs 2606 of the user interface 2605 and / or one or more outputs 2713 of the user interface 2705, as described in further detail below. In some embodiments, the one or more inputs 2711 include an input 2711 A, which can be a button or other actuator, for powering on / off the external unit 2700 and / or the electronics and user interface 2605 of the suturing device 2001A. In some embodiments, the one or more inputs 2711 include an input 271 IB, which can be a switch or other actuator, to select an operating mode of the suturing device 2001 A, as described below. In some embodiments, the one or more inputs 2711 include an input 2711C, which can be a knob or other actuator, for setting a threshold force in automatic mode of the suturing device 2001 A, as described below. In some embodiments, the one or more outputs 2713 include an indicator 2713A, which can indicate the power on or off status of the suturing device 2001 A and / or the external unit 2700.

[0197] In some embodiments, the system can only include the user interface 2605 of the suturing device 2001 A for controlling the suturing device 2001 A and / or the external unit 2700. In some embodiments, the system can include only the user interface 2705 of the external unit 2700 for controlling the suturing device 2001A and / or the external unit 2700. In some embodiments, the system can include the user interface 2605 of the suturing device 2001A and the user interface 2705 of the external unit 2700 for controlling the operation of the suturing device 2001A and / or the external unit 2700.

[0198] The external unit 2700, and particularly the energy source of the external unit 2700, can be used to supply electric current to the first muscle wire 2027A and / or the second muscle wire 2027B via the cable 2602. In some embodiments, the external unit 2700 supplies electric current to the first muscle wire 2027A and / or the second muscle wire 2027B via the insulated conductor wires 2033A, 2033B coupled to the distal ends of the muscle wires2027 A, 2027B. The supply of electric current to the muscle wires 2027A, 2027B controls the shortening or lengthening of the muscle wires 2027A, 2027B.

[0199] In some embodiments, the suturing device 2001 A is not coupled to the external unit 2700 for supply of electric current. In such embodiments, the suturing device 2001A can include an internal energy source (not depicted). The internal energy source can be positioned in the first handle 2002A or the second handle 2002B. In some embodiments, the internal energy source eliminates the need for one or more wires or cables to be extending from the suturing device 2001A. The operation and control of the internal energy source (through the user interface 2605 of the suturing device 2001A, for instance) is predominantly the same as that discussed with the external unit 2700. The energy source of the external unit 2700 and / or the internal energy source may be referred to generically as an energy source herein.

[0200] Referring to FIGS. 10A-10C, in some embodiments, the suturing device 2001 A includes a force sensor 2804. The force sensor 2804 can be a force sensitive resistor, piezoelectric film, a capacitive sensor, an inductive sensor, a Hall-effect sensor, etc, that is configured to measure the contact force of the handles 2002A, 2002B and / or one or more other properties related to the contact force of the handles 2002A, 2002B. In some embodiments, the force sensor 2804 can be placed on a medial surface 2806 of the first handle 2002A or the second handle 2002B. That is, the force sensor 2804 can be placed on a surface of the first handle 2002A or the second handle 2002B such that the force sensor 2804 is sandwiched between the first handle 2002A and the second handle 2002B as the first handle 2002A and the second handle 2002B are closed or brought together. In some embodiments, the suturing device 2001A can include multiple force sensors positioned on both the first handle 2002A and the second handle 2002B. In some embodiments, the force sensor 2804 can be positioned behind a flexible interface 2802 of the medial surface 2806 of the first handle 2002A and / or the second handle 2002B. The force sensor 2804 can detect contact and closing force between the first handle 2002A and the second handle 2002B as the first handle 2002A and the second handle 2002B are closed. The force sensor 2804 can be electrically coupled to the energy source (for instance, external unit 2700 or the internal energy source discussed above), via one or more control units for instance. In some embodiments, the force sensor 2804 can be coupled to the external unit 2700 via the cable 2602. The force sensor 2804 can relay an electrical signal or electrical feedback to a controller when the force sensor 2804 detects and measures a force (i.e. when the first handle2002A and the second handle 2002B are closed). In response, the controller can control the energy source to supply or cut off electric energy to the first muscle wire 2027A and supply or cut off electric energy to the second muscle wire 2027B to transfer the needle between the jaws 2005, 2006, as discussed in greater detail below.

[0201] In some embodiments, the force sensor 2804, the inputs 2604 of the user interface 2605, the inputs 2711 of the user interface 2705, (e.g. the buttons 2604A-C), the outputs 2606 of the user interface 2605, the outputs 2713 of the user interface 2705, and the energy source (e.g. internal or within the external unit 2700) can each be coupled to one or more processors or controllers, such as the microprocessor of the user interface 2605, that are configured to process information from and control operation of the force sensor 2804, inputs 2604 and 2711, outputs 2606 and 2713, and energy source. The one or more processors or controllers of the suturing system can be configured to execute instructions encoded on at least one non- transitory computer-readable storage medium to carry out any of the above-described or later- described functions and methods.

[0202] In some embodiments, the suturing device 2001A can be equipped with one or more additional sensors, such as one or more image sensors (for example, a fiber optic visual sensor or camera, including ultraviolet, infrared, and / or visible sensors / cameras), one or more temperature sensors, and / or one or more electrodes. The one or more additional sensors can be electrically coupled to the external unit 2700, for instance. The one or more additional sensors can be used to detect different tissues such as nerves, veins, arteries nearby the suturing device 2001A. The one or more additional sensors can be coupled to the energy source with a designated cable or electrical lead extending through and / or from the suturing device 2001 A. In some embodiments, the one or more additional sensors can be electrically coupled to the processor of the suturing device 2001A to communicate signals to and from the processor. In some embodiments, the one or more additional sensors can be electrically coupled to its own external processor. In some embodiments, one or more of the inputs 2606, 2711 can be actuated to control operation of the one or more additional sensors. In some embodiments, one or more of the outputs 2606, 2713 can be operated to indicate information relating to the operation of the one or more sensors. For example, the one or more image sensors can be one or more of a visible, infrared, and ultraviolet sensors, and can be used for image enhancement. In some embodiments, the one or more image sensors can be one or more ultrasound imaging probes that can be used for additional visualization.

[0203] While embodiments where the transfer mechanism 2004 includes the first spring 2022A and the second spring 2022B have been discussed in detail, it should be appreciated that this is a non-limiting example. In place of the springs 2022A, 2022B, the transfer mechanism 2004 can include any desirable potential energy member. Potential energy members, as used herein, can generally refer to elements that can store energy based on changes in their shape or position and independently release the energy to return to a low- energy shape or position without the need for outside stimulus to move the potential energy member back to a low-energy shape or position. For instance, the springs 2022A, 2022B can store energy as they are compressed. Once the muscle wires 2027A, 2027B are de-energized, the springs 2022A, 2022B can automatically transition to a low-energy position (e.g., the semi-compressed position) to advance the grasping members 2024A, 2024B. The transition to the low-energy position takes place due to the energy stored in the spring without the need for additional outside stimulus to apply energy to the spring. Potential energy members that can be used in the transfer mechanism include torsional springs, leaf springs, and elastomers, as examples.

[0204] For instance, and referring to FIG. 7MM, another embodiment of the suturing device 2001 A is depicted including elastomers 2019A and 2019B in place of the springs 2022 A, 2022B. The elastomers 2019A, 2019B can have the same mechanical connections (e.g. to the grasping members 2024A, 2024B) as the springs 2022A, 2022B described above. Machine elements such as 2023B can retain and position the elastomers 2019A and 2019B in the jaws 2005, 2006. When the muscle wires 2027A, 2027B are energized, proximal force on the elastomers 2019A, 2019B can compress the elastomers 2019A, 2019B into a stressed shape. When the muscle wires 2027A, 2027B are de-energized the elastomers 2019A, 2019B can transition to the unstressed, or less stressed state, to advance the grasping members 2024A, 2024B distally. Similar to the springs 2022A, 2022B, the elastomers 2019A, 2019B can be maintained in a semi-compressed state by machine elements in the jaws 2005, 2006 so that the elastomers provide a continual distal force on the grasping members 2024A, 2024B when the muscle wires 2027A, 2027B are de-energized.

[0205] As another example, referring to FIG. 7N, another embodiment of the suturing device 2001A is depicted including leaf springs 2017A and 2017B in place of the springs 2022A, 2022B. The leaf springs 2017A, 2017B can have the same mechanical connections (e.g. to the grasping members 2024A, 2024B) as the springs 2022A, 2022B described above.Machine elements such as 2023B and retaining features 2018AA, 2018AB, 2018BA, and 2018BB can retain and position the leaf springs 2017A and 2017B in the jaws 2005, 2006. When the muscle wires 2027A, 2027B are energized, proximal force on the leaf springs 2017A, 2017B can cause the leaf springs 2017A, 2017B to bend or arch into a stressed shape. When the muscle wires 2027A, 2027B are de-energized the leaf springs 2017A, 2017B can transition to the unstressed, or less stressed state, to advance the grasping members 2024A, 2024B distally. Similar to the springs 2022A, 2022B, the leaf springs 2017A, 2017B can be maintained in a semi-stressed, or bent, state by machine elements in the jaws 2005, 2006 so that the leaf springs 2017A, 2017B provide a continual distal force on the grasping members 2024A, 2024B when the muscle wires 2027A, 2027B are de-energized.

[0206] To use the suturing device 2001A, a user must first load a needle 2201 into the suturing device 2001A. To load a needle 2201 into the suturing device 2001A, a user can first power on the suturing device 2001 A and / or the external unit 2700 by actuation of one or more of the inputs 2604 and / or the inputs 2711. In some embodiments, the user can actuate the input 2711A of the user interface 2705 to power on the elements of the external unit 2700 and the suturing device 2001 A. When powered on, the indicator 2713A can change operation (e.g. light up) to indicate the system is powered on.

[0207] Once the system is powered on, a user can select load / unload mode with one or more of the inputs 2604 and / or the inputs 2711. In some embodiments, the user can select load / unload mode by actuating the input 271 IB of the user interface 2705. In the load-unload mode, the force sensor 2804 is disengaged, a needle transfer button of one or more of the inputs 2604, 2711 to be operational when the handles 2002A, 2002B are open and no force is imparted on the force sensor 2804. A user can open the jaws 2005, 2006 through manipulation of the handles 2002A, 2002B. The user can load the needle 2201 into the fixed jaw 2005 or the movable jaw 2006. For exemplary purposes only, examples where the needle 2201 is loaded into the fixed jaw 2005 will be discussed. In some embodiments, the needle 2201 can be loaded using a loader 2347 (FIG. 8C). In some embodiments, the needle 2201 can be loaded manually.

[0208] A user can check one or more of the outputs 2606 and / or the outputs 2713 to determine the energized or de-energized state of the muscle wires 2027A, 2027B. In some embodiments, if the indicator 2606A is off, the first muscle wire 2027A is energized, such that the first muscle wire 2027A is in its transformed length and the first grasping member2024A is retracted. In some embodiments, if the indicator 2606B is off, the second muscle wire 2027B is energized, such that the second muscle wire 2027B is in its transformed length and the second grasping member 2024B is retracted. The needle 2201 can be placed at either jaw 2005, 2006 where the respective grasping member 2024A, 2024B is retracted. Merely as an example, embodiments will be discussed where the needle 2201 is loaded into the fixed jaw 2005. Once the needle 2201 is placed at or in the first grasping slot 2103, and the user can operate one or more of the inputs 2604, 2711 to grasp the needle 2201 in the first grasping slot of the fixed jaw 2005 by de-energization of the first muscle wire 2027A. In some embodiments, the user can actuate the input 2604A of the user interface 2605 to deenergize the first muscle wire 2027A. In doing so, the first muscle wire 2027A begins lengthening to its baseline length, the proximal force on the first grasping member 2024A is removed, and the first spring 2022A transitions to push and maintain the first grasping member 2024A through the first grasping slot 2103 and into a receptacle (e.g. receptacles 2207 A, 2207B) of the needle 2201 to retain the needle 2201 in the first grasping slot 2103 of the fixed jaw 2005. The indicators 2606A, 2606B will change with operation of the input 2604A. For instance, the indicator 2606A can change operation (e.g. light up) to indicate the first muscle wire 2027A is de-energized, while the indicator 2606B can remain off to indicate the second muscle wire 2027B is still energized. Once the needle 2201 is loaded and grasped, the suturing device 2001A can then be removed from the loader 2347 (FIG. 8C), if used.

[0209] Once the needle 2201 is loaded, the suturing device 2001A can be used. In some embodiments, the transfer mechanism 2004 of the suturing device 2001A can function in a semi-automatic mode. In the semi-automatic mode, a user can control needle transfer with an input (e.g. one or more of the inputs 2604, 2711). In semi-automatic mode, the user can only activate the needle transfer mechanism 2004 when the handles 2002A, 2002B are fully closed. To prevent user errors, the force sensor 2804 works like a safety switch preventing the needle transfer and warning the user when he or she tries to activate the needle transfer when the handles 2002A, 2002B are not fully closed.

[0210] To use the suturing device, a user can operate one or more of the inputs 2604, 2711 to enter the semi-automatic mode of the transfer mechanism 2004. In some embodiments, the user can actuate the input 271 IB to exit the load-unload mode and enter the semi-automatic mode. Once semi-automatic mode is initiated, the force sensor 2804 is operational. When a threshold force is detected by the force sensors 2804, the processor can determine that thehandles 2002A, 2002B are fully closed. If a threshold force is not detected by the force sensor 2804, the processor can determine that the handles 2002A, 2002B are not fully closed.

[0211] In some embodiments, in semi-automatic mode, a single input of the one or more inputs 2604, 2711 can be used to control needle transfer between the jaws 2005, 2006. In some embodiments, the single input can be the input 2604A. Such embodiments may be referred to as single button semi-automatic mode. To suture tissue in single button semiautomatic mode, the user can position target tissue between the open jaws 2005, 2006 and close the handles 2002A, 2002B to close the jaws 2005, 2006, such that the needle 2201 secured in the fixed jaw 2005 enters the grasping slot 2104 of the movable jaw 2006. The user can then actuate a single input of the one or more inputs 2604, 2711 to transfer the needle 2201 between the jaws 2005, 2006. In some embodiments, the single input is the input 2604A (which may be referred to as the needle transfer button). In some embodiments, actuation of the needle transfer button 2604 A only results in needle 2201 transfer between the jaws 2005, 2006 when the force sensor 2804 measures a force indicating the handles 2002A, 2002B are closed. If the force sensor measures a force, or no force, indicating the handles 2002A, 2002B are not closed, the processor can lock or override the needle transfer button 2604A such that user actuation of the needle transfer button 2604A does not result in needle transfer between the jaws 2005, 2006, and the needle 2201 remains grasped in the jaw 2005, 2006 it was grasped in prior to the user actuating the needle transfer button 2604A. When the force sensor 2804 measures a force indicating the handles 2002A, 2002B are closed and the needle transfer button 2604A is actuated, one muscle wire 2027A, 2027B is energized and the other muscle wire 2027A, 2027B is not energized. For instance, when the needle 2201 is loaded into the fixed jaw 2005, actuation of the needle transfer button 2604A will cause the second muscle wire 2027B in connection with the second grasping member 2024B to be cut off from the energy source. Therefore, the muscle wire 2027B does not apply a proximal force on the second grasping member 2024B, and the second spring 2022B pushes and maintains the second grasping member 2024B through the second grasping slot 2104 and into a receptacle (e.g. receptacles 2207A, 2207B) of the needle 2201 to retain the needle 2201 in the second grasping slot 2104 of the movable jaw 2006. Subsequently, the energy source supplies an electric current to the first muscle wire 2027A, causing the first muscle wire 2027 A to shorten into its transformed length and apply a proximal force on the first grasping member 2024A (via the first pull wire 2021 A, for instance) to retract the first grasping member 2024 A from a receptacle of the needle 2201 and from the first grasping slot 2103,releasing the needle 2201 from the fixed jaw 2005. Therefore, actuation of the needle transfer button 2604A results in de-energization of the second muscle wire 2027B and energization of the first muscle wire 2027A, such that the needle 2201 is transferred from the fixed jaw 2005 to the movable jaw 2006.

[0212] The user can then open the jaws 2005, 2006, move the suturing device 2001A to a new location, and close the jaws 2005, 2006 to once again pass the needle 2201 between the jaws 2005, 2006. That is, once the force sensor 2804 detects the handles 2002A, 2002B are closed, actuation of the needle transfer button 2604A results in de-energization of the first muscle wire 2027A and energization of the second muscle wire 2027B, such that the needle 2201 is transferred from the movable jaw 2006 to the fixed jaw 2005. Each time the jaws 2005, 2006 are closed and the needle transfer button 2604A is actuated, the muscle wire associated with the jaw 2005, 2006 that, prior to actuation of the needle transfer button 2604A did not retain the needle 2201 (e.g. a first jaw), is de-energized to grasp and retain the needle 2201 in the first jaw, and the muscle wire associated with the jaw 2005, 2006 that, prior to actuation of the needle transfer button 2604A retained the needle 2201 (e.g. a second jaw) is energized to release the needle 2201 from the second jaw.

[0213] In some embodiments, in semi-automatic mode, multiple inputs of the one or more inputs 2604, 2711 can be used to control needle transfer between the jaws 2005, 2006. In some embodiments, two separate inputs 2604 of the user interface 2605 can be used to control needle transfer between the jaws 2005, 2006. Such embodiments may be referred to as dual button semi-automatic mode. For instance, a first button (e.g. a first needle transfer button) of the one or more inputs 2604 can be actuated to impart a state where the first muscle wire 2027A is energized and the second muscle wire 2027B is de-energized, and a second button (e.g. a second needle transfer button) of the one or more inputs 2604 can be actuated to impart a state where the first muscle wire 2027A is de-energized and the second muscle wire 2027B is energized.

[0214] To suture tissue in dual button semi-automatic mode, the user can position target tissue between the open jaws 2005, 2006 and close the handles 2002A, 2002B to close the jaws 2005, 2006, such that the needle 2201 secured in the fixed jaw 2005 enters the grasping slot 2104 of the movable jaw 2006. The user can then actuate the first needle transfer button to de-energize the second muscle wire 2027B in connection with the second grasping member 2024B. Therefore, the second muscle wire 2027B does not supply a proximal forceon the second grasping member 2024B, and the second spring 2022B pushes and maintains the second grasping member 2024B through the second grasping slot 2104 and into a receptacle (e.g. receptacles 2207A, 2207B) of the needle 2201 to retain the needle 2201 in the second grasping slot 2104 of the movable jaw 2006. Single actuation of the first needle transfer button subsequently energizes the first muscle wire 2027A in connection with the first grasping member 2024A, causing the first muscle wire 2027A to shorten into its transformed length and apply a proximal force on the first grasping member 2024A (via the first pull wire 2021 A, for instance) to retract the first grasping member 2024A from a receptacle of the needle 2201 and from the first grasping slot 2103, releasing the needle 2201 from the fixed jaw 2005. Therefore, actuation of the first needle transfer button transfers the needle 2201 from the fixed jaw 2005 to the movable jaw 2006.

[0215] The user can then open the jaws 2005, 2006, move the suturing device 2001A to a new location, and close the jaws 2005, 2006 to once again pass the needle 2201 between the jaws 2005, 2006. That is, once the force sensor 2804 detects the handles 2002A, 2002B are closed, the user can then actuate the second needle transfer button to de-energize the first muscle wire 2027A associated with the fixed jaw 2005. Therefore, the muscle wire 2027A does not supply a proximal force on the first grasping member 2024A, and the first spring 2022A pushes and maintains the first grasping member 2024A through the first grasping slot 2103 and into a receptacle (e.g. receptacles 2207A, 2207B) of the needle 2201 to retain the needle 2201 in the first grasping slot 2103 of the fixed jaw 2005. Single actuation of the second needle transfer button subsequently energizes the second muscle wire 2027B associated with the movable jaw 2006, causing the second muscle wire 2027B to shorten into its transformed length and apply a proximal force on the second grasping member 2024B (via the second pull wire 202 IB, for instance) to retract the second grasping member 2024B from a receptacle of the needle 2201 and from the second grasping slot 2104, releasing the needle 2201 from the movable jaw 2006.

[0216] Each time the jaws 2005, 2006 are closed, the needle 2201 can be transferred between the jaws 2005, 2006 through the above-described actuation of the first or second needle transfer buttons. Similar to the single button semi-automatic mode, the processor can lock out or override any actuation of the muscle wires 2027A, 2027B via the first needle transfer button and the second needle transfer button until the force sensor 2804 detects a force indicating the handles 202A, 202B are closed.

[0217] It should be appreciated that in single button semi-automatic mode and dual button semi-automatic mode, the outputs 2606, 2713 can change throughout a suturing operation to indicate the current state of the muscle wires 2027A, 2027B. For instance, the indicator 2606A can be off when the first muscle wire 2027A is energized (and the needle 2201 is not grasped in the fixed jaw 2005), and the indicator 2606A can be on when the first muscle wire 2027A is de-energized (and the needle 2201 is grasped in the fixed jaw 2005). Similarly, the indicator 2606B can be off when the second muscle wire 2027B is energized (and the needle 2201 is not grasped in the movable jaw 2006), and the indicator 2606B can be on when the second muscle wire 2027B is de-energized (and the needle 2201 is grasped in the movable jaw 2006).

[0218] Once the needle 2201 is loaded, the suturing device 2001A can be used. In some embodiments, the transfer mechanism 2004 of the suturing device 2001A can function in an automatic mode. In the automatic mode, a user does not need to actuate any of the inputs 2604, 2711 to operate the needle transfer mechanism 2004 to pass the needle 2201 between the jaws 2005, 2006. In automatic mode, the processor can automatically initiate needle transfer based on forces measured by the force sensor 2804. In some embodiments, the force measured by the force sensor 2804 that initiates needle transfer is a threshold force indicating the handles 2002A, 2002B are fully closed. In some embodiments, the force measured by the force sensor 2804 that initiates needle transfer is a threshold force greater than the force indicating the handles 2002A, 2002B are fully closed. In other words, needle transfer can be initiated when the user closes the handles 2002A, 2002B and then applies additional force on the handles 2002A, 2002B to reach the threshold needle transfer force.

[0219] Once a needle is loaded, as described above, to use the suturing device, a user can operate one or more of the inputs 2604, 2711 to enter the automatic mode of the transfer mechanism 2004. In some embodiments, the user can actuate the input 271 IB to exit the load-unload mode and enter the automatic mode. Once automatic mode is initiated, the force sensor 2804 is operational. The user can use one or more of the inputs 2604, 2711 to set a threshold force that must be measured by the force sensors 2804 to initiate needle transfer. In some embodiments, actuation of the 2711C can set the threshold force. The processor can be configured such that automatic mode needle transfer will only operate when the threshold force set by the user is greater than the expected force required to close the handles 2002A, 2002B.

[0220] As noted above, once automatic mode is initiated, a user can transfer the needle 2201 between the jaws 2005, 2006 without actuation of any of the inputs 2604, 2711. To suture tissue in automatic mode, the user can position target tissue between the open jaws2005, 2006 and close the handles 2002A, 2002B to close the jaws 2005, 2006, such that the needle 2201 secured in the fixed jaw 2005 enters the grasping slot 2104 of the movable jaw2006. In some embodiments, the user must apply an additional force to the handles 2002A, 2002B after they are closed to reach a threshold force to initiate needle transfer. Once the threshold force is measured by the force sensor 2804, the processor can begin transferring the needle 2201 between the jaws 2005, 2006. Particularly, the processor can operate the energy source such that one muscle wire is energized and one muscle wire is not energized. More specifically, the energy source can be operated to de-energize the muscle wire 2027A, 2027B associated with the jaw 2005, 2006 that did not retain the needle 2201 prior to the jaws 2005, 2006 being closed. Therefore, in the current example where the needle 2201 was loaded into the fixed jaw 2005, once the threshold force is measured by the force sensor 2804, the second muscle wire 2027B in in connection with the second grasping member 2024B is cut off from the energy source. Therefore, the muscle wire 2027B does not apply a proximal force on the second grasping member 2024B, and the second spring 2022B pushes and maintains the second grasping member 2024B through the second grasping slot 2104 and into a receptacle (e.g. receptacles 2207A, 2207B) of the needle 2201 to retain the needle 2201 in the second grasping slot 2104 of the movable jaw 2006. Subsequently, the energy source supplies an electric current to the muscle wire 2027A, 2027B associated with the jaw 2005, 2006 that retained the needle 2201 prior the handles 2002A, 2002B being closed. Therefore, in the current example, the first muscle wire 2027A is energized, causing the first muscle wire 2027 A to shorten into its transformed length and apply a proximal force on the first grasping member 2024A (via the first pull wire 2021 A, for instance) to retract the first grasping member 2024 A from a receptacle of the needle 2201 and from the first grasping slot 2103, releasing the needle 2201 from the fixed jaw 2005. Therefore, application of the threshold force to the handles 2002A, 2002B results in de-energization of the second muscle wire 2027B and energization of the first muscle wire 2027A, such that the needle 2201 is transferred from the fixed jaw 2005 to the movable jaw 2006.

[0221] The user can then open the jaws 2005, 2006, move the suturing device 2001A to a new location, and close the jaws 2005, 2006 to once again pass the needle 2201 between the jaws 2005, 2006. That is, once the force sensor 2804 again measures the threshold force, theprocessor operates the needle transfer mechanism 2004 and energy source to de-energize the first muscle wire 2027A and energize the second muscle wire 2027B, such that the needle 2201 is transferred from the movable jaw 2006 to the fixed jaw 2005. Each time the jaws 2005, 2006 are closed (and therefore the handles 2002A, 2002B are closed) and the force sensor 2804 measures the threshold force, the muscle wire associated with the jaw 2005, 2006 that, prior to closing the handles did not retain the needle 2201 (e.g. a first jaw), is deenergized to grasp and retain the needle 2201 in the first jaw, and the muscle wire associated with the jaw 2005, 2006 that, prior to closing the handles, retained the needle 2201 (e.g. a second jaw) is energized to release the needle 2201 from the second jaw.

[0222] It should be appreciated that in automatic mode, the outputs 2606, 2713 can change throughout a suturing operation to indicate the current state of the muscle wires 2027A, 2027B. For instance, the indicator 2606A can be off when the first muscle wire 2027A is energized (and the needle 2201 is not grasped in the fixed jaw 2005), and the indicator 2606A can be on when the first muscle wire 2027A is de-energized (and the needle 2201 is grasped in the fixed jaw 2005). Similarly, the indicator 2606B can be off when the second muscle wire 2027B is energized (and the needle 2201 is not grasped in the movable jaw 2006), and the indicator 2606B can be on when the second muscle wire 2027B is de-energized (and the needle 2201 is grasped in the movable jaw 2006. After each transfer of the needle 2201 between the jaws 2005, 2006, one or more of the outputs 2606, 2713 can indicate successful completion of needle transfer. For instance, one or more of the outputs 2606, 2713 can generate an audial or visual signal to indicate successful completion of the needle transfer.

[0223] In automatic mode, single handed operation of the suturing system is enabled. Specifically, the user can control the relative movement of the arms and jaws of the suturing device 2001 A and needle transfer with one hand gripping the handles 2002 A, 2002B and applying the needed threshold force to initiate needle transfer.

[0224] After suturing is complete using any of the above modes (automatic, single button semi-automatic, or dual button semi-automatic), the user can unload the needle 2201 from the suturing device 2001 A. To do so, the user can actuate one or more inputs 2604, 2711 to enter the load-unload mode. In some embodiments, the user can actuate the input 271 IB to exit the needle transfer mode (e.g. one of the automatic, single button semi-automatic, or dual button semi-automatic modes) and enter the load-unload mode. In the load-unload mode, the force sensor 2804 is disengaged, allowing muscle wire activation (needle transfer) button 2604 tobe activated when the handles 2002A, 2002B are open. With the jaws 2005, 2006 open, the user can operate one or more of the inputs 2604, 2711 to release the needle 2201 from the jaw 2005, 2006 the needle 2201 is retained in. In some embodiments, the user can actuate the input 2604A to release the needle 2201 from the jaw 2005, 2006 the needle 2201 is retained in. In some embodiments, the user can actuate the input 2604A of the user interface 2605 to de-energize the muscle wire 2027A, 2027B associated with the jaw 2005, 2006 the needle 2201 was retained in to release the needle 2201 from the jaw 2005, 2006. The user can then manually unload the needle 2201 from the suturing device 2001A. In some embodiments, using the loader 2347 (FIG. 8C), the suturing device 2001A can be placed in the loader 2347 with the jaws 2005, 2006 open, and then the user can actuate the needle transfer mechanism 2004 as described above to release and unload the needle 2201.

[0225] After the needle is unloaded, a user can power off the suturing device 2001A and / or the external unit 2700 by actuation of one or more of the inputs 2604, 2711. In some embodiments, the user can actuate the input 2711A of the user interface 2705 to power off the elements of the external unit 2700 and the suturing device 2001A. When powered off, the indicator 2713A can change operation (e.g. turn off a light) to indicate the system is powered off. It should be appreciated that during the needle transfer and suturing operations described above (e.g. automatic mode, single button semi-automatic mode, dual button semi-automatic mode) the system is powered on.

[0226] During use of the suturing device 2001 A, the one or more outputs 2606, 2713 can indicate information on the operation status of the suturing device 2001A to the user. For instance, in some embodiments, the processor can control one or more of the outputs to indicate what mode (e.g. load-unload, single button semi-automatic, dual-button semiautomatic, automatic) the suturing device is operating in. In some embodiments, the processor can control one or more of the outputs, such as the indicator 2713A, to indicate that the system is powered on or off. In some embodiments, the processor can control one or more of the outputs, such as the indicators 2606A and 2606B, to indicate the energy state (e.g., energized or de-energized) of the first muscle wire 2027A and / or the second muscle wire 2027B. In some embodiments, the processor can control one or more of the outputs to indicate the force threshold set by the user for the force sensor to initiate automatic needle transfer. In some embodiments, the processor can control one or more of the outputs to indicate whether a force measured by the force sensor is above or below a set threshold. Insome embodiments, the processor can control one or more of the outputs to indicate error and warning conditions, such as low battery, threshold force not reached, etc.

[0227] FIG. 11A and FIG. 11B depict an embodiment of the suturing device 2001A with attachment member 2106A and attachment member 2106B. In some embodiments, the attachment member 2106A or 2106B has the needle 2201 already preloaded. As shown in FIG. 11 A, the attachment member 2106A can be configured to be attached to the movable jaw 2006 that is configured to receive the attachment member 2106A. As shown in FIG. 1 IB, the attachment member 2106B can be configured to be attached to the fixed jaw 2005 that is configured to receive the attachment member 2106B. For example, instead of having to load the needle 2201 into the second grasping slot 2104, the attachment member 2106 A with the needle 2201 can be attached to the movable jaw 2006 of the suturing device 2001A. In another example, instead of having to load the needle 2201 into the first grasping slot 2103, the attachment member 2106B with the needle 2201 can be attached to the fixed jaw 2005 of the suturing device 2001A. In some embodiments, at the conclusion of a suturing operation, the attachment member 2106A or the attachment member 2106B can be removed with the needle 2201, and another attachment member 2106 A or the attachment member 2106B with a replacement needle 2201 can be attached to the fixed jaw 2005 or the movable jaw 2006. In some embodiments, the operator can use the same needle 2201 for suturing for more than one suture. For example, if the procedure requires so, the operator can also make suture after suture (sequential) with the same needle 2201, which is called Z-suture or 8-figure suture.

[0228] FIG. 12A and FIG. 12B depict embodiments of shapes of suturing devices (e.g., suturing device 2001A or suturing device 2001B (FIGS. 13A and 13B). The suturing devices can be in various sizes, shapes, and angles that are optimized based on the anatomy for which the suturing devices are to be used. The suturing devices can have sizes and angles optimized for the repair of pelvic floor disorders safely due to positional accuracy and in a minimally invasive way. The suturing devices can have sizes and angles optimized for minimally invasive usage in deep, narrow, and invisible to naked eye operating sites.

[0229] The size and angles of the devices can be selected according to the target tissue each device is designed to reach for suturing and according to the pathway each device needs to travel in order to reach the target tissue. For example, the pathway can have obstacles such as hard-bony tissues and soft tissues. The sizes and angles can ensure that the surgical methods for using the suturing devices can maneuver the suturing devices through the pathway suchthat the devices are delivered to their target tissue in the least invasive way. For example, the area of the pathway can be in the pelvic cavity, which can be very similar from patient to patient with minimal standard deviation. As such, the calculation can be accurate across patients even though they might have different bodily parameters (e.g., height, weight, etc.). The sizes and angles can be selected according to the target tissue such that once the device is delivered to the target tissue, the outer contour of the fixed jaw 5 can be used for positional accuracy.

[0230] Any of the suturing devices described herein can have a length such that during operation of the suturing device, the handle, for example the handles 2002A and 2002B and the handle 2306, can be positioned outside the cavity while the length defines a portion of the suturing device that can be positioned inside the cavity. For example, the suturing devices can have a length and angles for transvaginal approaches or procedures. For example, as shown in FIG. 12A, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle 2550 ranging from 0 to 165 degrees. In some embodiments, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle 2550 ranging from approximately 60 to 90 degrees. In some embodiments, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle of about 77 degrees. In some embodiments, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle of 77.2 degrees. A length 2205A can be measured from the tip of the fixed jaw 2005 and the fixed arm 2007. As shown in FIG. 12B, the fixed arm 2007 can have a distal portion that extends relative a proximal portion at an angle 2551 A ranging from 0 to 90 degrees. In some embodiments, the fixed arm 2007 can have a distal portion that extends relative a proximal portion at an angle 2551 A ranging from approximately 10 to 20 degrees. In some embodiments, the fixed arm 2007 can have a distal portion that extends relative a proximal portion at an angle of about 16 degrees. In some embodiments, the fixed arm 2007 can have a distal portion that extends relative a proximal portion at an angle of 15.88 degrees. The fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle 2551B ranging from 90 to 180 degrees. In some embodiments, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle 255 IB ranging from approximately 120 to 140 degrees. In some embodiments, the fixed jaw 2005 can extend relative to the fixed arm 2007 at an angle of 130 degrees. As shown in FIG. 12B, in some embodiments the fixed arm 2007 can have a plurality of corners 2553, 2554. It will be understood that any of the sharp comers or edges of the devices described herein can instead have smooth curvature. The fixed jaw 2005 and the fixed arm 2007 can have a length 2205B. It is contemplated that the suturingdevices can be modified to modify the sizes, shapes, and angles to optimize the suturing device for specific cavities and operations.

[0231] FIG. 13 A and FIG. 13B depict an embodiment of the suturing device 200 IB. The suturing device 200 IB can be similar to the suturing device 2001 A, and can be operated similar to the suturing device 2001 A described above, but differs in that its components have a different angle, size, and shape to optimize the suturing device 200 IB for the anatomy for which the suturing device 2001B is to be used. It should be appreciated that the suturing device 200 IB differs from the suturing device 2001 A only in its size and angles, and that any of the above or later described embodiments (including variations of needle transfer mechanism, jaw motion, and / or handle design) can be employed in the suturing device 2001B. In some embodiments, the suturing device 2001B can use the attachment member 2106A or the attachment member 2106B as described in reference to FIG. 11A and FIG. 1 IB. For example, the attachment member 2106 A can be configured to be attached to the movable jaw 2006 that is configured to receive the attachment member 2106A. In another example, the attachment member 2106B can be configured to be attached to the fixed jaw 2005 that is configured to receive the attachment member 2106B.

[0232] Referring to FIGS. 16A-16D, another suturing device 2001C is depicted. The suturing device 2001C includes a handle 2306 and a body 2302 extending distally from the handle 2306. The handle 2306 can be ergonomically designed for single hand operation by the user. In some embodiments, the handle 2306 includes one or more inputs. The inputs can be buttons, knobs, switches, dials, etc. In some embodiments, the handle 2306 includes an input 2303. The input 2303 can be used to enter a load / unload mode, in which the needle 2201 is released or grasped at both grasping slots of both jaws 2005A, 2006A. The input 2303 can be a button. In some embodiments, the handle 2306 includes an input 2304. The input 2304 can be used as to actuate a linear movement of the movable jaw 2006A, as discussed further below. The input 2304 can be a button. In some embodiments, the handle 2306 includes an input 2307. The input 2307 can be used to select a jaw 2005A, 2006A that will grasp or release the needle 2201. The input 2307 can be a rotary switch. In some embodiments, the handle 2306 includes one or more outputs. The outputs can generally indicate to a user which jaw 2005A, 2006A the needle 2201 is currently grasped in. In some embodiments, the handle 2306 includes an output 2308A. The output 2308A can indicate a status of the fixed jaw 2005A. Particularly, the output 2308A can indicate when the graspingmechanism in the fixed jaw 2005A is active, and that the needle 2201 is therefore grasped in the fixed jaw 2005A. In some embodiments, the output 2308A can be an LED. In some embodiments, the handle 2306 includes an output 2308B. The output 2308B can indicate a status of the movable jaw 2006A. Particularly, the output 2308B can indicate when the grasping mechanism in the movable jaw 2006A is active, and that the needle 2201 is therefore grasped in the movable jaw 2006A. In some embodiments, the output 2308B can be an LED. In some embodiments, the handle 2306 includes a protrusion 2309 on a superior surface of the handle 2306. The protrusion 2309 can provide a tactile grasping reference for the user, indicating where to place his or her thumb during use of the suturing device 2001C. In some embodiments, a cable 2305 extends from a proximal end of the handle 2306. The cable 2305 can extend from the handle 2306 in a similar fashion, and function similarly to, the cable 2602 (FIG. 8A) discussed above with respect to the suturing device 2001A. In some embodiments, the cable 2305 electrically connects to an external unit similar to, and which contains any or all of the functionalities of, the external unit 2700 (FIG. 9A) discussed with respect to the suturing device 2001 A. In some embodiments, a fiber optic wire 2310 extends from a proximal end of the handle 2306. In some embodiments, the fiber optic wire 2310 optically connects to the same or different external unit as the cable 2305.

[0233] In some embodiments, the body 2302 can be rigid. In some embodiments, the body 2302 can be bendable from a plurality of points. In some embodiments, the body 2302 can be flexible to a plurality of positions and maintain a set shape of a first position until bent or flexed to a second position. The body 2302 can be configured for entry into a cavity of patient. The body 2302 is generally a slim elongate member that provides increased maneuverability in the patient and can be inserted into the patient minimally invasively. The handle 2306 is generally configured to remain outside the cavity of patient during operation for gripping by the user and interaction with the user through the inputs and outputs of the handle 2306. FIG. 16D generally depicts the ergonomics of the handle 2306 for ease of gripping by the user.

[0234] Referring to FIGS. 18A-18D, the fixed jaw 2005A and the movable jaw 2006A are depicted in greater detail. The fixed jaw 2005A and the movable jaw 2006A can include grasping slots such as the grasping slots 2103, 2104 (FIGS. 4A and 4B) discussed with reference to the suturing device 2001A. In some embodiments, the fixed jaw 2005A is coupled to a fixed jaw body 2345. The fixed jaw body 2345 can be generally L-shaped. Thefixed jaw 2005A can be positioned at the distal end of the fixed jaw body 2345. In some embodiments, the fixed jaw 2005A is integral with the fixed jaw body 2345. The fixed jaw body 2345 is coupled to a distal end of the body 2302. Particularly, the proximal end of the fixed jaw body 2345 can be positioned at the distal end of the body 2302. In some embodiments, the fixed jaw body 2345 is integral with the body 2302.

[0235] In some embodiments, the fixed jaw body 2345 can include a linear guide 2337. In some embodiments, the linear guide 2337 can be positioned substantially perpendicular to the fixed jaw 2005A. The linear guide 2337 provides a track for linear movement of the movable jaw 2006A with respect to the fixed jaw 2005A. In some embodiments, the movable jaw 2006A is substantially parallel with the fixed jaw 2005A, and the jaws 2006A, 2005A do not rotate with respect to each other during movement of the movable jaw 2006A. In some embodiments, the movable jaw 2006A can move within the linear guide 2337 in a substantially perpendicular direction to the fixed jaw 2005A. FIGS. 18A-18D generally show the movement of the movable jaw 2006A in the linear guide 2337 with respect to the fixed jaw 2005A, and the transfer of the needle 2201E between the jaws 2005A, 2006A.

[0236] Referring to FIG. 19A, partially exploded views of the fixed jaw body 2345, fixed jaw 2005A, and movable jaw 2006A are depicted. In some embodiments, an actuator 2312A is positioned within the fixed jaw 2005A. In some embodiments, the actuator 2312A can partially extend through the fixed jaw body 2345. The actuator 2312A is generally configured for actuation of the grasping member 2316A of the fixed jaw 2005A. In some embodiments, the fixed jaw body 2345 includes a removable cover 2313 for inserting the actuator 2312A into the fixed jaw 2005A. In some embodiments, an actuator 2312B is positioned within the movable jaw 2006A. In some embodiments, the actuator 2312B can partially extend through the fixed jaw body 2345. The actuator 2312B is generally configured for actuation of the grasping member 2316B of the movable jaw 2006A. In some embodiments, the movable jaw 2006A includes a protrusion 2338. The protrusion 2338 is positioned at a proximal end of the movable jaw 2006A. The protrusion 2338 is generally sized and shaped to be received in the linear guide 2337, such that the protrusion 2338 coupled to movable jaw 2006A to the fixed jaw body 2345 and can slide within the linear guide 2337. The actuators 2312A, 2312B can each include muscle wire and elastomer elements therein, as described in further detail below. The needle transfer mechanism 2380 of the suturing device 2001C includes theactuators 2312A and 2312B. The needle actuators 2312A and 2312B can each be referred to independently as a needle transfer mechanism.

[0237] Referring now to FIGS. 19B, 20A, and 20B, the actuators 2312A and 2312B will be discussed in greater detail. FIG. 19B depicts an exploded view of the of the actuator 2312A. FIG. 20A depicts a transparent view of the fixed jaw body 2345, fixed jaw 2005A, and movable jaw 2006A. FIG. 20B depicts a cross sectional view of the fixed jaw body 2345, the jaws 2005A, 2006A, and the actuators 2312A, 2312B. With reference to the actuator 2312A associated with the fixed jaw 2005A, the actuator 2312A includes a muscle wire 2320A. The muscle wire 2320A may resemble the muscle wires 2027A, 2027B discussed above in design and function. In some embodiments, the proximal end of the muscle wire 2320A is crimped to the distal end of an insulated wire 2314A with a ferule 2324A. The insulated wire 2314A can prevent short circuiting. In some embodiments, the insulated wire 2314A can extend through the fixed jaw body 2345 and through a main wire 2333, which extends proximally through the body 2302. The insulated wire 2314A generally provides electrical current to the muscle wire 2320A. Particularly, the insulated wire 2314A can provide an electrical connection at the proximal end of the muscle wire 2320A. In some embodiments, an insulation sleeve 2323A is placed outside the ferrule 2324A. The insulation sleeve 2323A can be any suitable insulative material and can prevent short circuiting. In some embodiments, the actuator 2312A includes an insulated wire 2314B. In some embodiments, the distal end of the muscle wire 2320A is crimped to the distal end of the insulated wire 2314B. The insulated wire 2314B can be insulated to prevent short circuiting. In some embodiments, the insulated wire 2314B can extend through the fixed jaw body 2345 and through a main wire 2333, which extends proximally through the body 2302. The insulated wire 2314B generally provides electrical current to the muscle wire 2320A. Particularly, the insulated wire 2314B can provide an electrical connection at the distal end of the muscle wire 2320A. In some embodiments, the proximal end of the grasping member 2316A is crimped with the distal end of the muscle wire 2320A and the distal end of the insulated wire 2314B to create mechanical bonding therebetween. In some embodiments, an insulation sleeve 2322A is placed at the proximal end of the grasping member 2316A to insulate the grasping member 2316A from the muscle wire 2320A and its distal electrical connection with insulated wire 2314B.

[0238] In some embodiments, the actuator 2312A can include an elastomer member 2318A positioned around the proximal end of the grasping member 2316A and coupled to thegrasping member 2316A. The elastomer member 2318A can be any natural or synthetic polymer having elastic properties. When the muscle wire 2320A is in its baseline or extended length, as shown in FIG. 18B, the elastomer member 2318A can be retained in a semicompressed state by one or more machine elements (e.g. 2317A, 2319A) of the actuator 2312A or fixed jaw 2005A. When the muscle wire 2320A is energized, the muscle wire 2320A transitions to its shortened or transformed length, applying a proximal force on the grasping member 2316A to retract the grasping member 2316A from the grasping slot of the fixed jaw 2005A. The grasping member 2316A can also be retracted from a receptacle of a needle positioned in the grasping slot of the fixed jaw 2005A. As the grasping member 2316A is retracted from the grasping slot of the fixed jaw 2005A, the elastomer member 2318A can be fully compressed. In some embodiments the actuator 2312A includes a washer 2317A positioned around the grasping member 2316A and at a distal end of the elastomer member 2318A. The washer 2317A can travel with the grasping member 2316A, and as the grasping member 2316A is retracted, the washer 2317A can also be moved proximally to assist in fully compressing the elastomer member 2318A.

[0239] In some embodiments, the actuator 2312A includes a bushing 2319A. The grasping member 2316A, the insulation sleeve 2322A, the muscle wire 2320A, the insulated wire 2314B, the insulation sleeve 2323 A, and / or the ferule 2324A can be at least partially positioned in and / or at least partially moved through the annular recess of the bushing 2319A. The bushing 2319A can be aligned with and positioned proximally of the elastomer member 2318A to support the elastomer member 2318A and provide a surface which the elastomer member 2318A can be fully compressed against.

[0240] When the muscle wire 2320A is de-energized, the muscle wire 2320A can begin transitioning to its baseline or extended length, thereby eliminating the proximal retracting force applied to the grasping member 2316A and the elastomer member 2318 A. Removal of the proximal retracting force allows the elastomer member 2318A to transition from its fully compressed state to its semi-compressed state to move the grasping member 2316A distally to extend into the grasping slot of the fixed jaw 2005A and into a receptacle of a needle positioned in the grasping slot of the fixed jaw 2005 A.

[0241] As with the other potential energy members discussed above, the elastomer members 2318 A, 2318B need not be directly or indirectly coupled to the grasping member 2316 A, 2316B. The elastomer members 2318 A, 2318B can be otherwise situated such that theelastomer members 2318 A, 2318B can exert a force on the grasping members 2316 A, 2316B and / or vice versa. For instance, the elastomer 2318A, grasping member 2316A, and machine elements 2317A, 2319A may each be sized such that the distal end of the elastomer member 2318A is maintained in contact with at least a portion of the grasping member 2316A or other elements in contact with the grasping member 2316A (e.g. elements situated between the elastomer member 2318A and the grasping member 2316A, such as the washer 2317A) such that the elastomer member 2318A can apply a distal force on the grasping member 2316A. Similarly, the elastomer member 2318 A, grasping member 2316A, and machine elements 2317A, 2319A may each be sized such that the distal end of the elastomer member 2318A is maintained in contact with the at least a portion of the grasping member 2316A or other elements in contact with the grasping member 2316A (e.g. elements situated between the elastomer member 2318A and the grasping member 2316 A) such that the grasping member 2316A can apply a proximal force on the elastomer member 2318 A.

[0242] While only the actuator 2312A was discussed in detail above, it should be appreciated that the same description can apply to the actuator 2312B. For instance, the actuator 2312B can include a grasping member 2316B, a washer 2317B, an elastomer member 2318B, an insulation sleeve 2322B, a bushing 2319B, a muscle wire 2320B, an insulation sleeve 2323B, and a ferrule 2324B arranged and operational in a similar fashion as like numbered and named elements with respect to the actuator 2312A. The actuator 2312B can further include an insulated wire 2315A similar to the insulated wire 2314A described above. That is, the proximal end of the muscle wire 2320B can be crimped to the distal end of the insulated wire 2315A with the ferule 2324B, and the insulated wire 2315A can extend through the fixed jaw body 2345 and through the main wire 2333, which extends proximally through the body 2302. The insulated wire 2315A generally provides electrical current to the proximal end of the muscle wire 2320B. The actuator 2312B can further include an insulated wire 2315B similar to the insulated wire 2314B discussed above. That is, the distal end of the insulated wire 2315B can be crimped to the distal end of the muscle wire 2320B to provide an electrical connection at the distal end of the muscle wire 2320B. The insulated wire 2315B can extend through the fixed jaw body 2345 and through a main wire 2333, which extends proximally through the body 2302. The default state of the muscle wires 2320A, 2320B can be de-energized, such that the muscle wires 2320A, 2320B are in their baseline, extended length by default. Therefore, in the default state, the grasping members 2316A, 2316B are positioned distally by the elastomer members 2318 A, 2318B and extend into the graspingslots of the jaws 2005A, 2006A and into receptacles of a needle, if a needle is positioned in the grasping slots of the jaws 2005A, 2006A.

[0243] Referring now to FIGS. 20B, 20C, 20D, 20E, and 20F, the suturing device 2001C includes a drive mechanism 2350 for moving the movable jaw 2006A relative to the fixed jaw 2005A in the linear guide 2337. The drive mechanism 2350 can include a muscle wire 2327 and a pull wire 2325. The muscle wire 2327 can function similarly to the abovedescribed muscle wires by shortening in length when an electric current is applied to the muscle wire 2327 and extending in length when the muscle wire 2327 is cut off from electric current. The muscle wire 2327 and the pull wire 2325 can be crimped together by a ferrule 2326. In some embodiments, an insulation sleeve 2339 is inserted on to the ferrule 2326. In some embodiments, the ferrule 2326 is inserted into and coupled to the movable jaw 2006A. Particularly, in some embodiments, the ferrule 2326 is inserted into and coupled to the protrusion 2338 of the movable jaw 2006A. Through the coupling, the movable jaw 2006A can move together with the ferrule 2326. In some embodiments, the muscle wire 2327 extends proximally through the fixed jaw body 2345 and the body 2302. The muscle wire 2327 can connect to an energy source to supply current to the muscle wire 2327. In some embodiments, the pull wire 2325 extends proximally through fixed jaw body 2345 and the body 2302. In some embodiments, the pull wire 2325 extends into the handle 2306, where the proximal end of the pull wire 2325 can be coupled to a distal end of an elastomer member 2335. The proximal end of the elastomer member 2335 can be coupled to an interior portion 2336 of the handle 2306. In some embodiments, the drive mechanism 2350 can include one or more mechanical features, such as a mechanical feature 2328, a mechanical feature 2329, and / or a mechanical feature 2330. The mechanical features can provide guides for the muscle wire 2327 and the pull wire 2325. In some embodiments, the mechanical feature 2328, the muscle wire 2327, and the pull wire 2325 form a pulley system. Application of force on the pulley system, such as by energization of the muscle wire 2327 or by transition (e.g. extension or compression) of the elastomer member 2335, moves the ferrule 2326 proximally or distally. Movement of the ferrule 2326 proximally or distally in turn moves the movable jaw 2006A in the linear guide 2337 distally (in the direction of the fixed jaw 2005 A) to close the jaws 2005A, 2006A or proximally (away from the fixed jaw 2005A) to open the jaws 2005A, 2006A due to the permanent coupling between the ferrule 2326 and the protrusion 2338 of the movable jaw 2006A.

[0244] The default position of the movable jaw 2006A is a fully open position due to the elastomer member 2335 located at the proximal end of the pull wire 2325. To close the jaws 2005A, 2006A (i.e. move the movable jaw 2006A distally), electric current can be applied to the muscle wire 2327 to transition the muscle wire 2327 from its baseline, extended length to its shortened, transformed length. In doing so, the muscle wire 2327 can move around the mechanical feature 2328 such that the distal end of the muscle wire 2327 applies a pulling force in the distal direction on the ferrule 2326 (and therefore the protrusion 2338) to move the movable jaw 2006A in the distal direction toward the fixed jaw 2005A along the linear guide 2337, as shown in FIG. 20C. The distal pulling force applied to the ferrule 2326 further applies a distal pulling force on the pull wire 2325, which is also coupled to the ferrule 2326, and the pull wire 2325 in turn pulls the elastomer member 2335 at its proximal end distally, to transition the elastomer into a stressed, or extended, configuration. To open the jaws 2005A, 2006A, the muscle wire 2327 can be de-energized, thereby eliminating the distal pulling force on the ferrule 2326, the pull wire 2325, and the elastomer member 2335. With the distal pulling force eliminated, the elastomer member 2335 can transition from its stressed configuration to an unstressed, or shortened, configuration, thereby applying a proximal pulling force on the pull wire 2325, which in turn applies a proximal pulling force on the ferrule 2326 and the movable jaw 2006A coupled to the ferrule 2326 at the protrusion 2338. The proximal pulling force, therefore, moves the movable jaw 2006 A proximally in the linear guide 2337 to open the jaws 2005A, 2006A as shown in FIG. 20D.

[0245] It should be appreciated that, in embodiments, the muscle wire 2327 can be directly or indirectly coupled to the movable jaw 2006A such that the muscle wire 2327 can directly or indirectly apply a pulling force in the distal direction on the movable jaw 2006A. Similarly, it should be appreciated that, in embodiments, the elastomer member 2335 can be directly or indirectly coupled to the movable jaw 2006 A such that the elastomer member 2335 can directly or indirectly apply a pulling force in the proximal direction on the movable jaw 2006 A.

[0246] It should be appreciated that, in embodiments, the muscle wire 2327 can be directly or indirectly coupled to the movable jaw 2006A such that the muscle wire 2327 can directly or indirectly apply a pulling force in the proximal direction on the movable jaw 2006A. Similarly, it should be appreciated that, in embodiments, the elastomer member 2335 can be directly or indirectly coupled to the movable jaw 2006 A such that the elastomer member2335 can directly or indirectly apply a force in the distal direction on the movable jaw 2006A.

[0247] Referring now to FIG. 20E, FIG. 20F, and FIG, 21, the electrical and mechanical connections of the suturing device 2001C will be described in further detail. As mentioned above, the main wire 2333 can be the proximal continuation of the insulated wires 2314A, 2314B, 2315A, and 2315B, which can be bundled together in the main wire 2333. As noted above, the cable 2305 can extend from the proximal end of the handle 2306 for coupling to an energy source and / or a control unit that provides for user commands to control operation of the suturing device 2001C. In some embodiments, the main wire 2333 and / or the cable 2305 can be coupled to an electric circuit board 2334. In some embodiments, the muscle wire 2327 can be coupled to the electric circuit board 2334. In some embodiments, the electric circuit board 2334 is positioned within the handle 2306. In some embodiments, the electric circuit board 2334 is positioned external the handle 2306. The electric circuit board 2334 can include the necessary hardware and software components for collecting user commands from the inputs 2303, 2304, 2307, and / or one or more inputs external to the handle 2306 (e.g. on an external unit such as the external unit 2700) and selectively energizing the muscle wires 2320A, 2320B, 2327 based on the commands. The electric circuit board 2334 can include the necessary hardware and software components for controlling the outputs 2308A and 2308B based on the operation of the suturing device 2001C.

[0248] The operation of the suturing device 2001C will now be briefly discussed. Similar to the use of the suturing device 2001A, a user can load a needle, such as the needle 2201E or any other above-described needle, into one of the jaws 2005A, 2006A manually or using a loader 2347 (FIG. 8C) with the jaws 2005A, 2006A open. To load a needle, a user can actuate an input, such as the input 2303, which is designed not to be activated accidentally, to enter a load-unload mode, where the muscle wires 2320A and 2320B can both be energized to supply a proximal force on the grasping members 2316A and 2316B to retract the grasping members 2316A, 2316B from the grasping slots of the jaws 2005A, 2006A. The needle 2201 can then be placed in the grasping slot of a desired jaw 2005A, 2006A. Examples will be described where the needle 2201 is loaded into the fixed jaw 2005A. With the needle 2201 placed in the grasping slot of the fixed jaw 2005A, an input, such as the input 2307, can be actuated to de-energize the muscle wire 2320A such that the proximal force on the grasping member 2316A is removed and the elastomer member 2318A transitions from the fullycompressed state to the semi-compressed state to advance the grasping member 2316A distally into the grasping slot of the fixed jaw 2005A and into a receptacle of the needle 2201 to retain the needle in the fixed jaw 2005 A.

[0249] Once the needle 2201 is loaded, the suturing device 2001C can be positioned at desired tissue to suture with the jaws 2005A, 2006A open. The user can then close the jaws 2005A, 2006A by advancing the movable jaw 2006A distally in the linear guide 2337 toward the fixed jaw 2005A. More specifically, the user can actuate an input, such as the input 2304, to move the movable jaw 2006A distally. Actuation of the input 2304 can cause the muscle wire 2327 to be energized to apply a distal force on the ferrule 2326 and therefore the movable jaw 2006A to move the jaw 2006A distally. When the jaws 2005A, 2006A are closed, the needle 2201 can enter the grasping slot of the movable jaw 2006A. The user can then actuate the input 2307. Actuation of the input 2307 can first cause the muscle wire 2320B to be de-energized, such that the proximal force on the grasping member 2316B is removed and the elastomer member 2318B transitions from the fully compressed state to the semi-compressed state to advance the grasping member 2316B distally into the grasping slot of the movable jaw 2006 A and into a receptacle of the needle to retain the needle in the movable jaw 2006A. Actuation of the input 2307 can secondly cause the muscle wire 2320A to be energized, such that the muscle wire 2320A provides a proximal force on the grasping member 2316A to retract the grasping members 2316A from the grasping slots of the fixed jaw 2005A, thereby transferring the needle from the fixed jaw 2005A to the movable jaw 2006A. That is, single operation of the input 2307 can result in both de-energization of the muscle wire 2320B and energization of the muscle wire 2320A.

[0250] After needle transference, the jaws 2005A, 2006A can be opened by actuation of the input 2304. Actuation of the input 2304 can de-energize the muscle wire 2327 such that the distal force on the movable jaw 2006 A is removed, allowing the elastomer member 2335 to transition to an unstressed / semi-stressed state and supply a proximal force on the pull wire 2325 and movable jaw 2006A, thereby moving the movable jaw 2006A proximally away from the fixed jaw 2005A. The suturing device 2001C can then be moved to desired tissue, and the jaws 2005A, 2006A can be closed as described above. With the jaws 2005A, 2006A closed, the user can transfer the needle from the movable jaw 2006A to the fixed jaw 2005A, similarly to as described for the transference of the needle from the fixed jaw 2005A to the movable jaw 2006A described above. When suturing is complete, the user can again actuatethe input 2303 to enter an unloading mode and energize both muscle wires 2320A, 2320B such that the needle is released from either jaw 2005A, 2006A.

[0251] It should be appreciated that during use of the suturing device, the outputs 2308A and 2308B can change operation based on the energization or de-energization of respective muscle wires in the needle transfer mechanism of the suturing device 2001C and / or in the drive mechanism 2350 of the suturing device 2001C.

[0252] While embodiments of the suturing device 2001C have been described including the elastomer member 2335, the elastomer member 2318A, and the elastomer member 2318B, it should be appreciated that any or all of the elastomer members can be replaced with potential energy members of a different type. For instance, the elastomer member 2335, the elastomer member 2318 A, and / or the elastomer member 2318B can be replaced with a torsional spring or a leaf spring. It should be appreciated that, when included, potential energy members of different types can be similarly situated and mechanically connected as the elastomer members 2335, 2318A, and 2318B.

[0253] It should be appreciated that the suturing device 2001C can include one or more processors, internally (e.g. situated within the handle 2306) or externally, controlling operation of the inputs of the suturing device 2001C, the outputs of the suturing device 2001C, and energization of the muscle wires of the suture device 2001C. Particularly, the one or more processors can be configured to execute instructions encoded on at least one non- transitory computer-readable storage medium to cause the one or more processors to carry out any or all of the above functions and methods.

[0254] Referring now to FIGS. 27A, 27B, 28A, 28B, 28C, and 28D, a suturing device 2001E is depicted. The suturing device 2001E can largely resemble the suturing device 2001C, such that like reference numerals are used to represent similar parts throughout the suturing device 2001C and 2001E. The suturing device 2001E can include a fixed jaw 2005B, a movable jaw 2006B, and a fixed jaw body 2545. The suturing device 2001E differs from the suturing device 2001C in that the movable jaw 2006B is configured to pivot with respect to the fixed jaw 2005B. Particularly, the fixed jaw body 2545 can include a jaw joint 2100 about which the movable jaw 2006B pivots. While not depicted in FIGS. 27A, 27B, 28A, 28B, 28C, and 28D, it should be appreciated that the suturing device 2001E can include a similar needle transfer mechanism as the needle transfer mechanism 2380 of the suturingdevice 2001C. For instance, the fixed jaw 2005B can include the actuator 2312A (FIGS. 19A-20B) and the movable jaw 2006B can include the actuator 2312B (FIGS. 19A-20B).

[0255] The suturing device 2001E includes a drive mechanism 2500 for moving the movable jaw 2006B relative to the fixed jaw 2005B about the jaw joint 2100. The drive mechanism 2500 can include a muscle wire 2527 and a pull wire 2525. The muscle wire 2527 can function similarly to the above-described muscle wires by shortening in length when an electric current is applied to the muscle wire 2527 and extending in length when the muscle wire 2527 is cut off from electric current. The muscle wire 2527 and the pull wire 2525 can be crimped together by a ferrule 2520. In some embodiments, the ferrule 2520 is inserted into and coupled to the movable jaw 2006B. Particularly, in some embodiments, the ferrule 2520 is inserted into and coupled to a protrusion 2522 of the movable jaw 2006B which is positioned proximally of the jaw joint 2100. Through the coupling, the movable jaw 2006B can move together with the ferrule 2520. In some embodiments, the muscle wire 2527 extends proximally through the fixed jaw body 2545 and the body 2302, similar to the muscle wire 2327 discussed above with respect to the suturing device 2001C. The muscle wire 2527 can connect to an energy source to supply current to the muscle wire 2527. In some embodiments, the pull wire 2525 extends proximally through fixed jaw body 2545 and the body 2302, similar to the pull wire 2325 discussed above with respect to the suturing device 2001C. In some embodiments, the pull wire 2525 extends into the handle 2306, where the proximal end of the pull wire 2525 can be coupled to a distal end of an elastomer member 2535. The proximal end of the elastomer member 2535 can be coupled to an interior portion 2536 of the handle 2306. In some embodiments, the drive mechanism 2500 can include one or more mechanical features, such as a mechanical feature 2501, a mechanical feature 2502, a mechanical feature 2503, and / or a mechanical feature 2504. The mechanical features can provide guides for the muscle wire 2527 and the pull wire 2525. In some embodiments, the mechanical features, the muscle wire 2527, and the pull wire 2525 form a pulley system. Application of force on the pulley system, such as by energization of the muscle wire 2527 or by transition (e.g. extension or compression) of the elastomer member 2535, moves the ferrule 2520 laterally (e.g. in substantially leftward or rightward directions, as shown in FIG. 28C, with respect to the jaw joint 2100). Due to the permanent coupling between the ferrule 2520 and the protrusion 2522 of the movable jaw 2006B, rightward movement of the ferrule 2520 in turn pivots the movable jaw 2006B about the jaw joint 2100 away from the fixed jaw 2005B to open the jaws 2005B, 2006B, and leftward movement of the ferrule 2520 in turnpivots the movable jaw 2006B about the jaw joint 2100 toward the fixed jaw 2005B to close the jaws 2005B, 2006B. The default position of the movable jaw 2006B is a fully open position (shown in FIG. 28C) due to the elastomer member 2535 located at the proximal end of the pull wire 2525. To close the jaws 2005B, 2006B (i.e. pivot the movable jaw 2006B toward the fixed jaw 2005B), electric current can be applied to the muscle wire 2527 to transition the muscle wire 2527 from its baseline, extended length to its shortened, transformed length. In doing so, the muscle wire 2527 can move around the mechanical features 2503, 2504 such that the distal end of the muscle wire 2527 applies a pulling force in the leftward direction on the ferrule 2520 (and therefore the protrusion 2522) to pivot the movable jaw 2006B about the jaw joint 2100 relative to the fixed jaw 2005B toward the fixed jaw 2005B, as shown in FIG. 28B. The leftward pulling force applied to the ferrule 2520 further applies a leftward pulling force on the pull wire 2525, which is also coupled to the ferrule 2520, and the pull wire 2525 in turn pulls the elastomer member 2535 at its proximal end distally, to transition the elastomer 2535 into a stressed, or extended, configuration. To open the jaws 2005B, 2006B, the muscle wire 2527 can be de-energized, thereby eliminating the leftward pulling force on the ferrule 2520, the pull wire 2525, and the elastomer member 2535. With the leftward pulling force eliminated, the elastomer member 2535 can transition from its stressed configuration to an unstressed, or shortened, configuration, thereby applying a proximal pulling force on the pull wire 2525, which in turn applies a rightward pulling force on the ferrule 2520 and the movable jaw 2006B coupled to the ferrule 2520 at the protrusion 2522. The rightward pulling force pivots the movable jaw 2006B about the jaw joint 2100 relative to the fixed jaw 2005B away from the fixed jaw 2005B, as shown in FIG. 28C.

[0256] It should be appreciated that, in embodiments, the muscle wire 2527 can be directly or indirectly coupled to the movable jaw 2006B such that the muscle wire 2527 can directly or indirectly apply a pulling force in the leftward direction on the movable jaw 2006B. Similarly, it should be appreciated that, in embodiments, the elastomer member 2535 can be directly or indirectly coupled to the movable jaw 2006B such that the elastomer member 2535 can directly or indirectly apply a pulling force in the rightward direction on the movable jaw 2006B.

[0257] It should be appreciated that, in embodiments, the muscle wire 2527 can be directly or indirectly coupled to the movable jaw 2006B such that the muscle wire 2527 can directlyor indirectly apply a pulling force in the rightward direction on the movable jaw 2006B. Similarly, it should be appreciated that, in embodiments, the elastomer member 2535 can be directly or indirectly coupled to the movable jaw 2006B such that the elastomer member 2535 can directly or indirectly apply a pulling force in the leftward direction on the movable jaw 2006B.

[0258] It should be appreciated that the operation of the suturing device 200 IE is predominantly the same as the suturing device 2001C described above. While embodiments of the suturing device 200 IE have been described including the elastomer member 2535, it should be appreciated that the elastomer member 2535 can be replaced with potential energy members of a different type. For instance, the elastomer member 2535 can be replaced with a torsional spring or a leaf spring. It should be appreciated that, when included, potential energy members of different types can be similarly situated and mechanically connected as the elastomer members 2535.

[0259] It should be appreciated that the suturing device 2001E can include one or more processors, internally (e.g. situated within the handle 2306) or externally, controlling operation of the inputs of the suturing device 200 IE, the outputs of the suturing device 2001E, and energization of the muscle wires of the suturing device 2001E. Particularly, the one or more processors can be configured to execute instructions encoded on at least one non-transitory computer-readable storage medium to cause the one or more processors to carry out any or all of the above functions and methods.

[0260] Referring now to FIGS. 20B, 21, and 22A-22C, embodiments of the suturing device 2001C including one or more image sensors, such as one or more fiber optic cameras 2311 will now be discussed. In some embodiments, the fiber optic camera 2311 can allow for visualization of otherwise invisible operating sites. The fiber optic camera 2311 generally includes one or more fiber optic wires 2310. The fiber optic wire 2310 can generally be configured to collect images, or input data, at its distal end and communicate the images to its proximal end. In some embodiments, the fiber optic wire 2310 is positioned in a guide, or channel, 2332. The guide 2332 can extend through the fixed jaw body 2345. The distal end of the guide 2332 can terminate at an opening 2331 in the fixed jaw body 2345 positioned between the fixed jaw 2005A and the movable jaw 2006A. A distal end of the fiber optic wire 2310 can be disposed in the opening 2331. An optical window 2340 can be positioned over the opening 2331. The optical window 2340 can be a protective glass or other suitablematerial, which in some embodiments, can be an optical lens to provide a desired angle of view. In some embodiments, the optical window 2340 prevents contamination of the fiber optic wire 2310 by blood, tissue, etc., maintaining clear vision of the operative site. In some embodiments, a wiper 2341 can be coupled on a surface of the movable jaw 2006A, projecting from the movable jaw 2006A in the direction of the fixed jaw 2005A. As the movable jaw 2006A moves towards and away from the fixed jaw 2005A, the wiper 2341 can be configured to clean the optical window 2340. The wiper 2341 can be made of or coated in a biocompatible material. The fiber optic wire 2310 can extend through the guide 2332 in the fixed jaw body 2345, through the body 2302, and through or partially through the handle 2306. The fiber optic wire 2310 can be coupled to one or more processors and / or one or more display devices for processing and displaying the data or images collected from the fiber optic wire 2310. Particularly, the one or more processors can be configured to execute instructions encoded on at least one non-transitory computer-readable storage medium to cause the one or more processors to control operation of the fiber optic camera 2311, collect and analyze data or images from the fiber optic wire 2310, and display the data or images. Particularly, it should be appreciated, that while such elements are not depicted, that the fiber optic camera 2311 can further include an external unit containing the sensor, processing unit, light source, and display.

[0261] While an image sensor in the form of a fiber optic camera 2311 is discussed above, it should be appreciated that the fiber optic camera 2311 can be replaced with any suitable imaging device for imaging tissue, such as muscles, veins, nerves, and arteries in the direction of and around the jaws 2005A, 2006A. For instance, in some embodiments, the image sensor can be replaced by a fiber optic infrared sensor / camera to generate infrared images of the operating site, a fiber optic visible sensor / camera, a fiber optic ultraviolet sensor / camera, and / or an ultrasound probe. In some embodiments, one or more ultrasound sensors / probes can be used to generate ultrasound images of the operating site. In some embodiments there can be multiple sensors of each type stated above in any combination.

[0262] While the image sensor in the form of the fiber optic camera 2311 was particularly discussed in relation to the suturing device 2001C, it should be appreciated that an image sensor described herein can be similarly included in any of the suturing devices described herein. For instance, the suturing device 2001A, 2001B, and / or 2001E can include one ormore image sensors, such as the fiber optic camera 2311 in the fixed jaw 2005 and / or fixed arm 2007 for imaging the operating site.

[0263] Referring now to FIGS. 23 A and 23B, in some embodiments, the suturing device 2001C can include one or more electric field sensors 2343. The electric field sensor 2343 can be integrated into the fixed jaw 2005A. In some embodiments, the electric field sensor 2343 can be detachable from the suturing device 2001C. In some embodiments, the electric field sensor 2343 is positioned at a distal end of the fixed jaw 2005A. The electric field sensor 2343 and one or more input and output cables for the electric field sensor 2343 can be positioned in or extend through a channel 2342 in the fixed jaw 2005A. The one or more input and output cables can extend proximally through the body 2302 and the handle 2306 to be coupled to one or more processors and / or one or more display devices. In some embodiments, the one or more input and output cables can be coupled to the electric circuit board 2334. The electric field sensor 2343 can sense and locate nerves in and around the operating site. In some embodiments, the electric field sensor 2343 operates similarly to electrocardiography (ECG), electromyography (EMG), or electroencephalography (EEG), but with higher resolution. The location of the electrical field sensor 2343 on the distal tip of the fixed jaw 2005A, which is the palpation point of the suturing device 2001C, improves utilization of the sensor 2343 by allowing the sensor 2343 to differentiate the tissue to suture from the tissue not to suture. The electric field sensor 2343 can be coupled to one or more processors and / or one or more display devices for processing and displaying the data collected from the electric field sensor 2343. Particularly, the one or more processors can be configured to execute instructions encoded on at least one non-transitory computer-readable storage medium to cause the one or more processors to control operation of the electric field sensor 2343, collect and analyze data from the electric field sensor 2343, and display the data collected from the electric field sensor 2343.

[0264] While the electric field sensor 2343 was particularly discussed in relation to the suturing device 2001C, it should be appreciated that the electric field sensor 2343 can be similarly included in any of the suturing devices described herein. For instance, the suturing device 2001A, the suturing device 2001B, and / or the suturing device 2001E can include the electric field sensor 2343 in the fixed jaw 2005 and / or fixed arm 2007 for collecting data on the operating site.

[0265] In some embodiments, the data (e.g., images) sourced by the fiber optic cameras 2311 and data sourced by the electrical field sensor 2343 are processed by image processing algorithms indicating the correct placement of sutures on the target tissue, the location of nerves to avoid, excessive bleeding, and / or other features or conditions of interest. For example, processed images from the fiber optic camera 2311 and / or the electric field sensor 2343 can be shown on a screen, including graphics, such as green squares, which by use of machine learning algorithms, can indicate correct placement of sutures on target tissue. In some embodiments, the surgeon can also select target tissue of interest on the screen or one or more user interfaces to lock on and track the target tissue in the data displayed on the screen as the surgeon moves the suturing device in the operating site. In some embodiments, different anatomical features or conditions identified in the data or images can be labeled with unique markers on the display screen. For instance, nerves to be avoided can be shown on the screen by yellow squares, and excessive bleeding can be shown by red squares. As another example, or each anatomical feature or condition can be indicated by any unique audial and / or visual indicators. One or more processors of the system can be configured to execute instructions encoded on at least one non-transitory computer-readable storage medium to cause the one or more processors to carry out any or all of the above image or data processing.

[0266] Referring now to FIGS. 24A and 24B, a foot pedal 2344 is depicted. In some embodiments, the foot pedal 2344 can be connected to any of the above-described suturing devices. For instance, the foot pedal 2344 can be connected to the suturing device 2001A via the cable 2602 or connected to the suturing device 2001C or 2001E via the cable 2305. A user can supply one or more operating inputs to the suturing devices via the foot pedal 2344. For instance, operation of the foot pedal 2344 can control the energization of any of the above-described muscle wires and / or operation of any of the above-described. The suturing devices can include one or more processors configured to execute instructions encoded on at least one non-transitory computer-readable storage medium to cause the one or more processors to carry out any or all of the above functions and methods based on inputs from the foot pedal 2344.

[0267] Referring now to FIG. 25, in some embodiments, the suturing devices can include one or more piezo films 2346. The piezo films 2346 can be incorporated in any of the suturing devices described herein. The piezo film 2346 can be positioned on one or moresurfaces of the fixed jaw 2005, 2005A and / or the movable jaw 2006, 2006A. The piezo film 2346 can induce vibrations with a desirable frequency, phase, and amplitude. One or more electrical connections may extend from the proximally from the piezo films 2346 to an energy source and a controller for controlling operation of the piezo films 2346 based on inputs or commands from the user. Vibrations applied by the piezo films 2346 on the one or more jaws can reduce the force required for passing the needle 2201 through the tissue. Vibrations applied by the piezo films 2346 on the one or more jaws can reduce the stress between the needle 2201 and the tissue resulting in less trauma in the tissue being sutured and therefore faster healing outcome. Vibrations applied by the piezo films 2346 on the one or more jaws can improve the needle 2201 engagement between the jaws.

[0268] It should be appreciated that the needle transfer mechanisms contemplated herein are not limited to needle transfer mechanisms for transferring needles between a pair of jaws, as discussed above. Instead, the needle transfer mechanisms herein can be designed for use in suturing devices including one jaw, or no jaws. For instance, the needle transfer mechanisms discussed herein can be designed and used to advance a needle from a first position to a second position, and can further be used to move the needle from the second position to the first position. Such movement can take place between or from any suitable hardware components based on the design of a given suturing device. Therefore, the phrase “needle transfer mechanism” as used herein is not limited to mechanisms for transferring a needle between two separate hardware components (e.g. jaws). Instead, “needle transfer mechanism” as used herein, can describe any mechanism designed to move a needle from a first position to a second position, regardless of any selective release and / or capture of the needle in different hardware components. Also, “needle transfer mechanism” as used herein, can describe any mechanism designed to provide a force on or engage with a needle. For instance, the actuator 2312A (FIG. 20A) can itself be described as a needle transfer mechanism because the actuator 2312A selectively moves the grasping member 2316A (FIG. 20B) for engagement with the needle 2201. “Needle transfer mechanism” as used herein can describe any mechanism that moves a needle. “Needle transfer mechanism” as used herein can describe any mechanism that includes one or more moving parts that act on a needle.

[0269] For instance, with reference to FIGS. 26 A and 26B, a distal end 2402 of a suturing device 2001D is depicted. The distal end 2402 can include a needle holding member 2403. The needle holding member 2403 can include a port 2405. The suturing device 2001D caninclude a needle 2404 and a needle transfer mechanism 2406. The port 2405 can be an opening to receive the needle 2404, such that the needle 2404 can move through the port 2405. The needle transfer mechanism 2406 is shown schematically, but generally includes a muscle wire 2408, similar to the above-described muscle wires, and a potential energy member 2410. The muscle wire 2408 can be directly or indirectly coupled to the needle 2404 such that the muscle wire 2408 can apply a force to the needle 2404. In some embodiments, the muscle wire 2408 applies a pulling force on the needle 2404 in the proximal direction. The potential energy member 2410 can be directly or indirectly coupled to the needle 2404, or otherwise positioned relative the needle 2404, such that the potential energy member 2410 can apply a force to the needle 2404. In some embodiments, the potential energy member 2410 applies a force on the needle 2404 in the distal direction. The potential energy member 2410 can be a torsional spring, a leaf spring, an elastomer, etc. The muscle wire 2408 can be connected to an energy source, such that when the muscle wire 2408 is energized, the muscle wire 2408 shortens and applies a proximal pulling force on the needle 2404 to move the needle 2404 to and retain the needle 2404 in a first position shown in FIG. 26B. In the first position, the needle 2404 can be predominantly or fully retracted within the distal end 2402 and the needle holding member 2403 of the suturing device 200 ID. Movement of the needle 2404 to the first position and / or energization and shortening of the muscle wire 2408 can apply a force to the potential energy member 2410 to move the potential energy member 2410 into a loaded configuration (e.g. compress a spring). When the muscle wire 2408 is deenergized, the muscle wire 2408 begins to transition back to its baseline or extended length, and the proximal pulling force is eliminated. Therefore, the potential energy member 2410 moves and transitions to a relaxed configuration (e.g. a semi-compressed spring), such that the potential energy member 2410 applies a distal force on the needle 2404 to move the needle 2404 into a second position shown in FIG. 26A. In the second position, the needle 2404 can extend from the distal end 2402, and particularly the port 2405 of the needle holding member 2403, of the suturing device 200 ID a greater distance than when the needle 2404 is in the first position. Depending on the design of the needle 2404 and the suturing device 2001D, the needle 2404 can move linearly and / or rotationally between the first position and the second position. In both the first position and the second position, the needle 2404 can be coupled to or retained in the distal end 2402 of the suturing device 200 ID.

[0270] The embodiment depicted in FIGS. 26A and 26B can be modified to transfer a needle from a first position on a suturing device to a second position on a suturing device. Forinstance, FIG. 26C depicts an embodiment of the suturing device 2001D, including the same transfer mechanism 2406 discussed and shown in FIGS. 26A and 26B. In the embodiment shown in FIG. 26C, the suturing device 2001D includes a first port 2435 positioned on the first needle holding member 2403 and a second port 2436 on a second needle holding member 2407, such that the needle 2404 can be moved out of the first port 2435 of the suturing device 200 ID and into the second port 2436 of the suturing device 200 ID. In other words, the needle 2404 can be transferred between the ports 2435, 2436 by the muscle wire 2408 and the potential energy member 2410. In some embodiments, the first needle holding member 2403 and the second needle holding member 2407 can be fixed relative to each other. In some embodiments, the ports 2435, 2436 can be positioned in jaws of the suturing device 2001D. In some embodiments, the ports 2435, 2436 can be positioned in jaws of the suturing device 200 ID that are immovable, and therefore fixed with respect to each other. In some embodiments, similar to those discussed above, it should be appreciated that the muscle wire 2408 (FIG. 26B) and the potential energy member 2410 (FIG. 26B) can be positioned to directly apply a force on the needle 2404 or indirectly apply a force on the needle 2404. For instance, the muscle wire 2408 (FIG. 26B) and the potential energy member 2410 (FIG. 26B) can be positioned to indirectly apply a force on the needle 2404, for instance, through a needle carrier (not depicted) that is coupled to the needle 2404.

[0271] It should be appreciated that the features of any of the above-described embodiments of suturing devices and suturing systems can be combined in any desirable manner. For instance, any of the above-described embodiments of suturing devices can include a muscle wire as an actuator for a needle transfer mechanism. Any of the above-described embodiments of suturing devices can include a muscle wire as an actuator for jaw movement. Any of the above-described embodiments of suturing devices can include the fiber optic camera. Any of the above-described embodiments of suturing devices can include the electric field sensor. Any of the above-described embodiments of suturing devices can include piezo films. Any of the above-described embodiments of suturing devices can include any combination of the muscle wire as actuator for a needle transfer mechanism, muscle wire as actuator for jaw movement, fiber optic camera, electric field sensor, and / or the piezo films. It should be appreciated that the muscle wire as actuator for a needle transfer mechanism, muscle wire as actuator for jaw movement, fiber optic camera, electric field sensor, and / or the piezo films (alone or together in any combination) can be incorporated into suturing devices including a needle transfer mechanism similar to that described in PCT ApplicationNo. PCT / TR2022 / 050959. It should be appreciated that the muscle wire as actuator for a needle transfer mechanism, muscle wire as actuator for jaw movement, fiber optic camera, electric field sensor, and / or the piezo films (alone or together in any combination) can be incorporated into suturing devices that include a needle transfer mechanism that does not transfer a needle between two jaws, such as the suturing device 2001D. It should be appreciated that the muscle wire as actuator for a needle transfer mechanism, muscle wire as actuator for jaw movement, fiber optic camera, electric field sensor, and / or the piezo electric films (alone or together in any combination) can be incorporated into suturing devices, such as those disclosed in U.S. Patent No. 7,048,749, U.S. Patent No. 6,475,135, U.S. Patent No. 11,369,365, U.S. Patent No. 8,034,060, and U.S. Patent No. 8,545,521.

[0272] FIG. 14A depicts a flow chart of a method 2900 for using the suturing device 2001A or 2001B. At step 2902, the method 2900 can include providing the suturing device 2001 A or suturing device 200 IB. It is contemplated that method 2900 can be performed with any embodiment of the suturing device discussed herein. The shape of the suturing device and the angle between the jaws and arms can be optimal for certain procedures or tissues. For example, the angles can be optimized for safety to prevent hurting other tissues such as bladder. The operator can select the suturing device 2001A or the suturing device 2001B based on the treatment site to be sutured. For example, the operator can select among suturing devices based on the tissue to be sutured.

[0273] At a step 2904 of the method 2900, a user can load the needle 2201 into the suturing device 2001A. In some embodiments, as discussed above, the user can selectively enter a load-unload mode, through actuation of the input 271 IB for instance, and actuate the first muscle wire 2027A or the second muscle wire 2027B via one or more inputs (e.g. the button 2604A) to load the needle 2201 into the suturing device 2001A. In some embodiments, the user can connect the attachment member 2106A or the attachment member 2106B with a preloaded needle 2201 to the suturing device 2001A. The needle 2201 can be loaded into the first grasping slot 2103 of the fixed jaw 2005 or the second grasping slot 2104 of the movable jaw 2006. To retain the needle 2201 in the first grasping slot 2103 of the fixed jaw 2005, for instance, the first muscle wire 2027A is not energized with an electric current such that the first grasping member 2024A is maintained in a receptacle (e.g., the receptacle 2207 A) of the needle 2201.

[0274] At a step 2906 of the method 2900, a user can move the suturing device 2001A into a cavity of a patient. In some embodiments, the cavity can be a vaginal cavity. In some embodiments, the cavity is a pelvic cavity. In some embodiments, the user can move the suturing device 2001 A into the cavity while the movable jaw 2006 of the suturing device 2001 A is closed relative to the fixed jaw 2005 of the suturing device 2001 A.

[0275] At a step 2908 of the method 2900, a user can open the movable arm 2008 relative to the fixed arm 2007 to open the movable jaw 2006 until the tissue in the cavity is between the fixed jaw 2005 and the movable jaw 2006. After opening the movable jaw 2006, the user can position the fixed jaw 2005 on-the tissue to be sutured. It should be appreciated that the handle 2002 A and the handle 2002B of the suturing device 2001 A can remain outside the cavity during operation to ease user manipulation of the handles 2002A, 2002B. The movement of the movable arm 2008 in the cavity can cause the movable jaw 2006 to pivot about the jaw joint 2100 inside the cavity. Because the movable arm 2008 can cause the movable jaw 2006 to move while the fixed jaw 2005 and the fixed arm 2007 can remain in the same position, the user can predict where the needle 2201 would be suturing, which allows the user to more safely suture tissue that is difficult to see or not visible at all.

[0276] At a step 2910 of the method 2900, a user can close the movable jaw 2006 to move the needle 2201 through the tissue. While the movable jaw 2006 moves, the fixed jaw 2005 can provide a fixed reference, and the tissue inside the cavity to be sutured can be placed between the fixed jaw 2005 and the movable jaw 2006. By moving the movable jaw 2006 relative to the fixed jaw 2005, the needle 2201 is passed through the tissue. While the location where the suturing is required might be in a narrow, deep area that is difficult to see or not visible at all for the operator, the needle 2201 can suture in the desired location because the movement of the movable jaw 2006 is predictable and precise while the fixed jaw 2005 remains stationary with respect to the target tissue. The user can close the movable arm 2008 relative to the fixed arm 2007 to close the movable jaw 2006 relative to the fixed jaw 2005.

[0277] At a step 2912 of the method 2900, the user can actuate the needle transfer mechanism 2004 to transfer the needle 2201 from the fixed jaw 2005 to the movable jaw 2006 to pass the suture. The user can operate the needle transfer mechanism 2004 according to any of the above-described operating modes.

[0278] Referring to FIG. 14B, a suturing device performing sub-steps of the step 2912 of the method 2900 is depicted. Operation of the needle transfer mechanism 2004 in the single button semi-automatic mode is shown. At a step 2914, the user can actuate an input (e.g., the button 2604A). Actuation of the button 2604 A will selectively energize or de-energize the muscle wires 2027A, 2027B based on which jaw 2005, 2006 the needle 2201 is retained in prior to actuation of the button 2604A. In the current example, single actuation of the input first causes the second muscle wire 2027B to be de-energized, causing the second muscle wire 2027B to lengthen and the second spring 2022B to transition to the semi-compressed state, which causes the second grasping member 2024B to extend into the second grasping slot 2104 of the movable jaw 2006 and press into the receptacle 2207B of the needle 2201. The needle 2201 is then grasped and retained in the second grasping slot 2104. The single actuation of the input then causes the first muscle wire 2027A coupled to the first pull wire 2021 A and the first grasping member 2024 A in the fixed jaw 2005 to be energized, such that the first muscle wire 2027A shortens and a proximal pull force is applied to the first pull wire 2021 A and the first grasping member 2024 A. The force retracts the first grasping member 2024 A from the receptacle 2207 A of the needle 2201, releasing the needle 2201 from the first grasping slot 2103 of the fixed jaw 2005.

[0279] Referring to FIG. 14C, a suturing device performing sub-steps of the step 2912 of the method 2900 is depicted. Operation of the needle transfer mechanism 2004 in the dual button semi-automatic mode is shown. At a step 2916, the user can actuate one input of multiple inputs 2604. Particularly, with the needle 2201 first grasped in the fixed jaw 2005, the user selects the input for transfer of the needle 2201 from the fixed jaw 2005 to the movable jaw 2006. Single actuation of the input first causes the second muscle wire 2027B to be de-energized, causing the second muscle wire 2027B to lengthen and the second spring 2022B to transition to the semi-compressed state, which causes the second grasping member 2024B to extend into the second grasping slot 2104 of the movable jaw 2006 and press into the receptacle 2207B of the needle 2201. The needle 2201 is then grasped and retained in the second grasping slot 2104. The single actuation of the input then causes the first muscle wire 2027 A coupled to the first pull wire 2021 A and the first grasping member 2024 A in the fixed jaw 2005 to be energized, such that the first muscle wire 2027A shortens and a proximal pull force is applied to the first pull wire 2021 A and the first grasping member 2024 A. The force retracts the first grasping member 2024 A from the receptacle 2207 A of the needle 2201, releasing the needle 2201 from the first grasping slot 2103 of the fixed jaw 2005.

[0280] Referring to FIG. 14D, a suturing device performing sub-steps of the step 2912 of the method 2900 is depicted. Operation of the needle transfer mechanism 2004 in the automatic mode is shown. At a step 2918, the user can, with the handles 2002A, 2002B closed, apply an additional force to the handles 2002A, 2002B until the force sensor 2804 measures the threshold force. Once the threshold force is applied to the handles 2002A, 2002B, the muscle wires 2027A, 2027B are selectively energized or de-energized based on which jaw 2005, 2006 the needle 2201 is retained in prior to the threshold force being applied. In the current example, measurement of the threshold force causes the second muscle wire 2027B to be de-energized, causing the second muscle wire 2027B to lengthen and the second spring 2022B to transition to the semi-compressed state, which causes the second grasping member 2024B to extend into the second grasping slot 2104 of the movable jaw 2006 and press into the receptacle 2207B of the needle 2201. The needle 2201 is then grasped and retained in the second grasping slot 2104. Following this, the first muscle wire 2027A coupled to the first pull wire 2021 A and the first grasping member 2024 A in the fixed jaw 2005 is energized, such that the first muscle wire 2027A shortens and a proximal pull force is applied to the first pull wire 2021 A and the first grasping member 2024A. The force retracts the first grasping member 2024 A from the receptacle 2207 A of the needle 2201, releasing the needle 2201 from the first grasping slot 2103 of the fixed jaw 2005.

[0281] Referring again to FIG. 14A, the steps 2908, 2910, and 2912 of the method 2900 can be repeated in sequence as many times as desired. For instance, following the step 2912 discussed above, the jaws 2005,2006 of the suturing device 2001A can be opened, moved to a second site, and closed, and the user can actuate the needle transfer mechanism 2004 to release the needle 2201 from the grasping slot 2104 of the movable jaw 2006 and to grasp and retain the needle 2201 in the grasping slot of the fixed jaw 2005 through the similar actuation steps as those described with respect to the step 2912.

[0282] Referring to FIG. 14E a flow chart of a method 2920 for using the suturing device 2001C or the suturing device 2001E is depicted. At step 2922, the method 2920 can include providing the suturing device. It is contemplated that method 2920 can be performed with any embodiment of the suturing device 2001C or the suturing device 2001E discussed herein. The shape of the suturing device 2001C or 200 IE can be optimal for certain procedures or tissues. For example, the angles of the body 2302 and / or the angles of the jaws 2005A,2006A or 2005B, 2006B relative the body 2302 can be optimized for safety to prevent hurting other tissues such as bladder.

[0283] At a step 2924, a user can load the needle 2201 into the suturing device 2001C or the suturing device 2001E. In some embodiments, as discussed above, the user can selectively enter a load-unload mode, through actuation of the input 2303 for instance, causing the muscle wire 2320A and / or the muscle wire 2320B to be energized to load the needle 2201 into the suturing device 2001C or the suturing device 2001E. In some embodiments, the user can connect the attachment member 2106 A or the attachment member 2106B with a preloaded needle 2201 to the suturing device 2001C or the suturing device 2001E. The needle 2201 can be loaded into the grasping slot of the fixed jaw 2005A, 2005B or the grasping slot of the movable jaw 2006A, 2006B. To retain the needle 2201 in the grasping slot of the fixed jaw 2005A, 2005B, for instance, the muscle wire 2320A is not energized with an electric current such that the grasping member 2316A is maintained in a receptacle (e.g., the receptacle 2207 A) of the needle 2201.

[0284] At a step 2926 of the method 2920 a user can move the suturing device 2001C or the suturing device 200 IE into a cavity of a patient. In some embodiments, the cavity can be a vaginal cavity. In some embodiments, the cavity is a pelvic cavity. In some embodiments, the user can move the suturing device 2001C into the cavity while the movable jaw 2006A of the suturing device 2001C is closed relative to the fixed jaw 2005A of the suturing device 2001C. In some embodiments, the user can move the suturing device 2001E into the cavity while the movable jaw 2006B of the suturing device 2001E is closed relative to the fixed jaw 2005B of the suturing device 2001E.

[0285] In a step 2928 of the method 2920, a user can open the movable jaw 2006A, 2006B until the tissue in the cavity is between the fixed jaw 2005A, 2005B and the movable jaw 2006A, 2006B. More specifically, with reference to the suturing device 2001C, the user can actuate an input, such as the input 2304, to move the movable jaw 2006A proximally or away from the fixed jaw 2005A by de-energization of the muscle wire 2327. With reference to the suturing device 2001E, the user can actuate an input, such as the input 2304, to rotate the movable jaw 2006B away from the fixed jaw 2005B by de-energization of the muscle wire 2527 After opening the movable jaw 2006A, 2006B the user can position the fixed jaw 2005A, 2005B on the tissue to be sutured. It should be appreciated that the handle 2306 of the suturing device 2001C or the suturing device 2001E can remain outside the cavity duringoperation to ease user manipulation of suturing device 2001C or the suturing device 2001E. Because the movable jaw 2006A moves linearly in the linear guide 2337 and the fixed jaw 2005 A remains stationary, the user can predict where the needle 2201 would be suturing, which allows the user to more safely suture tissue that is difficult to see or not visible at all. Similarly, because the movable jaw 2006B rotates with respect to the jaw joint 2100 and the fixed jaw 2005B remains stationary, the user can predict where the needle 2201 would be suturing, which allows the user to more safely suture tissue that is difficult to see or not visible at all.

[0286] In a step 2930 of the method 2920, a user can close the movable jaw 2006A, 2006B to move the needle 2201 through the tissue. Particularly, with respect to the suturing device 2001C, a user can actuate an input, such as the input 2304, to energize the muscle wire 2327 to move the movable jaw 2006A distally along the linear guide 2337 toward the fixed jaw 2005A. With respect to the suturing device 2001E, a user can actuate an input, such as the input 2304, to energize the muscle wire 2527 to pivot the movable jaw 2006B toward the fixed jaw 2005B. While the movable jaw 2006A, 2006B moves, the fixed jaw 2005A, 2005B can provide a fixed reference, and the tissue inside the cavity to be sutured can be placed between the fixed jaw 2005A, 2005B and the movable jaw 2006A, 2006B. By moving the movable jaw 2006A, 2006B relative to the fixed jaw 2005A, 2005B, the needle 2201 is passed through the tissue. While the location where the suturing is required might be in a narrow, deep area that is difficult to see or not visible at all for the operator, the needle 2201 can suture in the desired location because the movement of the movable jaw 2006A, 2006B is known and precise along the linear guide 2337 or rotated about the jaw joint 2100 while the fixed jaw 2005A, 2005B remains stationary with respect to the target tissue.

[0287] In a step 2932 of the method 2920, the user can actuate the needle transfer mechanism to transfer the needle 2201 from the fixed jaw 2005A, 2005B to the movable jaw 2006A, 2006B to pass the suture. Particularly, the user can actuate an input (e.g. the input 2307) to transfer the needle 2201. Single actuation of the input first causes the muscle wire 2302B to be de-energized, causing the muscle wire 2320B to lengthen and the elastomer member 2318B to transition to the semi-compressed state, which causes the grasping member 2316B to extend into the grasping slot of the movable jaw 2006A, 2006B and press into the receptacle 2207B of the needle 2201. The needle 2201 is then grasped and retained in the grasping slot of the movable jaw 2006A, 2006B. The single actuation of the input then causesthe muscle wire 2320A coupled to the grasping member 2316A in the fixed jaw 2005 A, 2005B to be energized, such that the muscle wire 2320A shortens and a proximal pull force is applied to the grasping member 2316A. The force retracts the grasping member 2316A from the receptacle 2207 A of the needle 2201, releasing the needle 2201 from the grasping slot of the fixed jaw 2005A, 2005B.

[0288] The steps 2928, 2930, and 2932 of the method 2920 can be repeated in sequence as many times as desired. For instance, following the step 1612 discussed above, the jaws 2005A, 2006A of the suturing device 2001C, or the jaws 2005B, 2006B of the suturing device 2001E, can be opened, moved to a second site, and closed, and the user can actuate the needle transfer mechanism to release the needle 2201 from the grasping slot of the movable jaw 2006 A, 2006B and to grasp and retain the needle 2201 in the grasping slot of the fixed jaw 2005A, 2005B through the similar actuation steps as those described with respect to the step 2932.

[0289] Now referring generally to the suturing device 2001A, 2001B, and 2001C. The suturing devices can be used for pelvic floor disorders’ treatment, such as the treatment of SUI and POP. For example, the suturing devices can be angled for transvaginal approaches or procedures. In another example, the suturing devices can be a minimally invasive operation device of the vaginal wall or uterine prolapse in women. The suturing devices can include various sizes, shapes, and angles calculated and optimized based on the pelvis anatomy for which the suturing device is to be used. The optimal size and shape enable the suturing devices to safely access target tissues for each device for their specified surgeries. The angled design of the suturing devices enables the tip of the devices to reach the target pelvic structures to be sutured via vaginal route. The angled design and sizes prevent unintended contact with other tissues. The shape of the suturing devices can improve performance and provides safety and ease of reach to target tissues by preventing unintended tissue injuries. The suturing devices can be minimally invasive, disposable or non-disposable, sterile, and for single use or multiple-use.

[0290] The suturing devices can be a transvaginal device to place sutures in tissues at the operative site during the pelvic floor surgery in women (e.g., to treat stress urinary incontinence or pelvic organ prolapse, which is the bulging of pelvic organs such as bladder, rectum and uterus into the vagina and past the vaginal opening). The suturing devices can be transvaginal devices used with a single incision, which can be advantageous over abdominaland a plurality of incisions. The suturing devices can be used for consistent placement of sutures in difficult to access locations, such as those that are narrow and not visible. The suturing devices can be a one-step suturing device with an operating mechanism that enables the needle to be caught safely at the opposite jaw.

[0291] The suturing devices can suture the specified tissue to vesicovaginal fascia at the level of bladder neck to elevate the bladder outlet to its normal position. The suturing devices can be ergonomic and shaped to perform the vaginal native tissue repair procedure for stress urinary incontinence. The suturing devices can be designed for the surgical treatment of stress urinary incontinence in women to facilitate the consistent placement of sutures in difficult to access locations (narrow and not visible). The suturing devices can be designed for regaining anterior vaginal support or vaginal colposuspension procedure. The suturing devices can be used in difficult to access general suturing applications during urogynecological procedures, including but not limited to stress urinary incontinence procedures, to assist in the placement of sutures at the operative site.

[0292] The suturing devices can enable the operator to perform surgery via the vagina (e.g., transvaginal route as opposed to abdominal operations) in a minimally invasive way (e.g., single vaginal incision only). The suturing devices can be used for single vaginal incision native tissue repair via stitching vaginal wall to the pelvic floor supportive structures (to assist the placement of sutures in ligaments on to the pelvic floor supportive structures). The suturing devices can be used by an operator (e.g., surgeon) with sensory and / or direct visual control. The suturing device can be designed to enable the operator to perform a native tissue repair, without the placement of an artificial implant (as opposed to mid-urethral sling technique which requires the placement of a synthetic sling / mesh or transvaginal mesh operations).

[0293] The suturing devices can be designed to be safely inserted into the cavity. The safety of the suturing devices can be derived from the length of the suturing devices. For example, the lengths (of the arms 2007 and 2008 and jaws 2005 and 2006) and angles of the suturing devices can contribute to safety outcomes described herein, and as such the lengths and angles can be designed to not damage the vagina or the incision. In another example, because the entrance point of the suturing device into the body is through the vagina but the entrance to the operating site is through the incision which is opened at the wall of the vagina, the operator can insert the suturing device into the pelvic cavity where the ATFP is located. Forexample, for stress incontinence operations done with the suturing device, the suturing device does not need to be inserted beyond the ATFP, which is the anatomical landmark used to determine the length of the suturing device. Even if the suturing device is positioned in the vagina past the arm joint, the length of the suturing devices enables the widening of the suturing device caused by the opening of the handle to not affect the incision.

[0294] The suturing devices can facilitate the consistent and sequential placement of sutures (e.g., making multiple sutures with the same needle; also called Z- suture or 8-figure suture) onto the pelvic floor structures, which are in difficult to access locations during pelvic floor surgery. The suturing devices can be designed to facilitate the consistent placement of sutures in difficult to access locations (deep, narrow, and not visible operating site) during transvaginal prolapse surgery (as opposed to abdominal surgery). The suturing devices can suture the specified tissue to the apical vaginal wall or cervix uteri in order to provide vaginal apex elevation.

[0295] The suturing devices can be used for a transvaginal minimally invasive procedure. The suturing devices can be designed for vaginal wall or uterine prolapse surgery based on native tissue repair in women with pelvic organ prolapse (sagging of pelvic organs such as bladder, uterus or bowel into the vagina). The suturing devices can be designed to enable the operator to perform a native tissue repair, without the placement of an artificial implant (as opposed to operations requiring the placement of synthetic mesh). The suturing devices can enable operators to perform surgery via the vagina in a minimally invasive way, such as with just a single incision. The suturing devices can be used in difficult to access general suturing applications during urogynecological procedures, including but not limited to transvaginal pelvic organ prolapse procedures, to assist in the placement of sutures at the operative site. The suturing devices can be used with sensory and / or direct visual control.

[0296] While one or more embodiments of the present disclosure have been described, it is understood that these embodiments are illustrative only, and not restrictive, and that many modifications may become apparent to those of ordinary skill in the art, including that various embodiments of the inventive methodologies, the illustrative systems and platforms, and the illustrative devices described herein can be utilized in any combination with each other. Further still, the various steps may be carried out in any desired order (and any desired steps may be added, and / or any desired steps may be eliminated).

[0297] Now referring generally to FIG. 29A and FIG. 29B, the suturing device 4001A can be scissor-shaped and ergonomically sized to reach target tissues in a tight space. The suturing device 4001 A can include a fixed arm 4007 integral with a fixed jaw 4005. In some embodiments, a distal end of the fixed arm 4007 includes the fixed jaw 4005. The suturing device 4001 A can include a movable arm 4008 coupled to a movable jaw 4006.

[0298] The fixed jaw 4005 and the moveable jaw 4006 can both receive and grasp a needle, and the suturing device 4001 A can also include a needle transfer mechanism 4004 to transfer the needle between the fixed jaw 4005 and the movable jaw 4006. The needle transfer mechanism 4004 may include a lever 4003 for controlling the transfer of the needle between the fixed jaw 4005 and the moveable jaw 4006. In some embodiments, the lever 4003 extends from the fixed arm 4007.

[0299] In some embodiments, the suturing device 4001A can include a first handle 4002A coupled to the fixed arm 4007 and a second handle 4002B coupled to the movable arm 4008. The handle 4002A and the handle 4002B can aid the user in moving the moveable arm 4008 relative to the fixed arm 4007. The handle 4002A and the handle 4002B can be disposed at the end of the suturing device 4001 A that remains outside of the cavity during the operation such that the operator can control the suturing device 4001A.

[0300] FIG. 30A and FIG. 30B depict an embodiment of the suturing device 4001A. In some embodiments, the fixed jaw 4005 includes a first grasping slot 4103 that can receive the needle 4201 (further described in reference to FIG. 33B). In some embodiments, the movable jaw 4006 includes a second grasping slot 4104 that can receive the needle 4201. In some embodiments, the grasping slots are channel sized and shaped to receive the needle. For example, the grasping slots can define a round channel or a round hole for receiving and grasping the needle.

[0301] In some embodiments, the needle transfer mechanism 4004 can transfer the needle between the first grasping slot 4103 and the second grasping slot 4104. To that end, the needle transfer mechanism can secure the needle in the first grasping slot 4103 or the second grasping slot 4104, or to release the needle from the first grasping slot 4103 or the second grasping slot 4104.

[0302] FIGS. 31A-31E show an embodiment of a mechanism for moving the movable arm 4008 to pivot relative to the fixed arm 4007 to pivot the movable jaw 4006 relative to thefixed jaw 4005. As shown in FIG. 31 A, the movable arm 4008 can have an arm movement 4105 along which the movable arm 4008 pivots away or towards the fixed arm 4007. For example, the arm movement 4105 can be caused by a surgeon’s manual movement of handle 4002A to open and close the device 4001A. This control can be advantageous while operating in invisible areas to make sure that movement of the device 4001A can be under the operator’s control. In some embodiments, the arm movement 4105 can be caused by additional mechanical force elements such as a spring.

[0303] The fixed arm 4007 can remain immovable relative to the movable arm 4008 while the movable arm 4008 moves. The movable arm 4008 can pivot relative to the fixed arm 4007 to pivot the movable jaw 4006 relative to the fixed jaw 4005. The movement of the moveable arm 4008 relative to the fixed arm 4007 can enable the movable jaw 4006 to have a jaw movement 4107 along which the movable jaw 4006 can pivot away or towards the fixed jaw 4005. The fixed jaw 4005 can remain immovable relative to the movable jaw 4006 while the movable jaw 4006 moves. In some embodiments, the movable arm 4008 and the movable jaw 4006 move relative to the fixed arm 4007. In some embodiments, the movable arm 4008 and the movable jaw 4006 move relative to the fixed jaw 4005. In some embodiments, the movable arm 4008 and the movable jaw 4006 move relative to each other. In some embodiments, the fixed arm 4007 and the fixed jaw 4005 do not move. In some embodiments, the fixed jaw 4005 cannot move independently of the fixed arm 4007 because the fixed arm 4007 is integral with the fixed jaw 4005.

[0304] The fixed jaw 4005 can make it easier to work safely in narrow spaces because having the fixed jaw 4005 remain stationary with respect to the target tissue allows the sutures to be placed while staying in a safe area. For example, when an operator moves the movable jaw 4006 relative to the fixed jaw 4005, the operator would know the location of the fixed jaw 4005. When the target tissue is referenced with the fixed jaw 4005 at an operating place that is difficult to see or not visible at all, the fixed jaw 4005 enables the suture to pass through the targeted tissue. The fixed jaw 4005 and the movable jaw 4006 can come together at a constant or predictable location with respect to the tissue such that the location and distance does not need to be predicted continuously to center the tissue. Thus, the fixed jaw 4005 enables suturing in areas that are difficult to see.

[0305] As shown in FIG. 3 IB, in some embodiments, the movable arm 4008 can be pivoted relative to the fixed arm 4007 to pivot the movable jaw 4006 relative to the fixed jaw 4005.The movable arm 4008 can pivot the movable jaw 4006 relative to the fixed jaw 4005 until the needle 4201 is received in both the first grasping slot 4103 and the second grasping slot 4104 to exchange the needle between the slots.

[0306] The lever 4003 can move between one or more positions to control the function of the first and second grasping slots. As shown in FIGS. 31A-31E, in some embodiments, the lever 4003 can move among a first position 4110A, a second position 4110B, or a third position 4110C to control the securing and releasing of both the first grasping slot 4103 and the second grasping slot 4104. For example, the lever 4003 can be a shifter, grip, or switch that can be moved by the operator. In the first position 4110A, the needle 4201 is secured in the first grasping slot 4103 of the fixed jaw 4005. As shown in FIG. 31 A, when the movable arm 4008 is moving or open, the needle transfer mechanism 4004 can grasp of the needle 4201 in the fixed jaw 4005 while keeping the grasping inactive in the movable jaw 4006. As shown in FIG. 3 IB, when the movable arm 4008 is adjacent to the fixed arm 4007, the needle transfer mechanism 4004 can grasp the needle 4201 in the fixed jaw 4005 while keeping the grasping inactive in the movable jaw 4006 by keeping the lever 4003 in the first position 4110A.

[0307] As shown in FIG. 31C, the lever 4003 can then be moved to the second position 4110B, so the needle 4201 is released from the first grasping slot 4103, while still unsecure in the second grasping slot 4104. As shown in FIG. 31C, the needle transfer mechanism 4004 can be inactive in both the fixed jaw 4005 and the movable jaw 4006 to release the needle 4201.

[0308] As shown in FIG. 3 ID, in the third position 4110C, the needle 4201 is secured in the second grasping slot 4104. As shown in FIG. 3 ID, the needle transfer mechanism 4004 can grasp of the needle 4201 in the movable jaw 4006 while keeping the grasping inactive in the fixed jaw 4005. As shown in FIG. 3 IE, when the moveable jaw 4006 pivots away from the fixed jaw 4005 by the movement of the moveable arm 4008, the needle is secured in the moveable jaw 4006, thus completing the transfer of the needle between the fixed jaw 4005 and the moveable jaw 4006. As shown in FIG. 3 IE, when the movable arm 4008 is moving or open, the needle transfer mechanism 4004 can grasp of the needle 4201 in the movable jaw 4006 while keeping the grasping inactive in the fixed jaw 4005.

[0309] Referring generally to FIGS. 31A-31E, in some embodiments, the suturing device 4001A further includes a cover 4108 partially disposed over the lever 4003. The lever 4003 can move among the positions to set the first position 4110A, the second position 4110B, or the third position 4110C. In some embodiments, the cover 4108 includes ticks, indents, or indicators corresponding to movements of the lever 4003 to the first position 4110A, the second position 4110B, or the third position 4110C.

[0310] FIGS. 32A-32C depict an embodiment mechanism of the suturing device 4001A for the movement of the moveable arm 4008 relative to the fixed arm 4007 to enable the movable jaw 4006 to have the jaw movement 4107 along which the movable jaw 4006 pivots away or towards the fixed jaw 4005. In some embodiments, the fixed arm 4007 can include an arm joint 4101 to couple the fixed arm 4007 to the movable arm 4008. For example, the arm joint4101 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the arm joint 4101 enables the movement of the moveable arm 4008 relative to the fixed arm 4007. For example, the movable arm 4008 can pivot about the arm joint 4101 and relative to the fixed arm 4007. In another example, the arm joint 4101 can allow the movable arm 4008 to pivot relative to the fixed arm 4007 in one degree of freedom. In yet another example, the arm joint 4101 can restrict some movement of the movable arm 4008, such as to prevent the movable arm 4008 from breaking or exerting excessive force on the movable jaw 4006, the slots, or any other component described herein.

[0311] In some embodiments, the fixed arm 4007 includes a jaw joint 4100. In some embodiments, the fixed jaw 4005 includes the jaw joint 4100. The jaw joint 4100 is coupled to the movable jaw 4006 so that the movable jaw 4006 can pivot relative to the fixed jaw 4005. For example, the jaw joint 4100 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the movable jaw 4006 can pivot about the jaw joint 4100 and relative to the fixed jaw 4005. For example, the jaw joint 4100 can allow the movable jaw 4006 to pivot relative to the fixed jaw 4005 in one degree of freedom. In another example, the jaw joint 4100 can restrict some movement of the movable jaw 4006, such as to prevent the movable jaw 4006 from breaking or exerting excessive force on the fixed jaw 4005, the slots, or any other component described herein.

[0312] In some embodiments, the suturing device 4001A further includes a connecting joint4102 coupled to the movable arm 4008 and the movable jaw 4006. The connecting joint 4102can be positioned between the jaw joint 4100 and the arm joint 4101 such that the jaw joint 4100 and the arm joint 4101 are decoupled and mechanically independent from each other. The connecting joint 4102 can allow movement of the movable arm 4008 to pivot the movable jaw 4006. For example, the connecting joint 4102 can be a mechanical joint for connecting two components and allowing them to move relative to each other. In some embodiments, the movable arm 4008 can physically move the connecting joint 4102 to cause the movable jaw 4006 to pivot about the jaw joint 4100. Movement of the movable arm 4008 can move the connecting joint 4102 to pivot the movable jaw 4006 about the jaw joint 4100. For example, as shown in FIG. 32B and FIG. 32C, movement of the movable arm 4008 away from the fixed arm 4007 causes the connecting joint 4102 to move across the width of the fixed arm 4007. The connecting joint 4102 pulls on the movable jaw 4006, which causes the movable jaw 4006 to pivot about the jaw joint 4100 and away from the fixed jaw 4005.

[0313] In some embodiments, the connecting joint 4102 can restrict some movement of the movable jaw 4006 and the movable arm 4008, such as to prevent them from disconnecting or exerting excessive force on the slots or any other component described herein. For example, the connecting joint 4102 can be restricted to movements along the width of the fixed arm 4007, which would prevent from excessive movements of the movable jaw 4006 and the movable arm 4008. In some embodiments, the part of the fixed arm 4007 between the jaw joint 4100 and the arm joint 4101 can remain in a fixed position while the movable jaw 4006 moves inside the pelvic cavity and the movable arm 4008 moves outside the vaginal cavity. Such movements can advantageously reduce the profile of the movable jaw 4006 and the movable arm 4008.

[0314] In some embodiments, the fixed arm 4007 includes a reference location (or reference body) 4009 comprising the jaw joint 4100, the arm joint 4101, and the connecting joint 4102. The pivoting movements of the movable arm 4008 and the movable jaw 4006 about the reference location 4009 enable the suturing device 4001A to move like a scissors-type mechanism. For example, the suturing device 4001A can be comprised of 3 rigid metal parts (e.g., (1) fixed jaw 4005 integral with the fixed jaw 4005, (2) the movable arm 4008, and (3) the movable jaw 4006) that are attached to each other with the three joints 4100-4102. The movable jaw 4006 and the movable arm 4008 can move with respect to each other and the fixed arm 4007 and fixed jaw 4005 about the reference location 4009 in 2D space as described above. In some embodiments, the movable arm 4008 pivots about the referencelocation 4009 and relative to the fixed arm 4007. In some embodiments, the movable jaw 4006 pivots about the reference location 4009 and relative to the fixed arm 4005.

[0315] For example, during the operation of the suturing device 4001 A inside the pelvic cavity, in order to perform the stitching at the correct location, the fixed arm 4007, whose outer contour can be designed accordingly, can be aligned with the specific area of the pelvic cavity and becomes fixed with respect to this specific area of the pelvic cavity while the jaw joint 4100, the arm joint 4101, and the connecting joint 4102 enable the operator to move the handle 4002A to move the movable arm 4008 to move the movable jaw 4006. By keeping the fixed arm 4007 fixed in position, the jaws 4005 and 4006 can be correctly positioned for suturing.

[0316] FIGS. 33A-33I depict embodiments of the needle 4201. The needle 4201C, the needle 4201D, and the needle 4201E (generally referred to as needle 4201) can include a first notch 4207A and a second notch 4207B. The position of the first notch 4207A and the second notch 4207B on the needle 4201 enable the needle 4201 to be grasped within the first grasping slot 4103 or the second grasping slot 4104, or both. For example, the first notch 4207 A can be attached to the fixed jaw 4005 and the second notch 4207B can be attached to the movable jaw 4006.

[0317] As shown in FIG. 33A, the needle 4201 can be a needle 4201C that has a concave shape. FIG. 33B, FIG. 33C, FIG. 33D, and FIG. 33E depict an embodiment of a needle 420 ID that has a straight shape. In some embodiments, the needle 4201C and the needle 4201D can include a hole 4208. In some embodiments, the hole 4208 can be used for needlethread joining by drilling a hole in the middle of the needle 4201C or the needle 4201D, inserting the thread (e.g., thread 4016) into the hole 4208, and deforming the hole 4208 with the help of a suitable die geometry attached to a press. In some embodiments, the needle 4201 and the thread 4016 can be joined by using a proper adhesive instead of deforming the hole 4208.

[0318] FIG. 33F, FIG. 33G, FIG. 33H, and FIG. 331 depict an embodiment of a needle 4201E that includes a channel 4209. It will be understood that other needles (including straight and curved needles) described herein, such as the needle 4201C and the needle 4201D, can include a channel. The channel 4209 can be an open channel feature-based joining of the needle 4201 and thread 4016. The channel 4209 can be opened in the middleregion of the needle 4201E. A thread can be placed within the channel 4209, and the channel 4209 can be deformed onto the thread with the help of a suitable die geometry attached to a press. In some embodiments, the needle 4201 and the thread 4016 can be joined by using a proper adhesive instead of deforming the channel 4209.

[0319] FIG. 33J depicts an embodiment of the needle transfer mechanism 4004 of the suturing device 4001A. The needle transfer mechanism 4004 can enable the needle 4201 to be retained in or released from the jaws 4005 and 4006 with the help of back and forth moving flexible plates (e.g., the first control bar 4505A and the second control bar 4505B and / or the first grasping member 4510A and the second grasping member 4510B). These plates can be pulled or pushed by a control lever (e.g., lever 4003) attached to the plates. In some embodiments, the first control bar 4505 A, the second control bar 4505B, the first grasping member 4510A, and the second grasping member 4510B can be located in the fixed arm 4007. In some embodiments, the first control bar 4505 A, the second control bar 4505B, the first grasping member 4510A, and the second grasping member 4510B can be located in the fixed jaw 4005 and the fixed arm 4007.

[0320] In reference to FIG. 33J, the needle transfer mechanism 4004 includes the first control bar 4505 A and the second control bar 4505B. In some embodiments, the first control bar 4505A and the second control bar 4505B extend within respective channels in the fixed arm 4007. In some embodiments, the first control bar 4505A extends within a channel through the fixed jaw 4005. In some embodiments, the second control bar 4505B extends within a channel through the movable jaw 4006.

[0321] The control bars can advance or retract independently within their respective channels. In some embodiments, the first control bar 4505A can advance towards the first grasping slot 4103 and towards the first notch 4207 A or the second notch 4207B of the needle 4201 disposed in the first grasping slot 4103 to secure the needle 4201 in the first grasping slot 4103. In some embodiments, the first control bar 4505A can retract from the first grasping slot 4103 and the first notch 4207A or the second notch 4207B to release the needle 4201 from the first grasping slot 4103. In some embodiments, the second control bar 4505B can advance towards the second grasping slot 4104 and towards the first notch 4207A or the second notch 4207B of the needle 4201 disposed in the second grasping slot 4104 to secure the needle 4201 in the second grasping slot 4104. In some embodiments, the second control bar 4505B can retract from the second grasping slot 4104 and the first notch 4207A orthe second notch 4207B to release the needle 4201 from the second grasping slot 4104. For example, the control bars can be pulled within their respective channels.

[0322] The needle transfer mechanism 4004 can include a switching joint 4106 that is coupled to the lever 4003, the first control bar 4505 A, and the second control bar4505B. In some embodiments, the switching joint 4106 is disposed on the fixed arm 4007. Movement of the lever 4003 can cause movement of the switching joint 4106, which can cause movement of the first control bar 4505A and the second control bar 4505B to secure or release the needle 4201 in the first grasping slot 4103 or the second grasping slot 4104. For example, the switching joint 4106 can be a mechanical joint for connecting two components and allowing them to move relative to each other.

[0323] In some embodiments, the lever 4003 can rotate or move the switching joint 4106 to move the first control bar 4505A and the second control bar 4505B. For example, the lever 4003 can spin the switching joint 4106 and thus push or pull the control bars connected to the switching joint 4106. In this manner, the movement of the lever 4003 can advance the first control bar 4505A towards the first grasping slot 4103 while retracting the second control bar 4505B from the second grasping slot 4104 or retract the first control bar 4505A away from the first grasping slot 4103 while advancing the second control bar 4505B towards the second grasping slot 4104. For example, the switching joint 4106 is rotated clockwise by the lever 4003 such that the first control bar 4505A is retracted away from the first grasping slot 4103 and the second control bar 4505B is advanced towards the second grasping slot 4104. In another example, the switching joint 4106 is rotated counterclockwise by the lever 4003 such that the first control bar 4505A is advanced towards the first grasping slot 4103 and the second control bar 4505B is retracted away from the second grasping slot 4104.

[0324] FIG. 33K, FIG. 33L, and FIG. 33M depict an exploded view of an embodiment of the first control bar 4505 A and the second control bar 4505B, and the first grasping member 4510A and the second grasping member 4510B. In some embodiments, the first grasping member 4510A and the second grasping member 4510B extend within respective channels in the fixed arm 4007. In some embodiments, the first grasping member 4510A extends within a channel in the fixed jaw 4005. In some embodiments, the first grasping member 4510A extends within a channel in the movable jaw 4006.

[0325] In some embodiments, the control bars are linked or over molded onto a respective grasping member. For example, the first control bar 4505A and the first grasping member 4510A can be one bar such that the first grasping member 4510A is an extension of the first control bar 4505A. While not shown, in another example, it is contemplated that the first control bar 4505A and the first grasping member 4510A can be separate bars such that the first grasping member 4510A is coupled to the first control bar 4505A. As shown in FIG. 33M, the first grasping member 4510A (or the second grasping member 4510B) can bend relative to the first control bar 4505A (or the second control bar 4505B). The highly elastic nature of the first grasping member 4510A and the second grasping member 4510B allows them to move and function in the angled channels of the jaws 4005 and 4006.

[0326] Referring back to FIG. 33J, in some embodiments, the first control bar 4505A can advance the first grasping member 4510A towards the first notch 4207A or the second notch 4207B of the needle 4201 disposed in the first grasping slot 4103 to secure the needle 4201 in the first grasping slot 4103. For example, the first control bar 4505 A can be pushed towards the first grasping slot 4103. In this manner, the movement of the first control bar 4505A can cause the first grasping member 4510A to grasp the first notch 4207A or the second notch 4207B to grasp the needle 4201 in the first grasping slot 4103.

[0327] In some embodiments, the first control bar 4505A can retract the first grasping member 4510A from the first notch 4207A or the second notch 4207B to release the needle 4201 from the first grasping slot 4103. For example, the first control bar 4505A can be pulled away from the first grasping slot 4103. In this manner, the movement of the first control bar 4505A can cause the first grasping member 4510A to release the first notch 4207A or the second notch 4207B to release the needle 4201 from the first grasping slot 4103.

[0328] In some embodiments, the second control bar 4505B can advance the second grasping member 4510B towards the first notch 4207A or the second notch 4207B of the needle 4201 disposed in the second grasping slot 4104 to grasp the needle 4201 in the second grasping slot 4104. For example, the second control bar 4505B can be pushed towards the second grasping slot 4104. In this manner, the movement of the second control bar 4505B can cause the second grasping member 4510B to grasp the first notch 4207A or the second notch 4207B of the needle 4201 to grasp the needle 4201 in the second grasping slot 4104.

[0329] In some embodiments, the second control bar 4505 can retract the second grasping member 4510B from the first notch 4207A or the second notch 4207B to release the needle 4201 from the second grasping slot 4104. For example, the second control bar 4505B can be pulled away from the second grasping slot 4104. In this manner, the movement of the second control bar 4505B can cause the second grasping member 4510B to release the first notch 4207 A or the second notch 4207B to release the needle 4201 from the second grasping slot 4104. In some embodiments, the control bars or the grasping members have different lengths. For example, the first grasping member 4510A or the first control bar 4505A can be longer than the second grasping member 4510B or the second control bar 4505B because they must extend a greater distance to reach the first grasping slot 4103. In another example, the second grasping member 4510B or the second control bar 4505B can be longer than the first grasping member 4510A or the first control bar 4505A because they must be able to bend with the movable jaw 4006 that comprises the second grasping slot 4104.

[0330] The lever 4003 can move to the first position 4110A to move the switching joint 4106 to advance the first control bar 4505A to advance the first grasping member 4510A to grasp the needle 4201 in the first grasping slot 4103 and to retract the second control bar 4505B to retract the second grasping member 4510B to release the needle 4201 from the second grasping slot 4104. For example, as shown in FIG. 33 J, the lever 4003 can rotate the switching joint 4106 counterclockwise to move into the first position 4110A. In some embodiments, the lever 4003 can move to the first position 4110A to move the switching joint 4106 to advance the first control bar 4505A to advance the first grasping member 4510A to grasp the needle 4201 in the first grasping slot 4103. For example, as shown in FIG. 33 J, by moving the lever 4003 to the first position 4110A, the switching joint 4106 can be rotated in the counterclockwise direction, which can advance the first control bar 4505A to the left and retract the second control bar 4505B to the right such that the first control bar 4505A causes the first grasping member 4510A to grasp the needle 4201 in the first grasping slot 4103 and the second control bar 4505B causes the second grasping member 4510B to release the needle 4201 from the second grasping slot 4104. The lever 4003 can include the security notch 4515A of the suturing device 4001 to maintain the lever 4003 in the first position 4110A so that the lever 4003 is not accidently moved to a different position during use (e.g., during surgery).

[0331] The lever 4003 can move to the second position 4110B to move the switching joint 4106 to retract the first control bar 4505A to retract the first grasping member 4510A to release the needle 4201 from the first grasping slot 4103 and to retract the second control bar 4505B to retract the second grasping member 4510B to release the needle 4201 from the second grasping slot 4104. In some embodiments, the lever 4003 can move to the second position 4110B to move the switching joint 4106 to retract the first control bar 4505A to retract the first grasping member 4510A to release the needle 4201 from the first grasping slot 4103.

[0332] For example, as shown in FIG. 33J, if the lever 4003 is moved to second position 4110B from the first position 4110A, the switching joint 4106 can be rotated in the clockwise direction, which can partially retract the first control bar 4505A to the right and partially advance the second control bar 4505B to the left such that the first control bar 4505A and the second control bar 4505B are in an inactive position that prevents the first grasping slot 4103 and the second grasping slot 4104 from grasping the needle 4201.

[0333] In another example, as shown in FIG. 33J, if the lever 4003 is moved to the second position 4110B from the third position 4110C, the switching joint 4106 can be rotated in the counterclockwise direction, which can partially advance the first control bar 4505A to the left and partially retract the second control bar 4505B to the right such that the first control bar 4505A and the second control bar 4505B are in an inactive position that prevents the first grasping slot 4103 and the second grasping slot 4104 from grasping the needle 4201. The lever 4003 can include the security notch 4515B of the suturing device 4001 to maintain the lever 4003 in second position 4110B so that the lever 4003 is not accidently moved to a different position during use (e.g., during surgery).

[0334] The lever 4003 can move to the third position 4110C to move the switching joint 4106 to advance the second control bar 4505B to advance the second grasping member 4510B to grasp the needle 4201 in the second grasping slot 4104 and to retract the first control bar 4505A to retract the first grasping member 4510A to release the needle from the first grasping slot 4103. In some embodiments, the lever 4003 can move to the third position 4110C to move the switching joint 4106 to advance the second control bar 4505B to advance the second grasping member 4510B to grasp the needle in the second grasping slot 4104. For example, as shown in FIG. 33 J, by moving the lever 4003 to the third position 4110C from the second position 4110B, the switching joint 4106 can be rotated in the clockwise direction,which can retract the first control bar 4505A to the right and advance the second control bar 4505B to the left such that the first control bar 4505A causes the first grasping member 4510A to release the needle 4201 from the first grasping slot 4103 and the second control bar 4505B causes the second grasping member 4510B to grasp the needle 4201 in the second grasping slot 4104. The lever 4003 can include the security notch 4515C of the suturing device 4001 to maintain the lever 4003 in the third position 4110C so that the lever 4003 is not accidently moved to a different position during use (e.g., during surgery). In some embodiments, a lever can be used that has a first and second indicator rather than the three indicators described above. For example, a lever can include only position 4110A and position 4110C. At all positions of the lever between the positions 4110A, 4110C, the needle will stay grasped at both grasping slots and the stopper will not allow the needle transfer between jaws unless the handles are fully closed. It will be understood that any number of positions for the lever can be used. In some embodiments, the stopper can be optional.

[0335] Now referring to FIG. 33N, FIG. 330, and FIG. 33P, in some embodiments, the needle transfer mechanism 4004 includes a cable 4019A, a cable 4019B, a spring 4021A, and a spring 4021B. The cable 4019A and the cable 4019B can be attached to the lever 4003 with the stub 4025A and stub 4025B at the end of the cable 4019A and the cable 4019B. In some embodiments, the cable 4019A and the cable 4019B extend within respective channels in the fixed arm 4007. In some embodiments, the cable 4019A extends within a channel in the fixed jaw 4005. In some embodiments, the cable 4019B extends within a channel in the movable jaw 4006. In some embodiments, the spring 4021 A is located within the fixed jaw 4005. In some embodiments, the spring 402 IB is located within the movable jaw 4006.

[0336] The lever 4003 can be rotated along the switching joint 4106. There can be 3 distinct positions in which the lever 4003 can be rotated. The lever 4003 can be designed so that a predetermined amount of user-applied force is needed to change positions of the lever 4003. In some embodiments, the predetermined amount of user-applied force is based on the tension of the cable 4019A and the cable 4019B. The geometric features 4027 A, 4027B, 4031 A, 403 IB, 4029A, and 4029B of the fixed arm 4007 can be used to route the cable 4019A and the cable 4019B in an optimal path. The spring 4021A and the spring 4021B can be placed on the cylindrical piston 4023A and the cylindrical piston 4023B and retained by machine elements (e.g., machine element 4033B retains spring 4021B), which can include rings, pins, etc. or structural features such as protrusions. In some embodiments, thecylindrical piston 4023A is located within the fixed jaw 4005. In some embodiments, the cylindrical piston 4023B is located within the movable jaw 4006.

[0337] In some embodiments, a proximal end (e.g., proximal to the operator) of the pistons 4023A and 4023B are attached to the cables 4019A and 4019B, respectively. In some embodiments, a distal end of the pistons 4023A and 4023B can be designed and shaped to engage and grasp the needle 4201. In some embodiments, the distal end of the piston 4023A can be advanced to engage and grasp the needle 4201 in the fixed jaw 4005. In some embodiments, the distal end of the piston 4023A can be retracted to disengage and release the needle 4201 in the fixed jaw 4005. In some embodiments, the distal end of the piston 4023B can be advanced to engage and grasp the needle 4201 in the movable jaw 4006. In some embodiments, the distal end of the piston 4023B can be retracted to disengage and release the needle 4201 in the movable jaw 4006.

[0338] In some embodiments, the lever 4003 can be in a middle position (e.g., similar to the second position 4110B) as shown in FIG. 33N and FIG. 330. In the middle position, both cables 4019A and 4019B can be semi-pulled, both springs 4021A and 4021B can be semicompressed and both pistons 4023A and 4023B can be semi-retracted. In some embodiments, when the pistons 4023A and 4023B are semi-retracted, the pistons 4023A and 4023B are disengaged from the needle 4201 such that the needle 4201 can be released from both the fixed jaw 4005 and the movable jaw 4006. In some embodiments, when the pistons 4023A and 4023B are semi-retracted, the pistons 4023 A and 4023B engage the needle 4201 such that the needle 4201 is secured in both the fixed jaw 4005 and the movable jaw 4006. In some embodiments, with the jaws 4005 and 4006 in the closed position (e.g., moveable jaw 4006 moved towards the fixed jaw 4005), the needle 4201 can be retained by both jaws 4005 and 4006 and the suturing device (e.g., device 4001A or 4001B) can be locked.

[0339] In some embodiments, the lever 4003 can be in a forward position (e.g., similar to the first position 4110A). In the forward position, the lever 4003 can cause the spring 4021A corresponding to the fixed jaw 4005 to be fully released by the cable 4019A, which can cause the piston 4023 A to move forward from the spring force, and the needle 4201 can be retained in the fixed jaw 4005. At the same time, the lever 4003 can cause the spring 4021B corresponding to the movable jaw 4006 to be pulled by the cable 4019B and fully compress, which can cause the piston 4023B to be pulled by the cable 4019B, and the needle 4201 to be released from the movable jaw 4006.

[0340] In some embodiments, the lever 4003 can be in a backward position (e.g., similar to the third position 4110C). In the backward position, the lever 4003 can cause the spring 4021B corresponding to the movable jaw 4006 to be fully released by the cable 4019B, which can cause the piston 4023B to move forward from the spring force, and the needle 4201 can be retained by the movable jaw 4006. At the same time, the lever 4003 can cause the spring 4021 A corresponding to the fixed jaw 4005 to be pulled by the cable 4019A and fully compressed, which can cause the piston 4023A to be pulled by the cable 4019A, and the needle 4201 to be released from the fixed jaw 4005.

[0341] FIG. 34A, FIG. 34B, and FIG. 34C depict an embodiment of the suturing device 4001A including a stopper 4605 in an activated position. In terms of safety, if the movable jaw 4006 moves when the lever 4003 is in the second position 4110B, the needle 4201 might fall out because the needle 4201 is not secured in either the first grasping slot 4103 or the second grasping slot 4104. To address this problem, the suturing device 4001A includes the stopper 4605 to control, based on the position of the lever 4003, when the movable arm 4008 can move and thus when the movable jaw 4006 can move. For example, the stopper 4605 can physically impede the movable arm 4008 from moving to prevent the needle 4201 from falling out.

[0342] As shown in FIG. 34A and FIG. 34B, the stopper 4605 can be disposed on the movable arm 4008 to control when the movable arm 4008 can move relative to the fixed arm 4007. For example, the stopper 4605 can grasp or secure the fixed arm 4007 to prevent the movable arm 4008 from moving to prevent the needle 4201 from falling out. The stopper 4605 can be disposed on the movable arm 4008 and adjacent to the lever 4003 on the fixed arm 4007 to control the movable arm 4008 based on the position of the lever 4003. In some embodiments, the stopper 4605 is covered by a lid 4606 to protect the stopper 4605.

[0343] The stopper 4605 can slide on the movable arm 4008 between an activated position and a deactivated position. The stopper 4605 can control the movement of movable arm 4008 when the stopper 4605 is in the activated position. In the activated position, the stopper 4605 can be positioned closer to the movable arm 4008 to be adjacent to the fixed arm 4007 to grasp a portion of the fixed arm 4007 to control the movement of the movable arm 4008 relative to the fixed arm 4007.

[0344] The stopper 4605 can slide on the movable arm 4008 from the activated position to the deactivated position in which the stopper 4605 does not control the movement of the movable arm 4008. For example, the stopper 4605 can be a plastic or metal cap that slides on the movable arm 4008. In the deactivated position, the stopper 4605 can be positioned farther away from the movable arm 4008 to avoid grasping the fixed arm 4007 and thus avoid controlling the movement of the movable arm 4008 relative to the fixed arm 4007. The stopper 4605 can slide on the movable arm 4008 towards the fixed arm 4007 and into the activated position to grasp the fixed arm 4007 to control the movable arm 4008.

[0345] As shown in FIG. 34B and FIG. 34C, the stopper 4605 can include a flap 4607 to secure the stopper 4605 in the activated position. For example, the flap 4607 can be a bendable extension of the stopper 4605. The flap 4607 can be snap onto and over an edge of the movable arm 4008 to secure the stopper 4605 in the activated position. The flap 4607 can bend away from the movable arm 4008 to release the stopper 4605 from the activated position. As shown in FIG. 34C, the operator can bend the flap 4607 to release the stopper 4605 from the activated position.

[0346] FIG. 35A and FIG. 35B depict an embodiment of the suturing device 4001A including the stopper 4605 in the activated position and a safety member 4610 preventing movement of the movable arm 4008 and the movable jaw 4006 when the needle 4201 is unsecured because the lever 4003 is in the second position 4110B. In some embodiments, FIG. 35A shows a cross sectional view of the stopper 4605 without the lid 4606. In some embodiments, the stopper 4605 does not have the lid.

[0347] Because the stopper 4605 is disposed on the movable arm 4008, the stopper 4605 would move when the movable arm 4008 moves. Because the safety member 4610 disposed on the fixed arm 4007, the stopper 4605 would move relative to the safety member 4610 when the movable arm 4008 moves. Interlocking of the safety member 4610 and the stopper 4605 would thus prevent the stopper 4605 from moving and thus prevent the movable arm 4008 from moving to prevent the needle 4201 from falling out.

[0348] The safety member 4610 and the stopper 4605 can interlock if the stopper 4605 protrudes against the safety member 4610. In the activated position, the stopper 4605 is positioned to interlock with the safety member 4610. For example, the stopper 4605 can block or grasp the safety member 4610. In some embodiments, when the lever 4003 is in thesecond position 4110B (e.g., needle 4201 unsecured) and the jaws are closed, the stopper 4605 and the safety member 4610 interlock to prevent the movable jaw from opening. In some embodiments, when the lever 4003 is in the first position 4110A or the third position 4110C (needle 4201 is secured) and the jaws are open, the stopper 4605 and the safety member 4610 can interlock to prevent the lever 4003 from moving to the second position 4110B to release the needle 4201.

[0349] By positioning the stopper 4605 and the safety member 4610 to interlock when the lever 4003 is in the second position 4110B and the jaws are closed, the needle 4201 would not fall out when it is not secured in neither the first grasping slot 4103 or the second grasping slot 4104 but the movable arm 4008 could move when the needle 4201 is secured in either the first grasping slot 4103 or the second grasping slot 4104. The safety member 4610 and the stopper 4605 can interlock because the stopper 4605 in the activated position protrudes against the safety member 4610 when the lever 4003 is in the second position 4110B. By protruding against the stopper 4605, the safety member 4610 prevents the movable arm 4008 and thus the movable jaw 4006 from moving when the lever 4003 is in the second position 4110B to prevent the needle 4201 from falling out.

[0350] To position the stopper 4605 and the safety member 4610 to interlock based on the position of the lever 4003, the safety member 4610 can be disposed on the second control bar 4505B. Since the lever 4003 moves the second control bar 4505B, the position of the lever 4003 determines the position of the safety member 4610. The lever 4003 in the second position 4110B causes the safety member 4610 to be in safety position 4112A such that the safety member 4610 interlocks with the stopper 4605 to prevent the movable arm 4008 from moving relative to the fixed arm 4007 to prevent the needle 4201 from falling out.

[0351] As shown in FIG. 36A and FIG. 36B depict an embodiment of the suturing device 4001A including the stopper 4605 in the activated position and the safety member 4610 allowing movement of the movable arm 4008 and the movable jaw 4006 when the needle 4201 is secured in the first grasping slot 4103. The lever 4003 in the first position 4110A causes the safety member 4610 to be in safety position 4112B, which would enable the safety member 4610 to bypass the stopper 4605 so that the movable arm 4008 can move.

[0352] FIG. 36B depicts the movable arm 4008 moving when the lever 4003 is in the first position 4110A. In the activated position when the movable arm 4008 and the movable jaw4006 are open, the stopper 4605 can prevent the lever 4003 from moving to second position 4110B (in which the needle 4201 is unsecured) from the first position 4110A (in which the needle 4201 is secured) to prevent the needle 4201 from falling out.

[0353] FIG. 36C and FIG. 36D depict an embodiment of the suturing device 4001A including the stopper 4605 in the activated position allowing movement of the movable arm 4008 and the movable jaw 4006 when the needle 4201 is secured in the second grasping slot 4104. The lever 4003 in the third position 4110C causes the safety member 4610 to be in safety position 4112C, which would enable the safety member 4610 to bypass the stopper 4605 so that the movable arm 4008 can move.

[0354] FIG. 36D depicts the movable arm 4008 moving when the lever 4003 is in the third position 4110C. In the activated position when the movable arm 4008 and the movable jaw4006 are open, the stopper 4605 can prevent the lever 4003 from moving to second position 4110B (in which the needle 4201 is unsecured) from the third position 4110C (in which the needle 4201 is secured) to prevent the needle 4201 from falling out.

[0355] As shown in FIG. 37A, the stopper 4605 transitions from an active position to a deactivated position. The operator can bend the flap 4607 to release the stopper 4605 from the activated position. The operator can pull the stopper 4605 away from the safety member 4610. The stopper 4605 can slide on the movable arm 4008 and away from the fixed arm4007 and into the deactivated position. In some embodiments, the operator can keep sliding the stopper 4605 until it is removed from the movable arm 4008.

[0356] FIG. 37B and FIG. 37C depict exploded views of the stopper 4605 and the movable arm 4008. As shown in FIG. 37B, the movable arm 4008 can include a base region 4615. The base region 4615 can be integral to the movable arm 4008. The base region 4615 can be aligned with the lever 4003 or the switching joint 4106. The position of the stopper 4605 relative to the base region 4615 can determine whether the stopper 4605 is in the activated or deactivated position. In the activated position, the stopper 4605 can be positioned closer to the movable arm 4008 to be adjacent to the fixed arm 4007 to grasp a portion of the fixed arm4007 or interlock with safety member 4610 to control the movement of the movable arm4008 relative to the fixed arm 4007. In the deactivated position, the stopper 4605 can be positioned farther away from the movable arm 4008 to avoid grasping the fixed arm 4007 and thus avoid controlling the movement of the movable arm 4008 relative to the fixed arm 4007.

[0357] The base region 4615 can include a notch 4616A and a notch 4616B positioned in a sliding channel 4617 configured to receive the stopper 4605. The notch 4616A and the notch 4616B can be indents or incisions on the base region 4615. The notch 4616A can secure the stopper 4605 in the activated position and the notch 4616B can secure the stopper 4605 in the deactivated position. The notch 4616A can be disposed away from the side edge of the movable arm 4008 to secure the stopper 4605 closer to the movable arm 4008 in the activated position. The notch 4616B can be disposed closer to the side edge of the movable arm 4008 to secure the stopper 4605 further away from the movable arm 4008 in the deactivated position.

[0358] As shown in FIG. 37C, the stopper 4605 can include a protrusion 4608 that can be secured in the notch 4616A or the notch 4616B. For example, the protrusion 4608 can be a bump or tube that protrudes from the stopper 4605. The protrusion 4608 can slide or snap into the notch 4616A or the notch 4616B to be secured. The protrusion 4608 can slide into the notch 4616A to secure the stopper 4605 in the activated position. The protrusion 4608 can slide into the notch 4616B to secure the stopper 4605 in the deactivated position.

[0359] As shown in FIG. 37D and FIG. 37E, in the deactivated position, the stopper 4605 is positioned away from the fixed arm 4007 and the safety member 4610 such that the stopper 4605 and the safety member 4610 cannot interlock. Regardless of the position of the lever 4003 and thus the safety member 4610, the safety member 4610 can be positioned to not protrude against the stopper 4605 when the stopper 4605 is in the deactivated position.

[0360] FIG. 38A and FIG. 38B depict an embodiment of the suturing device 4001A including the stopper 4605 in the deactivated position to allow the movable arm 4008 to move even when the needle 4201 is unsecured. When the stopper 4605 is in the deactivated position, the movable arm 4008 can move when the lever 4003 is in the second position 4110B and the needle 4201 is not secured in either the first grasping slot 4103 or the second grasping slot 4104. By allowing the movable arm 4008 to move when the lever 4003 is in the second position 4110B, the needle 4201 can be released, such as at the end of a suturing operation. In the deactivated position, the stopper 4605 can allow the lever 4003 to move to the second position 4110B from the first position 4110A or the third position 4110C, such as to load, unload, and reload the needle 4201 in the loading apparatus 4010 described below.

[0361] FIG. 39A depicts an embodiment of the suturing device 4001A. In some embodiments, the first handle 4002A is coupled to the movable arm 4008 with a set of first fasteners 4301A and 4301B. In some embodiments, the second handle 4002B is coupled to the fixed arm 4007 with a set of second fasteners 4302A and 4302B.

[0362] FIG. 39B and FIG. 39C depict an embodiment of the suturing device 4001 A with attachment member 4035A and attachment member 4035B. In some embodiments, the attachment member 4035A or 4035B has the needle 4201 already preloaded. As shown in FIG. 39B, the attachment member 4035A can be configured to be attached to the movable jaw 4006 that is configured to receive the attachment member 4035A. As shown in FIG. 39C, the attachment member 4035B can be configured to be attached to the fixed jaw 4005 that is configured to receive the attachment member 4035B. For example, instead of having to load the needle 4201 into the second grasping slot 4104, the attachment member 4035 A with the needle 4201 can be attached to the movable jaw 4006 of the suturing device 4001A. In another example, instead of having to load the needle 4201 into the first grasping slot 4103, the attachment member 4035B with the needle 4201 can be attached to the fixed jaw 4005 of the suturing device 4001A. In some embodiments, at the conclusion of a suturing operation, the attachment member 4035A or the attachment member 4035B can be removed with the needle 4201, and another attachment member 4035A or the attachment member 4035B with a replacement needle 4201 can be attached to the fixed jaw 4005 or the movable jaw 4006. In some embodiments, the operator can use the same needle 4201 for suturing for more than one suture. For example, if the procedure requires so, the operator can also make suture after suture (sequential) with the same needle 4201, which is called Z-suture or 8-figure suture.

[0363] FIG. 40A and FIG. 40B depict embodiments of shapes of suturing devices (e.g., suturing device 4001A or suturing device 4001B). The suturing devices can be in various sizes, shapes, and angles that are optimized based on the anatomy for which the suturing devices are to be used. The suturing devices can have sizes and angles optimized for the repair of pelvic floor disorders safely due to positional accuracy and in a minimally invasive way.

[0364] The size and angles of the devices can be selected according to the target ligament each device is designed to reach for suturing and according to the pathway each device needs to travel in order to reach the target ligament. For example, the pathway can have obstacles such as hard-bony tissues and soft tissues. The sizes and angles can ensure that the surgicalmethods for using the suturing devices can maneuver the suturing devices through the pathway such that the devices are delivered to their target ligament in the least invasive way. For example, the area of the pathway can be in the pelvic cavity, which can be very similar from patient to patient with minimal standard deviation. As such, the calculation can be accurate across patients even though they might have different bodily parameters (e.g., height, weight, etc.). The sizes and angles can be selected according to the target ligament. For example, once the device is delivered to the target ligament, the outer contour of the fixed jaw 4005 can be used for positional accuracy.

[0365] The suturing devices can have a length such that during operation of the suturing device, the handle 4002A and 4002B can be positioned outside the cavity while the length defines a portion of the suturing device that can be positioned inside the cavity. For example, the suturing devices can have a length and angles for trans vaginal approaches or procedures. As shown in FIG. 40A, the fixed jaw 4005 can extend relative to the fixed arm 4007 at an angle of 77.2 degrees. A length 4037A can be measured from the tip of the fixed jaw 4005 and the fixed arm 4007. As shown in FIG. 40B, the fixed arm 4007 can have a distal portion that extends relative a proximal portion at an angle of 15.88 degrees. The fixed jaw 4005 can extend relative to the fixed arm 4007 at angle of 130 degrees. The fixed jaw 4005 and the fixed arm 4007 can have a length 4037B. It is contemplated that the suturing devices can be modified to modify the sizes, shapes, and angles to optimize the suturing device for specific cavities and operations.

[0366] FIG. 41A, FIG. 41B, and FIG. 41C depict an embodiment of the suturing device 400 IB. The suturing device 400 IB can be similar to the suturing device 4001 A but differs in that its components have a different angle, size, and shape to optimize the suturing device 4001B for the anatomy for which the suturing device 4001B is to be used. FIG. 41C depicts an exploded view of an embodiment of the suturing device 400 IB. In some embodiments, the first handle 4002A is coupled to the fixed arm 4007 with a set of first fasteners 4301A- 4301B. In some embodiments, the second handle 4002B is coupled to the movable arm 4008 with a set of second fasteners 4302A-4302B. In some embodiments, the suturing device 4001B can use the attachment member 4035A or the attachment member 4035B as described in reference to FIG. 39B and FIG. 39C. For example, the attachment member 4035A can be configured to be attached to the movable jaw 4006 that is configured to receive the attachment member 4035A. In another example, the attachment member 4035B can beconfigured to be attached to the fixed jaw 4005 that is configured to receive the attachment member 4035B.

[0367] In some embodiments, one or more image sensors, such as one or more fiber optic cameras, such as the fiber optic camera 2311 described above, can be used with the suturing device 4001 A to allow for visualization of otherwise invisible operating sites. The one or more image sensors, such as the fiber optic camera, can generally include one or more fiber optic wires. The fiber optic wire can generally be configured to collect images, or input data, at its distal end and communicate the images to its proximal end. In some embodiments, the fiber optic wire is positioned in a guide, or channel. The guide can extend through the fixed jaw body. The distal end of the guide can terminate at an opening in the fixed jaw body positioned between the fixed jaw and the movable jaw. A distal end of the fiber optic wire can be disposed in the opening. An optical window can be positioned over the opening. The optical window can be a protective glass or other suitable material, which in some embodiments, can be an optical lens to provide a desired angle of view. In some embodiments, the optical window prevents contamination of the fiber optic wire by blood, tissue, etc., maintaining clear vision of the operative site. In some embodiments, a wiper can be coupled on a surface of the movable jaw, projecting from the movable jaw in the direction of the fixed jaw. As the movable jaw moves towards and away from the fixed jaw, the wiper can be configured to clean the optical window. The wiper can be made of or coated in a biocompatible material. The fiber optic wire can extend through the guide in the fixed jaw body, through the body, and through or partially through the handle. The fiber optic wire can be coupled to one or more processors and / or one or more display devices for processing and displaying the data or images collected from the fiber optic wire. Particularly, the one or more processors can be configured to execute instructions encoded on at least one non- transitory computer-readable storage medium to cause the one or more processors to control operation of the fiber optic camera, collect and analyze data or images from the fiber optic wire, and display the data or images. Particularly, it should be appreciated, that while such elements are not depicted, that the fiber optic camera can further include an external unit containing the sensor, processing unit, light source, and display. It should be appreciated that one or more image sensors, such as the fiber optic camera, can be replaced with any suitable imaging device for imaging tissue, such as muscles, veins, nerves, and arteries in the direction of and around the jaws. For instance, in some embodiments, the image sensor can be replaced by a fiber optic infrared sensor / camera to generate infrared images of theoperating site, a fiber optic visible sensor / camera, a fiber optic ultraviolet sensor / camera, and / or an ultrasound probe. In some embodiments, one or more ultrasound sensors / probes can be used to generate ultrasound images of the operating site. In some embodiments there can be multiple sensors of each type stated above in any combination.

[0368] In some embodiments, the suturing device 4001 A can include one or more electric field sensors, similar to the electric field sensor 2343 described above. The electric field sensor can be integrated into the fixed jaw. In some embodiments, the electric field sensor can be detachable from the suturing device. In some embodiments, the electric field sensor is positioned at a distal end of the fixed jaw. The electric field sensor and one or more input and output cables for the electric field sensor can be positioned in or extend through a channel in the fixed jaw. The one or more input and output cables can extend proximally through the body and the handle to be coupled to one or more processors and / or one or more display devices. In some embodiments, the one or more input and output cables can be coupled to the electric circuit board. The electric field sensor can sense and locate nerves in and around the operating site. In some embodiments, the electric field sensor operates similarly to electrocardiography (ECG), electromyography (EMG), or electroencephalography (EEG), but with higher resolution. The location of the electrical field sensor on the distal tip of the fixed jaw, which is the palpation point of the suturing device, improves utilization of the sensor by allowing the sensor to differentiate the tissue to suture from the tissue not to suture. The electric field sensor can be coupled to one or more processors and / or one or more display devices for processing and displaying the data collected from the electric field sensor. Particularly, the one or more processors can be...

Claims

CLAIMS1. A suturing device, comprising: a first jaw comprising a first grasping slot configured to receive a needle; a second jaw comprising a second grasping slot configured to receive the needle; and a needle transfer mechanism, comprising: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle.

2. A suturing system, comprising: a suturing device, comprising: a first jaw comprising a first grasping slot configured to receive a needle; a second jaw comprising a second grasping slot configured to receive the needle; and a needle transfer mechanism, comprising: a first grasping member positioned in the first jaw; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; andthe second grasping member is configured to removably couple with the needle; and an energy source coupled to the first wire and the second wire and configured to supply electric current to the first wire and the second wire.

3. A method, comprising: opening a second jaw of a suturing device with respect to a first jaw of the suturing device, wherein: the first jaw comprises a first grasping slot configured to receive a needle and a first grasping member configured to removably couple with the needle to retain the needle in the first grasping slot; the second jaw comprises a second grasping slot configured to receive the needle and a second grasping member configured to removably couple with the needle to retain the needle in the second grasping slot; and the needle is coupled to the first grasping member and retained in the first grasping slot of the first jaw; closing the second jaw with respect to the first jaw, optionally wherein the device is positioned so that a target tissue is between the first jaw and the second jaw before closing the second jaw; and transferring the needle from the first grasping slot of the first jaw to the second grasping slot of the second jaw, wherein transferring the needle comprises: supplying an electric current to a first wire coupled to the first grasping member to change a length of the first wire and uncouple the first grasping member from the needle.

4. A transfer mechanism for a suturing device, comprising: a wire, wherein: the wire is coupled to a needle; the wire is coupled to an energy source configured to supply an electric current through the wire; the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the needle from a first position to a second position when electric current is supplied through the wire.

5. The transfer mechanism of claim 4, further comprising a potential energy member, wherein: the potential energy member is configured to transition between a first configuration and a second configuration; and the potential energy member is configured to move the needle from the second position to the first position when the potential energy member transitions from the second configuration to the first configuration.

6. A transfer mechanism for a suturing device, comprising: a wire, wherein: the wire is coupled to a grasping member; the wire is coupled to an energy source configured to supply an electric current through the wire; the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the grasping member is configured to couple to a needle in the first position; and the grasping member is configured to uncouple from the needle in the second position.

7. The transfer mechanism of claim 6, further comprising a potential energy member, wherein: the potential energy member is configured to transition between a first configuration and a second configuration; and the potential energy member is configured to move the grasping member from the second position to the first position when the potential energy member transitions from the second configuration to the first configuration.

8. A suturing device, comprising: a needle transfer mechanism; anda fiber optic camera comprising an optical wire extending through the suturing device, wherein the fiber optic camera is configured to generate image data of an operating site of the suturing device.

9. A suturing device, comprising: a needle transfer mechanism; and an electric field sensor positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

10. A suturing device, comprising: a first jaw comprising a first grasping slot configured to receive a needle; a second jaw comprising a second grasping slot configured to receive the needle; and a piezo film positioned on a surface of at least one of the first jaw or the second jaw, wherein the piezo film is configured to vibrate the at least one of the first jaw or the second jaw.

11. A suturing device, comprising: an elongate body; a needle; and a needle transfer mechanism comprising a wire coupled to the needle and coupled to an energy source, wherein: the wire is configured to change length in response to electric current being supplied through the wire; and the wire is configured to move the needle when electric current is supplied through the wire.

12. A suturing device comprising: a fixed arm integral with a fixed jaw comprising a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism comprising:a first grasping member configured to secure the needle in the first grasping slot and release the needle from the first grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member configured to secure the needle in the second grasping slot and release the needle from the second grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; and a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire.

13. The suturing device of claim 12, wherein the fixed arm further comprises an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm.

14. The suturing device of claim 13, wherein the fixed arm further comprises a jaw joint located in the reference body, wherein the jaw joint is coupled to the movable jaw, and wherein the movable jaw is configured to pivot about the jaw joint and relative to the fixed jaw.

15. The suturing device of claim 14, wherein the suturing device further comprises a connecting joint configured to link the movable arm and the movable jaw, wherein the movable arm is configured to move the connecting joint to cause the movable jaw to pivot about the jaw joint.

16. A suturing device comprising: a fixed arm integral with a fixed jaw comprising a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism comprising first and second wires configured to secure the needle in the first grasping slot or the second grasping slot, the first and second wires configured to:change length in response to electric current supplied through the first and second wires, respectively; and control first and second grasping members to retain and release the needle from the first and second grasping slots.

17. A suturing device comprising: a needle configured to include a channel for threading a suture therethrough; a fixed arm integral with a fixed jaw comprising a first grasping slot configured to receive the needle; a movable jaw movably coupled to a movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism comprising first and second needle securing members configured to secure the needle in the first grasping slot or the second grasping slot, the first and second needle securing members coupled to first and second wires and configured to engage one or more features on the needle to selectively retain and release the needle from the first and second grasping slots in response to electric current supplied through the first and second wires.

18. A suturing device, comprising: a first jaw comprising a first grasping slot configured to receive a needle; a second jaw comprising a second grasping slot configured to receive the needle; and a needle transfer mechanism, comprising: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a first potential energy member, wherein the first potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the first grasping member; a second grasping member positioned in the second jaw; a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire; anda second potential energy member, wherein the second potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the second grasping member, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle.

19. A suturing device comprising: a fixed arm integral with a fixed jaw comprising a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a needle transfer mechanism comprising: a first grasping member configured to secure the needle in the first grasping slot and release the needle from the first grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a first potential energy member, wherein the first potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the first grasping member; a second grasping member configured to secure the needle in the second grasping slot and release the needle from the second grasping slot, the first grasping member configured to selectively engage the needle while the needle is positioned in the first grasping slot; a second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire; and a second potential energy member, wherein the second potential energy member is configured to transition between a first configuration and a second configuration to apply a force on the second grasping member.

20. A suturing device comprising: an elongate body; a fixed jaw body extending from the elongate body and comprising a linear guide; a fixed jaw fixedly coupled to and extending from the fixed jaw body; a movable jaw coupled to the fixed jaw body at the linear guide and configured to move linearly with respect to the fixed jaw in the linear guide; and a drive mechanism, comprising: a wire configured to move the movable jaw along the linear guide, wherein the wire is configured to change length in response to electric current supplied through the wire.

21. The suturing device of claim 20, wherein the drive mechanism further comprises: a potential energy member, wherein: the wire is configured to move the movable jaw along the linear guide in a first direction; and the potential energy member is configured to move the movable jaw along the linear guide in a second direction opposite of the first direction.

22. A suturing device comprising: an elongate body; a fixed jaw body extending from the elongate body and comprising a jaw joint; a fixed jaw fixedly coupled to and extending from the fixed jaw body; a movable jaw coupled to the fixed jaw body and configured to pivot with respect to the fixed jaw about the jaw joint; and a drive mechanism, comprising: a wire configured to rotate the movable jaw about the jaw joint, wherein the wire is configured to change length in response to electric current supplied through the wire.

23. The suturing device of claim 22, wherein the drive mechanism further comprises: a potential energy member, wherein: the wire is configured to rotate the movable jaw about the jaw joint in a first direction; and the potential energy member is configured to rotate the movable jaw about the jaw joint in a second direction opposite of the first direction.

24. A suturing device, comprising: a needle; a first needle holding member comprising a first port configured to receive the needle; a second needle holding member in alignment with the first needle holding member comprising a second port configured to receive the needle; and a needle transfer mechanism at least partially positioned within the first needle holding member, comprising: a wire coupled to the needle, wherein: the wire is configured to change length in response to electric current supplied through the wire; and the needle transfer mechanism is configured to move the needle from the first port of the first needle holding member to the second port of the second needle holding member.

25. The suturing device of claim 24, wherein the first needle holding member and the second needle holding member are fixed relative to each other.

26. A suturing device, comprising: a first jaw comprising a first grasping slot configured to receive a needle; a second jaw comprising a second grasping slot configured to receive the needle, wherein the second jaw is movable with respect to the first jaw; and a needle transfer mechanism configured to secure the needle in the first grasping slot or the second grasping slot and release the needle from the first grasping slot or the second grasping slot, wherein the needle transfer mechanism comprises a wire configured to change length in response to electric current supplied through the wire.

27. The suturing device of any one of claims 24-26, wherein the needle transfer mechanism comprises: a first grasping member positioned in the first jaw and selectively extendable in the first grasping slot; a first wire coupled to the first grasping member, wherein the first wire is configured to change length in response to electric current supplied through the first wire; a second grasping member positioned in the second jaw and selectively extendable in the second grasping slot; anda second wire coupled to the second grasping member, wherein the second wire is configured to change length in response to electric current supplied through the second wire, wherein: the first grasping member is configured to removably couple with the needle; and the second grasping member is configured to removably couple with the needle.

28. The suturing device of any one of claims 24-27, wherein the first wire is configured to move the first grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the first grasping member is configured to couple to the needle in the first position; and the first grasping member is configured to uncouple from the needle in the second position.

29. The suturing device of any one of claims 24-28, further comprising a first potential energy member, wherein: the first potential energy member is configured to transition between a first configuration and a second configuration; and the first potential energy member is configured to move the first grasping member from the second position to the first position when the first potential energy member transitions from the second configuration to the first configuration.

30. The suturing device of any one of claims 24-29, wherein the second wire is configured to move the second grasping member from a first position to a second position when electric current is supplied through the wire, wherein: the second grasping member is configured to couple to the needle in the first position; and the second grasping member is configured to uncouple from the needle in the second position.

31. The suturing device of any one of claims 24-30, further comprising a second potential energy member, wherein: the second potential energy member is configured to transition between a first configuration and a second configuration; andthe second potential energy member is configured to move the second grasping member from the second position to the first position when the second potential energy member transitions from the second configuration to the first configuration.

32. The suturing device of any one of claims 24-31, further comprising an input, wherein the input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire.

33. The suturing device of any one of claims 24-32, further comprising an input, wherein the input, upon being actuated once, is configured to cause the energy source coupled to the first wire and the second wire to de-energize the second wire and energize the first wire.

34. The suturing device of any one of claims 24-33, further comprising an input, wherein the input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to: de-energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member not coupled to the needle prior to actuation of the input; and energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member coupled to the needle prior to actuation of the input.

35. The suturing device of any one of claims 24-34, further comprising a first input and a second input, wherein: the first input, upon being actuated once, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire; and the second input, upon being actuated once, is configured to cause the energy source coupled to the first wire and the second wire to de-energize the second wire and energize the first wire.

36. The suturing device of any one of claims 24-35, further comprising: a first handle; a second handle; and a force sensor, wherein:the force sensor is configured to detect contact and closing force between the first handle and the second handle as the first handle and the second handle are closed; and the force sensor, upon detecting a threshold force, is configured to cause an energy source coupled to the first wire and the second wire to de-energize the first wire and energize the second wire.

37. The suturing device of any one of claims 24-36, wherein the force sensor, upon detecting the threshold force, is configured to cause the energy source to de-energize the second wire and energize the first wire.

38. The suturing device of any one of claims 24-37, further comprising: a first handle; a second handle; and a force sensor, wherein: the force sensor is configured to detect contact and closing force between the first handle and the second handle as the first handle and the second handle are closed; the force sensor, upon detecting a threshold force, is configured to cause an energy source coupled to the first wire and the second wire to de-energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member not coupled to the needle prior to detecting the threshold force; and the force sensor, upon detecting the threshold force, is configured to cause the energy source coupled to the first wire and the second wire to energize one of the first wire or the second wire coupled to one of the first grasping member or the second grasping member coupled to the needle prior to detecting the threshold force.

39. The suturing device of any one of claims 24-38, further comprising: a fixed arm integral with the first jaw; and a movable arm movably coupled with the second jaw, the second jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw.

40. The suturing device of any one of claims 24-39, wherein the fixed arm further comprises an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm.

41. The suturing device of any one of claims 24-40, wherein the fixed arm further comprises a jaw joint located in the reference body, wherein the jaw joint is coupled to the second jaw, and wherein the second jaw is configured to pivot about the jaw joint and relative to the first jaw.

42. The suturing device of any one of claims 24-41, wherein the suturing device further comprises a connecting joint configured to link the movable arm and the second jaw, wherein the movable arm is configured to move the connecting joint to cause the second jaw to pivot about the jaw joint.

43. The suturing device of any one of claims 24-42, further comprising: a fixed jaw body comprising a linear guide; the first jaw fixedly coupled to and extending from the fixed jaw body; the second jaw coupled to the fixed jaw body at the linear guide and configured to move linearly with respect to the first jaw in the linear guide; and a drive mechanism, comprising: a wire configured to move the second jaw along the linear guide, wherein the wire is configured to change length in response to electric current supplied through the wire.

44. The suturing device of any one of claims 24-43, wherein the drive mechanism further comprises: a potential energy member, wherein: the wire is configured to move the second jaw along the linear guide in a first direction; and the potential energy member is configured to move the second jaw along the linear guide in a second direction opposite of the first direction.

45. The suturing device of any one of claims 24-44, further comprising: a fixed jaw body comprising a jaw joint; the first jaw fixedly coupled to and extending from the fixed jaw body; the second jaw coupled to the fixed jaw body and configured to pivot with respect to the first jaw about the jaw joint; and a drive mechanism, comprising:a wire configured to rotate the second jaw about the jaw joint, wherein the wire is configured to change length in response to electric current supplied through the wire.

46. The suturing device of any one of claims 24-45, wherein the drive mechanism further comprises: a potential energy member, wherein: the wire is configured to rotate the second jaw about the jaw joint in a first direction; and the potential energy member is configured to rotate the second jaw about the jaw joint in a second direction opposite of the first direction.

47. The suturing device of any one of claims 24-46, further comprising: a fixed arm integral with the first jaw; a first handle coupled to a proximal end of the fixed arm; a movable arm movably coupled with the second jaw, the second jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; and a second handle coupled to a proximal end of the movable arm.

48. The suturing device of any one of claims 24-47, further comprising a single handle.

49. The suturing device of any one of claims 1-48, further comprising: a fiber optic camera comprising an optical wire extending through the suturing device, wherein the fiber optic camera is configured to generate image data of an operating site of the suturing device.

50. The suturing device of any one of claims 1-49, further comprising: an electric field sensor positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

51. The suturing device of any one of claims 1-50, further comprising a piezo film positioned on a surface of at least one of the first jaw or the second jaw, wherein the piezo film is configured to vibrate the at least one of the first jaw or the second jaw.

52. A suturing device comprising: a fixed arm integral with a fixed jaw comprising a first grasping slot configured to receive a needle; a movable jaw movably coupled to a movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw; a needle transfer mechanism comprising first and second plates configured to secure the needle in the first grasping slot or the second grasping slot and release the needle from the first grasping slot or the second grasping slot, the first and second plates configured to selectively engage the needle while the needle is positioned in the first grasping slot or the second grasping slot; and at least one of a fiber optic camera, an electric field sensor, or a piezo film.

53. The suturing device of claim 52, wherein: the first plate comprises a first control bar configured to advance a first grasping member towards a first receptacle of the needle disposed in the first grasping slot to grasp the needle in the first grasping slot or retract the first grasping member from the first receptacle to release the needle from the first grasping slot; and the second plate comprises a second control bar configured to advance a second grasping member towards a second receptacle of the needle disposed in the second grasping slot to grasp the needle in the second grasping slot or retract the second grasping member from the second receptacle to release the needle from the second grasping slot.

54. The suturing device of claim 52 or claim 53, further comprising a lever configured to move among: a first position to advance the first control bar to grasp the needle in the first grasping slot and retract the second control bar to release the needle from the second grasping slot, a second position to retract the first control bar to release the needle from the first grasping slot and retract the second control bar to release the needle from the second grasping slot, and a third position to retract the first control bar to release the needle from the first grasping slot and advance the second control bar to grasp the needle in the second grasping slot.

55. The suturing device of any one of claims 52-54, further comprising a cover partially disposed over the lever, the cover comprising indicators corresponding to movements of the lever to the first position, the second position, and the third position.

56. The suturing device of any one of claims 52-55, further comprising a switching joint coupled to the first control bar and the second control bar.

57. The suturing device of any one of claims 52-56, wherein the lever is coupled to the switching joint, wherein the lever is configured to rotate the switching joint to move the first control bar and the second control bar.

58. The suturing device of any one of claims 52-57, wherein the fixed arm further comprises an arm joint coupled to the movable arm, and wherein the movable arm is configured to pivot about the arm joint and relative to the fixed arm.

59. The suturing device of any one of claims 52-58, wherein the fixed arm further comprises a jaw joint located in the reference body, wherein the jaw joint is coupled to the movable jaw, and wherein the movable jaw is configured to pivot about the jaw joint and relative to the fixed jaw.

60. The suturing device of any one of claims 52-59, wherein the suturing device further comprises a connecting joint configured to link the movable arm and the movable jaw, wherein the movable arm is configured to move the connecting joint to cause the movable jaw to pivot about the jaw joint.

61. The suturing device of any one of claims 52-60, further comprising: one or more image sensors comprising one or more optical wires extending through the suturing device, wherein the one or more image sensors are configured to generate image data of an operating site of the suturing device.

62. The suturing device of any one of claims 52-61, further comprising: one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

63. The suturing device of any one of claims 52-62, further comprising one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw.

64. A suturing method, comprising: forming an incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a first suturing device inside a pelvic cavity and adjacent to a first target tissue through the incision, the first target tissue being a first arcus tendinous fascia pelvis (ATFP) in the pelvic cavity; placing, using the first suturing device, at least one suture in the first ATFP; placing at least one suture in the vesicovaginal fascia, the at least one suture in the vesicovaginal fascia connected to the at least one suture in the first ATFP; and pulling the at least one suture in the first ATFP and the at least one suture in the vesicovaginal fascia to form a loop, thereby bringing the vaginal wall closer to the first ATFP.

65. The method of claim 64, wherein pulling the at least one suture in the ATFP and the at least one suture in the vesicovaginal fascia results in lifting the vaginal wall, the bladder neck, and urethra.

66. The method of claim 64 or 65, further comprising: positioning the suturing device inside the pelvic cavity and adjacent to a second target tissue through the incision, the second target tissue being a second ATFP in the pelvic cavity; placing at least one suture in the second ATFP; placing at least one suture in the vesicovaginal fascia, the at least one suture in the vesicovaginal fascia connected to the at least one suture in the second ATFP; and pulling the at least one suture in the second ATFP and the at least one suture in the vesicovaginal fascia to form a loop, thereby bringing the vaginal wall closer to the second ATFP.

67. The method of any one of claims 64-66, wherein the anatomical position of at least one of the vaginal wall, bladder neck or urethra in the pelvic cavity is restored.

68. The method of claim 67, wherein the anatomical position of each of the vaginal wall, bladder neck and urethra in the pelvic cavity is restored.

69. The method of any one of claims 64-68, wherein the physiological function of at least one of the vaginal wall, bladder neck or urethra in the pelvic cavity is restored.

70. The method of claim 69, wherein the physiological function of each of the vaginal wall, bladder neck and urethra in the pelvic cavity is restored.

71. The method of claim 64, wherein the at least one suture is formed from at least one of a thread, a fiber, a filament, and a wire.

72. The method of claim 64, wherein the at least one suture is formed from an absorbable material.

73. The method of claim 64, wherein the at least one suture is formed from a non-absorbable material.

74. The method of any one of claims 64-71, wherein the at least one suture in the first ATFP or the second ATFP is placed in an anteroposterior part of the first ATFP or the second ATFP.

75. The method of claim 74, wherein the at least one suture in the first ATFP or the second ATFP is placed at the junction of pubic ramus and symphysis pubis.

76. The method of claim 74 or 75, wherein the at least one suture in the first ATFP or the second ATFP comprises a first suture and a second suture, wherein the first suture is placed in an anteroposterior part of the first ATFP or the second ATFP, and the second suture is placed in a mediolateral pubic part of the first ATFP or the second ATFP, 0.5 to 1 cm distance posteroinferior to the first suture.

77. The method of any one of claims 64-76, wherein, after forming the incision in the vaginal wall and before positioning the device inside the pelvic cavity, the method further comprises forming a dissection from over the vesicovaginal fascia towards a junction of the pubic ramus and symphysis pubis.

78. The method of any one of the claims 64-77, wherein the restoration is performed solely using the sutures without a mesh.

79. The method of claims 64-70, wherein, when the vesicovaginal fascia is approximated to ATFPs bilaterally, the connection between pelvic floor structures and urethra and bladder neck is restored.

80. The method of claim 64, wherein the at least one suture in the vesicovaginal fascia is placed with a second suturing device.

81. The method of claim 64, further comprising palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

82. A suturing method, comprising: forming a transverse incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a suturing device inside a pelvic cavity and adjacent to a target tissue through the incision, the target tissue being a sacrospinous ligament in the pelvic cavity; placing a plurality of sutures in the target tissue;placing a plurality of sutures in the cervix uteri or the vaginal cuff; and pulling the plurality of sutures to form a loop with the sutures passed on the sacrospinous ligament and the cervix uteri or vaginal cuff to correct apical prolapse.

83. A suturing method, comprising: forming an incision in a vaginal wall to gain access to a pelvic cavity of a patient; positioning a suturing device inside a pelvic cavity through the incision, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw, the target tissue being each of the arcus tendinous fasciae pelvis (ATFP) in the pelvic cavity; placing a plurality of sutures in the target tissue, the plurality of sutures being placed in each arcus tendinous fasciae pelvis (ATFP); placing a plurality of sutures in the vesicovaginal fascia; and pulling the plurality of sutures to form a loop with the sutures passed on ATFP and vesicovaginal fascia to bring the vaginal wall closer to the ATFP at each side and to lift the vaginal wall, the bladder neck and urethra to restore their anatomical and physiological positions in the pelvic cavity.

84. The method of claim 83, further comprising forming a dissection from over the vesicovaginal fascia towards the junction of the pubic ramus and symphysis pubis.

85. The method of claim 83, further comprising palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

86. The method of claim 83, further comprising pulling the suturing device away from the target tissue to create a distance between the suturing device and the target tissue to open the movable jaw relative to the fixed jaw.

87. The method of claim 83, wherein the suturing device further comprises:a fixed jaw integral with a distal end of the fixed arm and comprising a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference body on the fixed arm and relative to the fixed jaw.

88. The method of claim 87, wherein the distal ends of the fixed and movable arms are angled such that the distal end accurately reaches the target tissue in the pelvic cavity to be sutured via a vaginal incision.

89. The method of claim 83, wherein the suturing device further comprises: a fixed jaw integral with a distal end of the fixed arm and comprising a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to move linearly relative to the fixed arm.

90. The method of claim 83, wherein the suturing device further comprises: a handle; an elongate arm connected to the handle at a proximal end thereof and having the first jaw and second jaw positioned on a distal end thereof, the first jaw being movable and comprising a first grasping slot configured to receive a needle and the second jaw being fixed and comprising a second grasping slot configured to receive the needle; and a mandrel mechanism configured to connect the handle to the elongate arm such that the first and second jaws on the distal end of the arm are rotatable about a longitudinal axis of the arm to allow the first and second jaws to assume any angular position while the handle remains fixed.

91. The method of claim 83, wherein the suturing device further comprises: a handle; andan elongate arm connected to the handle at a proximal end thereof and having the first and second jaws positioned on a distal end thereof, the first jaw comprising a first grasping slot configured to receive a needle and the second jaw comprising a second grasping slot configured to receive the needle, the first and second jaws having a fixed aperture therebetween.

92. A suturing method, comprising: positioning a suturing device inside a pelvic cavity of a patient through an incision in a vaginal wall, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw, the target tissue being arcus tendinous fasciae pelvis (ATFP); and forming a Z- suture with the suturing device to place a plurality of sutures in the target tissue.

93. The method of claim 92, further comprising palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

94. A suturing method, comprising: positioning a suturing device inside a pelvic cavity of a patient, the suturing device including a movable jaw and a fixed jaw; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw; and providing treatment of pelvic organ prolapse by suturing the target tissue using the suturing device to place a plurality of sutures in the target tissue to suture the target tissue to the apical vaginal wall or cervix uteri, the target tissue being in the form of a ligament in the pelvic cavity such that suturing the ligament to the apical vaginal wall or cervix uteri provides vaginal apex elevation.

95. The method of claim 94, further comprising palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

96. A suturing method, comprising: positioning a suturing device inside a pelvic cavity of a patient through an incision in a vaginal wall, the suturing device including a movable jaw and a fixed jaw and a needle; opening the movable jaw relative to the fixed jaw until a target tissue in the pelvic cavity is positioned between the movable jaw and the fixed jaw; and actuating the movable jaw relative to the fixed jaw such that the movable jaw moves towards the fixed jaw to move a needle positioned in at least one of the movable jaw and the fixed jaw through the target tissue to apply a suture to the target tissue; optionally wherein the suturing device is sized and shaped to be received in the pelvic cavity through the vaginal wall in order to position sutures to lift the vaginal wall, the bladder neck and urethra to restore their anatomical and physiological positions in the pelvic cavity.

97. The method of claim 96, further comprising palpating a tissue to determine a location of the target tissue inside the pelvic cavity.

98. The method of claim 96, wherein the suturing device further comprises: a fixed jaw integral with a distal end of the fixed arm and comprising a first grasping slot configured to receive a needle; and a movable jaw movably coupled to a distal end of the movable arm comprising a second grasping slot configured to receive the needle, the movable jaw configured to pivot about a reference location on the fixed arm and relative to the fixed jaw while the fixed jaw remains immovable.

99. The method of claim 98, wherein the distal end of the fixed and movable arms are angled such that the distal end reaches accurately the target tissue in the pelvic cavity to be sutured via the vaginal wall.

100. A suturing device, comprising: a handle; an elongate arm connected to the handle at a proximal end thereof and having a first jaw and a second jaw positioned on a distal end thereof, the first jaw being movable andcomprising a first grasping slot configured to receive a needle and the second jaw being fixed and comprising a second grasping slot configured to receive the needle; and a mandrel mechanism configured to connect the handle to the elongate arm such that the first and second jaws on the distal end of the arm are rotatable about a longitudinal axis of the arm to allow the first and second jaws to assume any angular position while the handle remains fixed.

101. The suturing device of claim 100, wherein the mandrel mechanism comprises a user activated button configured to move a spring-loaded pin positioned inside the mandrel mechanism to one of at least one recess positioned along an angular path of the mandrel mechanism.

102. The suturing device of claim 101, wherein the position of the pin inside one of the at least one recess is configured to set an angular position of the first and second jaws.

103. The suturing device of claim 100, further comprising a lever mechanism configured to move the first jaw relative to the second jaw on a linear guide.

104. The suturing device of claim 103, wherein the lever mechanism has a distal position in which the first and second jaws are fully closed and a proximal position in which the first and second jaw are fully open.

105. The suturing device of claim 100, further comprising a needle transfer mechanism configured to transfer a needle between a first grasping slot in the first jaw and a second grasping slot in the second jaw for applying sutures to a target tissue.

106. The suturing device of claim 105, wherein the needle transfer mechanism comprises: a toggle switch configured to move between a distal position and a proximal position transferring the needle between the first jaw and the second jaw using a first cable and a second cable;wherein a distal position of the toggle switch transfers the needle from the first jaw to the second jaw by pulling on the first cable, and wherein the proximal position of the toggle switch transfers the needle from the second jaw to the first jaw by pulling on the second cable.

107. The suturing device of any one of claims 100-106, further comprising: one or more image sensors comprising one or more optical wires extending through the suturing device, wherein the one or more image sensors are configured to generate image data of an operating site of the suturing device.

108. The suturing device of any one of claims 100-106, further comprising: one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

109. The suturing device of any one of claims 100-106, further comprising one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw.

110. The suturing device of claim 100, further comprising a dual-action needle unload button positioned on a proximal end of the handle, the dual-action needle unload button being configured to unload the needle while the first and second jaws are open.

111. A suturing device, comprising: a handle; and an elongate arm connected to the handle at a proximal end thereof and having first and second jaws positioned on a distal end thereof, the first jaw comprising a first grasping slot configured to receive a needle and the second jaw comprising a second grasping slot configured to receive the needle, the first and second jaws having a fixed aperture therebetween; wherein the distal end of the arm is angled relative to the proximal end such that the distal end is configured to reach a target tissue to be sutured.

112. The suturing device of claim 111, wherein the first and second jaws are rotated between 60 degrees and 90 degrees relative to the elongate arm.

113. The suturing device of claim 111, further comprising: one or more image sensors comprising one or more optical wires extending through the suturing device, wherein the one or more image sensors are configured to generate image data of an operating site of the suturing device.

114. The suturing device of claim 111, further comprising: one or more electric field sensors positioned on a surface of the suturing device and configured to locate nerves in and around an operating site of the suturing device.

115. The suturing device of claim 111, further comprising one or more piezo electric films positioned on a surface of at least one of the first jaw or the second jaw, wherein the one or more piezo electric films is configured to vibrate the at least one of the first jaw or the second jaw.

116. A suturing needle, comprising: an elongate body with a proximal end and a distal end; a first circumferential slot positioned at the proximal end of the elongate body and a second circumferential slot positioned at the distal end of the elongate body, the first and second circumferential slots being configured to interface with a suturing device; and a thread slot formed in a middle portion of the elongate body between the proximal and distal ends of the elongate body, the thread slot being configured to receive a thread, wherein the thread is forcibly deformed into the thread slot creating a desired holding force between the suturing needle and the thread to join the thread to the suturing needle.

117. The suturing needle of claim 116, wherein the thread slot has a cross-sectional geometry that is at least one of rectangular, triangular, slanted, straight, linear, or circumferential.

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