Endoscopic suturing device

Abstract

Tissue suturing systems, devices, apparatus, and methods are provided for endoscopic suturing of tissue within the body. [Solution] An endoscopic suturing system configured to be attached to and used with an endoscope is provided, the suturing system including an arcuate needle, a needle guide, and a needle guide cover, the needle guide having a notch and pawl for engaging and rotating the needle, and a backstop for preventing the needle guide from rotating more than 270 degrees in the opposite direction.

Description

[Technical Field]

[0001] cross reference

[0001] This application claims the benefit of U.S. Provisional Patent Application No. 63 / 042,375, filed June 22, 2020, and U.S. Provisional Patent Application No. 63 / 142,677, filed January 28, 2021, which are incorporated by reference in their entireties.

[0002]

[0002] This application also claims the benefit of U.S. Utility Application No. 17 / 354,649, filed June 22, 2021, which is a continuation-in-part of U.S. Patent Application No. 16 / 433,710, filed June 6, 2019, which claims the benefit of U.S. Provisional Patent Application No. 62 / 681,783, filed June 7, 2018, the entire contents of which are incorporated herein by reference. Statement regarding federally sponsored research

[0003] This invention was made with U.S. government support under award #1912944 from the National Science Fund (NSF) SBIR Phase I. The U.S. government has certain rights in this invention. [Background technology]

[0003]

[0004] Full-thickness gastrointestinal defects, including perforations, anastomotic leaks, and fistulas, are serious conditions resulting from various types of lesions. These conditions are associated with a high potential for intensive care, prolonged hospital stays, and high morbidity and mortality. Currently available advanced endoscopic suturing techniques play a major role in the treatment of full-thickness gastrointestinal defects. Endoscopic clips are the most common treatment for suturing small defects. However, endoscopic clips are less useful for larger defects due to the limited opening distance between the clip jaws, low suturing force, and the inability to achieve deep tissue capture.

[0004]

[0005] Innovative endoscopic devices for placing full-thickness sutures have been in the field for suturing large anomalies. However, many of the suturing devices developed over the past 20 years are cumbersome and expensive, and therefore, an increasing number of physicians continue to search for simpler suturing devices. Endoscopic suturing is a minimally invasive technique that can be used for a variety of gastrointestinal indications, such as stoma reduction and gastric atresia, fistula repair, bariatric care, stent and graft fixation, and gastrointestinal bleeding. Summary of the Invention [Means for solving the problem]

[0005]

[0006] One aspect provided herein is an endoscopic suturing system comprising: a distal assembly comprising: a first housing comprising an arcuate needle guide, a shuttle guide, and an endoscope fixture, the endoscope fixture coupling the first housing to an endoscope; an arcuate needle comprising a notch and a suture attachment, the arcuate needle having a central axis, the arcuate needle disposed within the arcuate needle guide; and a shuttle having a pawl, the shuttle carried within the shuttle guide, wherein the notch and pawl are engaged when the shuttle translates in a first rotational direction about the central axis and the notch and pawl are disengaged when the shuttle translates in a direction opposite to the first rotational direction; and a proximal assembly comprising: a second housing and an actuator connected to the second housing. The solid body includes a cable connecting an actuator to the shuttle and configured to translate the shuttle in a first direction and a second direction in response to actuation of the actuator.

[0006]

[0007] In some embodiments, the pawl comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, the pawl is biased upon engagement. In some embodiments, the notch is angled in a direction opposite the first direction. In some embodiments, the endoscope securement device comprises a fastener, a string, a band, a hook and loop securement, tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

[0007]

[0008] In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 16 mm. In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 6 mm, about 5 mm to about 7 mm, about 5 mm to about 8 mm, about 5 mm to about 9 mm, about 5 mm to about 10 mm, about 5 mm to about 11 mm, about 5 mm to about 12 mm, about 5 mm to about 13 mm, about 5 mm to about 14 mm, about 5 mm to about 15 mm, about 5 mm to about 16 mm, about 6 mm to about 7 mm, about 6 mm to about 8 mm, about 6 mm to about 9 mm, about 6 mm to about 10 mm, about 6 mm to about 11 mm, about 6 mm to about 12 mm. About 12mm, about 6mm to about 13mm, about 6mm to about 14mm, about 6mm to about 15mm, about 6mm to about 16mm, about 7mm to about 8mm, about 7mm to about 9mm, about 7mm to about 10mm, about 7mm to about 11mm, about 7mm to about 12mm, about 7mm to about 13mm, about 7mm to about 14mm, about 7mm to about 15mm, about 7mm to about 16mm, about 8mm to about 9mm, about 8mm to about 10mm, about 8mm to about 11mm, about 8mm to about 12mm, about 8 ...1mm, about 8mm to about 12mm, about 8mm to about 13mm, about 7mm to about 14mm, about 7mm to about 15mm, about 7mm to about 16mm, about 8mm to about 9mm, about 8mm to about 10mm, about 8mm to about mm to about 13 mm, about 8 mm to about 14 mm, about 8 mm to about 15 mm, about 8 mm to about 16 mm, about 9 mm to about 10 mm, about 9 mm to about 11 mm, about 9 mm to about 12 mm, about 9 mm to about 13 mm, about 9 mm to about 14 mm, about 9 mm to about 15 mm, about 9 mm to about 16 mm, about 10 mm to about 11 mm, about 10 mm to about 12 mm, about 10 mm to about 13 mm, about 10 mm to about 14 mm, about 10 mm to about 15 mm, about 10 mm to about 16 mm, The endoscope has a distal outer diameter of about 11 mm to about 12 mm, about 11 mm to about 13 mm, about 11 mm to about 14 mm, about 11 mm to about 15 mm, about 11 mm to about 16 mm, about 12 mm to about 13 mm, about 12 mm to about 14 mm, about 12 mm to about 15 mm, about 12 mm to about 16 mm, about 13 mm to about 14 mm, about 13 mm to about 15 mm, about 13 mm to about 16 mm, about 14 mm to about 15 mm, about 14 mm to about 16 mm, or about 15 mm to about 16 mm. In some embodiments, the endoscope has a distal outer diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.In some embodiments, the endoscope has a minimum distal outer diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, or about 15 mm. In some embodiments, the endoscope has a maximum distal outer diameter of about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.

[0008]

[0009] In some embodiments, the endoscope fixation device has an inner diameter of about 5 mm to about 16 mm. In some embodiments, the endoscope fixation device has an inner diameter of about 5 mm to about 6 mm, about 5 mm to about 7 mm, about 5 mm to about 8 mm, about 5 mm to about 9 mm, about 5 mm to about 10 mm, about 5 mm to about 11 mm, about 5 mm to about 12 mm, about 5 mm to about 13 mm, about 5 mm to about 14 mm, about 5 mm to about 15 mm, about 5 mm to about 16 mm, about 6 mm to about 7 mm, about 6 mm to about 8 mm, about 6 mm to about 9 mm, about 6 mm to about 10 mm, about 6 mm to about 11 mm, about 6 mm to about 12 mm, about 6 mm to about 13 mm, about 6 mm to about 14 mm, about 6 mm to about 15 mm, about 6 mm to about 16 mm, about 7 mm to about 8 mm, about 7 mm to about 8 mm, about 7 mm to about 8 mm, about 7 mm to about 9 mm, about 7 mm to about 11 mm, about 5 mm to about 12 mm, about 6 mm to about 13 mm, about 6 mm to about 14 mm, about 6 mm to about 15 mm, about 6 mm to about 16 mm, about 7 mm to about 8 mm, about 7 mm to about 8 mm, about 7 mm to about 9 mm, about 7 mm to about 11 mm, about 5 mm to about 12 mm, about 5 mm to about 13 mm, about 5 mm to about 14 mm, about 6 mm to about 15 mm, about 6 mm to about 16 mm, about 7 mm to about 8 mm, about 7 mm to about 9 mm, about 7 mm to about 11 mm, about 5 mm to about 12 mm, about mm to about 9mm, about 7mm to about 10mm, about 7mm to about 11mm, about 7mm to about 12mm, about 7mm to about 13mm, about 7mm to about 14mm, about 7mm to about 15mm, about 7mm to about 16mm, about 8mm to about 9mm, about 8mm to about 10mm, about 8mm to about 11mm, about 8mm to about 12mm, about 8mm to about 13mm, about 8mm to about 14mm, about 8mm to about 15mm, about 8mm to about 16mm, about 9mm to about 10mm, about 9mm to about 11mm, about 9mm to about 12mm, about 9mm to about 13mm, about 9mm to about 14mm, about 9mm to about 15mm, about 9mm to about 16mm, about 10mm to about 11 mm, about 10 mm to about 12 mm, about 10 mm to about 13 mm, about 10 mm to about 14 mm, about 10 mm to about 15 mm, about 10 mm to about 16 mm, about 11 mm to about 12 mm, about 11 mm to about 13 mm, about 11 mm to about 14 mm, about 11 mm to about 15 mm, about 11 mm to about 16 mm, about 12 mm to about 13 mm, about 12 mm to about 14 mm, about 12 mm to about 15 mm, about 12 mm to about 16 mm, about 13 mm to about 14 mm, about 13 mm to about 15 mm, about 13 mm to about 16 mm, about 14 mm to about 15 mm, about 14 mm to about 16 mm, or about 15 mm to about 16 mm. In some embodiments, the endoscope fixture has an inner diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm. In some embodiments, the endoscope fixture has a minimum inner diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, or about 15 mm. In some embodiments, the endoscope fixture has a maximum inner diameter of about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.

[0009]

[0010] In some embodiments, the system further comprises a cable sheath surrounding at least a portion of the cable. In some embodiments, the system further comprises a cable securement that removably couples at least a portion of the cable sheath to the endoscope. In some embodiments, the cable securement comprises a fastener, a string, a band, a hook and loop securement, a tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

[0010]

[0011] In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 120 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 10 degrees, from about 5 degrees to about 20 degrees, from about 5 degrees to about 30 degrees, from about 5 degrees to about 40 degrees, from about 5 degrees to about 50 degrees, from about 5 degrees to about 60 degrees, from about 5 degrees to about 70 degrees, from about 5 degrees to about 80 degrees, from about 5 degrees to about 90 degrees, from about 5 degrees to about 100 degrees, from about 5 degrees to about 120 degrees, from about 10 degrees to about 20 degrees, from about 10 degrees to about 3 ...20 degrees, from about 10 degrees to about 30 degrees, from about 10 degrees to about 20 degrees, from about 10 degrees to about 30 degrees, from about 10 degrees to about 20 degrees, from about 10 degrees to about 20 degrees, from about 10 degrees to about 30 degrees, from about 10 degrees to about to about 40 degrees, about 10 degrees to about 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 70 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 90 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 20 degrees to about 60 degrees, about 20 degrees to about 70 degrees, about 20 degrees to about 80 degrees, about 20 degrees to about 90 degrees, about 20 degrees to about 100 degrees, about 20 degrees to about 12 0 degrees, approximately 30 degrees to approximately 40 degrees, approximately 30 degrees to approximately 50 degrees, approximately 30 degrees to approximately 60 degrees, approximately 30 degrees to approximately 70 degrees, approximately 30 degrees to approximately 80 degrees, approximately 30 degrees to approximately 90 degrees, approximately 30 degrees to approximately 100 degrees, approximately 30 degrees to approximately 120 degrees, approximately 40 degrees to approximately 50 degrees, approximately 40 degrees to approximately 60 degrees, approximately 40 degrees to approximately 70 degrees, approximately 40 degrees to approximately 80 degrees, approximately 40 degrees to approximately 90 degrees, approximately 40 degrees to approximately 100 degrees, approximately 40 degrees to approximately 120 degrees, approximately 50 degrees to approximately 60 degrees, approximately 50 degrees to about 70 degrees, about 50 degrees to about 80 degrees, about 50 degrees to about 90 degrees, about 50 degrees to about 100 degrees, about 50 degrees to about 120 degrees, about 60 degrees to about 70 degrees, about 60 degrees to about 80 degrees, about 60 degrees to about 90 degrees, about 60 degrees to about 100 degrees, about 60 degrees to about 120 degrees, about 70 degrees to about 80 degrees, about 70 degrees to about 90 degrees, about 70 degrees to about 100 degrees, about 70 degrees to about 120 degrees, about 80 degrees to about 90 degrees, about 80 degrees to about 100 degrees, about 80 In some embodiments, the angle between the central axis of the planar arcuate needle guide and the distal axis of the endoscope is about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees. In some embodiments, the angle between the central axis of the planar arcuate needle guide and the distal axis of the endoscope is at least about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, or about 100 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is at most about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees.

[0011]

[0012] In some embodiments, the angle between the central axis adjustable within the plane of the arcuate needle guide and the distal side adjustable within the plane of the endoscope is adjustable within a range of about 5 degrees to about 120 degrees. In some embodiments, the angle between the central axis adjustable within the plane of the arcuate needle guide and the distal side adjustable within the plane of the endoscope is adjustable within a range of about 5 degrees to about 10 degrees, about 5 degrees to about 20 degrees, about 5 degrees to about 30 degrees, about 5 degrees to about 40 degrees, about 5 degrees to about 50 degrees, about 5 degrees to about 60 degrees, about 5 degrees to about 70 degrees, about 5 degrees to about 80 degrees, about 5 degrees to about 90 degrees, about 5 degrees to about 100 degrees, about 5 degrees to about 120 degrees, about 10 degrees to about 20 degrees, about 10 degrees to about 30 degrees, about 10 ... degrees to about 40 degrees, about 10 degrees to about 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 70 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 90 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 20 degrees to about 60 degrees, about 20 degrees to about 70 degrees, about 20 degrees to about 80 degrees, about 20 degrees to about 90 degrees, about 20 degrees to about 100 degrees, about 20 degrees to about 120 degrees, about 30 degrees to about 40 degrees, about 30 degrees to About 50 degrees, about 30 degrees to about 60 degrees, about 30 degrees to about 70 degrees, about 30 degrees to about 80 degrees, about 30 degrees to about 90 degrees, about 30 degrees to about 100 degrees, about 30 degrees to about 120 degrees, about 40 degrees to about 50 degrees, about 40 degrees to about 60 degrees, about 40 degrees to about 70 degrees, about 40 degrees to about 80 degrees, about 40 degrees to about 90 degrees, about 40 degrees to about 100 degrees, about 40 degrees to about 120 degrees, about 50 degrees to about 60 degrees, about 50 degrees to about 70 degrees, about 50 degrees to about 80 degrees, about 50 degrees to about 90 degrees, about 50 degrees to about 10 The angle can be adjusted within the range of 0 degrees, about 50 degrees to about 120 degrees, about 60 degrees to about 70 degrees, about 60 degrees to about 80 degrees, about 60 degrees to about 90 degrees, about 60 degrees to about 100 degrees, about 60 degrees to about 120 degrees, about 70 degrees to about 80 degrees, about 70 degrees to about 90 degrees, about 70 degrees to about 100 degrees, about 70 degrees to about 120 degrees, about 80 degrees to about 90 degrees, about 80 degrees to about 100 degrees, about 80 degrees to about 120 degrees, about 90 degrees to about 100 degrees, about 90 degrees to about 120 degrees, or about 100 degrees to about 120 degrees.In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable within and the distal side of the endoscope that is adjustable within is adjustable within a range of about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable within and the distal side of the endoscope that is adjustable within is adjustable within a range of at least about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, or about 100 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide, within which it is adjustable, and the distal side of the endoscope, within which it is adjustable, is adjustable within a range of at most about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees.

[0012]

[0013] In some embodiments, the arcuate needle comprises two or more notches. In some embodiments, at least one of the first housing, the second housing, the arcuate needle, the shuttle, or the actuator is constructed from plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof. In some embodiments, the first The housing further comprises a cable pulley that guides the cable. In some embodiments, the arcuate needle further comprises a suture attachment fixture. In some embodiments, the first housing further comprises a pulley, and the cable is threaded around the pulley. In some embodiments, the second housing is coupled to the endoscope.

[0013]

[0014] Another aspect provided herein is an endoscopic suturing system comprising: a distal assembly comprising: a first housing with an arcuate needle guide and an endoscope fixture, the endoscope fixture coupling the first housing to an endoscope; an arcuate needle with a notch and a suture attachment, the arcuate needle having a central axis and disposed within the arcuate needle guide; a proximal assembly comprising: a second housing removably attachable to the endoscope; and an actuator connected to the second housing; and a cable having a pawl, the notch and pawl engaged when the cable translates in a first rotational direction about the central axis and the notch and pawl disengaged when the cable translates opposite to the first rotational direction.

[0014]

[0015] Another aspect provided herein is an endoscopic suturing system, the endoscopic suturing system comprising: a distal assembly, the first housing having an arcuate needle guide and an endoscope fixture, the endoscope fixture attaching the first housing to an endoscope; an arcuate needle having a notch and a suture attachment, the arcuate needle having a central axis, the arcuate needle being disposed within the arcuate needle guide; and an arcuate needle guide cover, the arcuate needle guide cover removably attached to the first housing, the arcuate needle guide cover attaching to a backstop. a distal assembly comprising: an arcuate needle guide cover comprising: a proximal assembly comprising: a second housing; and an actuator connected to the second housing; and a cable having a pawl, wherein when the pawl translates in a first rotational direction about a central axis, the notch and pawl are engaged, and when the pawl translates in a second direction opposite the first rotational direction, the notch and pawl are disengaged, and the backstop and needle are engaged to prevent the arcuate needle from rotating in the second rotational direction by up to approximately 270 degrees within the arcuate needle guide.

[0015]

[0016] In some embodiments, the pawl comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, the pawl is biased upon engagement. In some embodiments, the notch is angled in a direction opposite the first direction. In some embodiments, the endoscope fixation device comprises a press fit fixation device, a clamp, adhesive, tape, a strap, a set screw, a hook and loop fixation device, a magnet, or any combination thereof.

[0016]

[0017] In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 16 mm. In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 6 mm, about 5 mm to about 7 mm, about 5 mm to about 8 mm, about 5 mm to about 9 mm, about 5 mm to about 10 mm, about 5 mm to about 11 mm, about 5 mm to about 12 mm, about 5 mm to about 13 mm, about 5 mm to about 14 mm, about 5 mm to about 15 mm, about 5 mm to about 16 mm, about 6 mm to about 7 mm, about 6 mm to about 8 mm, about 6 mm to about 9 mm, about 6 mm to about 10 mm, about 6 mm to about 11 mm, about 6 mm to about 12 mm, about 6 mm to about 13 mm, about 6 mm to about 14 mm, about 5 mm to about 15 mm, about 5 mm to about 16 mm, about 6 mm to about 16 mm, about 6 mm to about 17 mm, about 6 mm to about 18 mm, about 6 mm to about 19 mm, about 6 mm to about 20 mm, about 6 mm to about 21 mm, about 6 mm to about 22 mm, about 6 mm to about 23 mm, about 6 mm to about 24 mm, about 6 mm to about 25 mm, about 6 mm to about 26 mm, about 6 mm to about 27 mm, about 6 mm to about 28 mm, about 6 mm to about 29 mm, about 6 mm to about 30 mm, about 6 mm to about 31 mm, about 6 mm to about 32 mm, about 6 mm to about 33 mm, about 6 mm to about 34 mm, about 6 mm to about 35 mm, about 6 mm to about 36 mm, about 6 mm to about 37 mm, about 6 mm to about 3 1mm, about 6mm to about 12mm, about 6mm to about 13mm, about 6mm to about 14mm, about 6mm to about 15mm, about 6mm to about 16mm, about 7mm to about 8mm, about 7mm to about 9mm, about 7mm to about 10mm, about 7mm to about 11mm, about 7mm to about 12mm, about 7mm to about 13mm, about 7mm to about 14mm, about 7mm to about 15mm, about 7mm to about 16mm, about 8mm to about 9mm, about 8mm to about 10mm, about 8mm to About 11 mm, about 8 mm to about 12 mm, about 8 mm to about 13 mm, about 8 mm to about 14 mm, about 8 mm to about 15 mm, about 8 mm to about 16 mm, about 9 mm to about 10 mm, about 9 mm to about 11 mm, about 9 mm to about 12 mm, about 9 mm to about 13 mm, about 9 mm to about 14 mm, about 9 mm to about 15 mm, about 9 mm to about 16 mm, about 10 mm to about 11 mm, about 10 mm to about 12 mm, about 10 mm to about 13 mm, about 10 mm to about 14 mm, about 10 mm to about 15 mm, about 10 In some embodiments, the endoscope has a distal outer diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, about 11 mm, about 16 mm, about 12 mm, about 13 mm, about 12 mm, about 14 mm, about 12 mm, about 15 mm, about 12 mm, about 16 mm, about 13 mm, about 14 mm, about 13 mm, about 15 mm, about 13 mm, about 16 mm, about 14 mm, about 15 mm, about 14 mm, or about 15 mm to 16 mm. In some embodiments, the endoscope has a distal outer diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm. In some embodiments, the endoscope has a minimum distal outer diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, or about 15 mm. In some embodiments, the endoscope has a maximum distal outer diameter of about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.

[0017]

[0018] In some embodiments, the endoscope fixture has an inner diameter of about 5 mm to about 16 mm. In some embodiments, the endoscope fixture has an inner diameter of about 5 mm to about 6 mm, about 5 mm to about 7 mm, about 5 mm to about 8 mm, about 5 mm to about 9 mm, about 5 mm to about 10 mm, about 5 mm to about 11 mm, about 5 mm to about 12 mm, about 5 mm to about 13 mm, about 5 mm to about 14 mm, about 5 mm to about 15 mm, about 5 mm to about 16 mm, about 6 mm to about 7 mm, about 6 mm to about 8 mm, about 6 mm to about 9 mm, about 6 mm to about 10 mm, about 6 mm to about 11 mm, about 6 mm to about 12 mm, about 6 ... m to about 12mm, about 6mm to about 13mm, about 6mm to about 14mm, about 6mm to about 15mm, about 6mm to about 16mm, about 7mm to about 8mm, about 7mm to about 9mm, about 7mm to about 10mm, about 7mm to about 11mm, about 7mm to about 12mm, about 7mm to about 13mm, about 7mm to about 14mm, about 7mm to about 15mm, about 7mm to about 16mm, about 8mm to about 9mm, about 8mm to about 10mm, about 8mm to about 11mm, about 8mm to about 12m m, about 8mm to about 13mm, about 8mm to about 14mm, about 8mm to about 15mm, about 8mm to about 16mm, about 9mm to about 10mm, about 9mm to about 11mm, about 9mm to about 12mm, about 9mm to about 13mm, about 9mm to about 14mm, about 9mm to about 15mm, about 9mm to about 16mm, about 10mm to about 11mm, about 10mm to about 12mm, about 10mm to about 13mm, about 10mm to about 14mm, about 10mm to about 15mm, about 10mm to about 1 The endoscope fixation device has an inner diameter of about 6 mm, about 11 mm to about 12 mm, about 11 mm to about 13 mm, about 11 mm to about 14 mm, about 11 mm to about 15 mm, about 11 mm to about 16 mm, about 12 mm to about 13 mm, about 12 mm to about 14 mm, about 12 mm to about 15 mm, about 12 mm to about 16 mm, about 13 mm to about 14 mm, about 13 mm to about 15 mm, about 13 mm to about 16 mm, about 14 mm to about 15 mm, about 14 mm to about 16 mm, or about 15 mm to about 16 mm. In some embodiments, the endoscope fixation device has an inner diameter of about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.In some embodiments, the endoscope fixture has a minimum inner diameter of about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, or about 15 mm. In some embodiments, the endoscope fixture has a maximum inner diameter of about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, or about 16 mm.

[0018]

[0019] In some embodiments, the system further comprises a cable sheath surrounding at least a portion of the cable. In some embodiments, the system further comprises a cable fastener that removably couples at least a portion of the cable to the endoscope. In some embodiments, the cable fastener comprises a press-fit fastener, a clamp, adhesive, tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof.

[0019]

[0020] In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 120 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 10 degrees, from about 5 degrees to about 20 degrees, from about 5 degrees to about 30 degrees, from about 5 degrees to about 40 degrees, from about 5 degrees to about 50 degrees, from about 5 degrees to about 60 degrees, from about 5 degrees to about 70 degrees, from about 5 degrees to about 80 degrees, from about 5 degrees to about 90 degrees, from about 5 degrees to about 100 degrees, from about 5 degrees to about 120 degrees, from about 10 degrees to about 20 degrees, from about 10 degrees to about 30 degrees, from about 10 degrees to about 40 degrees, from about 10 ... About 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 70 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 90 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 20 degrees to about 60 degrees, about 20 degrees to about 70 degrees, about 20 degrees to about 80 degrees, about 20 degrees to about 90 degrees, about 20 degrees to about 100 degrees, about 20 degrees to about 120 degrees, about 30 degrees to about 40 degrees, about 30 degrees to about 50 degrees, about 30 degrees to approximately 60 degrees, approximately 30 degrees to approximately 70 degrees, approximately 30 degrees to approximately 80 degrees, approximately 30 degrees to approximately 90 degrees, approximately 30 degrees to approximately 100 degrees, approximately 30 degrees to approximately 120 degrees, approximately 40 degrees to approximately 50 degrees, approximately 40 degrees to approximately 60 degrees, approximately 40 degrees to approximately 70 degrees, approximately 40 degrees to approximately 80 degrees, approximately 40 degrees to approximately 90 degrees, approximately 40 degrees to approximately 100 degrees, approximately 40 degrees to approximately 120 degrees, approximately 50 degrees to approximately 60 degrees, approximately 50 degrees to approximately 70 degrees, approximately 50 degrees to approximately 80 degrees, approximately 50 degrees to approximately 90 degrees, approximately 50 degrees to approximately 100 degrees, about 50 degrees to about 120 degrees, about 60 degrees to about 70 degrees, about 60 degrees to about 80 degrees, about 60 degrees to about 90 degrees, about 60 degrees to about 100 degrees, about 60 degrees to about 120 degrees, about 70 degrees to about 80 degrees, about 70 degrees to about 90 degrees, about 70 degrees to about 100 degrees, about 70 degrees to about 120 degrees, about 80 degrees to about 90 degrees, about 80 degrees to about 100 degrees, about 80 degrees to about 120 degrees, about 90 degrees to about 100 degrees, about 90 degrees to about 120 degrees, or about 100 degrees to about 120 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees.In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is at least about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, or about 100 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is at least about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, or about 100 degrees. In some embodiments, the angle between the central axis of the planar surface of the arcuate needle guide and the distal axis of the endoscope is at most about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees.

[0020]

[0021] In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable therein and the distal side of the endoscope that is adjustable therein is adjustable within a range of about 5 degrees to about 120 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable therein and the distal side of the endoscope that is adjustable therein is adjustable within a range of about 5 degrees to about 10 degrees, about 5 degrees to about 20 degrees, about 5 degrees to about 30 degrees, about 5 degrees to about 40 degrees, about 5 degrees to about 50 degrees, about 5 degrees to about 60 degrees, about 5 degrees to about 70 degrees, about 5 degrees to about 80 degrees, about 5 degrees to about 90 degrees, about 5 degrees to about 100 degrees, about 5 degrees to about 120 degrees, about 10 degrees to about 20 degrees, about 10 degrees to about 30 degrees, about 10 degrees to about 40 degrees, about 10 degrees to about 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 70 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 90 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 20 degrees to about 60 degrees, about 20 degrees to about 70 degrees, about 20 degrees to about 80 degrees, about 20 degrees to about 90 degrees, about 20 degrees to about 100 degrees, about 20 degrees to about 120 degrees, about 30 degrees to about 40 degrees, about 30 degrees to about 50 degrees, about 30 degrees to about 60 degrees, about 30 degrees to about 70 degrees, about 30 degrees to about 80 degrees, about 30 degrees to about 90 degrees, about 30 degrees to about 100 degrees, about 30 degrees to about 120 degrees, about 40 degrees to about 50 degrees, about 40 degrees to about 60 degrees, about 40 degrees to about 70 degrees, about 40 degrees to about 80 degrees, about 40 degrees to about 90 degrees, about 40 degrees to about 100 degrees, about 40 degrees to about 120 degrees, about 5 The angle can be adjusted within a range of 0 degrees to about 60 degrees, about 50 degrees to about 70 degrees, about 50 degrees to about 80 degrees, about 50 degrees to about 90 degrees, about 50 degrees to about 100 degrees, about 50 degrees to about 120 degrees, about 60 degrees to about 70 degrees, about 60 degrees to about 80 degrees, about 60 degrees to about 90 degrees, about 60 degrees to about 100 degrees, about 60 degrees to about 120 degrees, about 70 degrees to about 80 degrees, about 70 degrees to about 90 degrees, about 70 degrees to about 100 degrees, about 70 degrees to about 120 degrees, about 80 degrees to about 90 degrees, about 80 degrees to about 100 degrees, about 80 degrees to about 120 degrees, about 90 degrees to about 100 degrees, about 90 degrees to about 120 degrees, or about 100 degrees to about 120 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable within and the distal side of the endoscope that is adjustable within is adjustable within a range of about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide that is adjustable within and the distal side of the endoscope that is adjustable within is adjustable within a range of at least about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, or about 100 degrees. In some embodiments, the angle between the central axis of the plane of the arcuate needle guide, within which it is adjustable, and the distal side of the endoscope, within which it is adjustable, is adjustable within a range of at most about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 100 degrees, or about 120 degrees.

[0021]

[0022] In some embodiments, the arched needle comprises two or more notches. In some embodiments, at least one of the first housing, the second housing, the arched needle, or the actuator is constructed from plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof. In some embodiments, the first housing further comprises a cable pulley that guides the cable. In some embodiments, the arched needle further comprises a suture attachment fixture. In some embodiments, the first housing further comprises a pulley, and the cable is threaded around the pulley. In some embodiments, the second housing is coupled to an endoscope.

[0022]

[0023] Another aspect provided herein is an endoscopic suturing system, the endoscopic suturing system comprising: a distal assembly, a first housing, a primary housing portion comprising an endoscope fixture, the endoscope fixture attaching the first housing portion to an endoscope; a secondary housing portion comprising an arcuate needle guide, the second housing portion being removably coupled to the primary housing portion; and a tertiary housing portion comprising an arcuate needle guide cover, the tertiary housing portion being removably coupled to the second housing portion and detachable from the primary housing portion. a distal assembly comprising a first housing having a tertiary housing portion coupled to a distal end of the ...

[0023]

[0024] In some embodiments, the pawl comprises a spring, a curved portion, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, the pawl is biased by engagement. In some embodiments, the notch is angled in a direction opposite the first direction. In some embodiments, the notch is located on an inner surface of the arched needle. In some embodiments, the notch is located on an outer surface of the arched needle. In some embodiments, the notch is located on a top surface of the arched needle. In some embodiments, the arched needle comprises two or more notches. In some embodiments, the endoscope fixation device comprises a press-fit fixation device, a clamp, adhesive, tape, a strap, a set screw, a hook and loop fixation device, a magnet, or any combination thereof. In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 16 mm. In some embodiments, the system further comprises a cable sheath surrounding at least a portion of the cable. In some embodiments, the system further comprises a cable fixation device removably coupling at least a portion of the cable to the endoscope. In some embodiments, the cable fastener comprises a press-fit fastener, a fastener, a string, a band, a hook-and-loop fastener, tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof. In some embodiments, an angle between a planar central axis of the arcuate needle guide and a distal axis of the endoscope is from about 5 degrees to about 85 degrees. In some embodiments, an angle between a planar central axis of the arcuate needle guide and a distal axis of the endoscope is adjustable within a range of from about 5 degrees to about 85 degrees. In some embodiments, at least one of the first housing, the second housing, the arcuate needle, and the actuator is comprised of plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof. In some embodiments, the first housing further comprises a cable pulley for guiding the cable. In some embodiments, the arcuate needle further comprises a suture attachment fastener. In some embodiments, the second housing is removably coupled to the endoscope.In some embodiments, the secondary housing portion is removably coupled to the primary housing portion by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof. In some embodiments, the arcuate needle is trapped between the arcuate needle guide and the tertiary housing portion when the tertiary housing is coupled to the primary housing portion. In some embodiments, the tertiary housing portion is removably coupled to the primary housing portion by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof. In some embodiments, the tertiary housing portion is further removably coupled to the secondary housing portion. In some embodiments, the tertiary housing portion is removably coupled to the secondary housing portion by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

[0024]

[0025] Another aspect provided herein is an endoscopic suturing system, the endoscopic suturing system comprising: a distal assembly comprising: a first housing comprising an arcuate needle guide and an endoscope fixture, the endoscope fixture attaching the first housing to an endoscope, the arcuate needle guide comprising a backstop; and an arcuate needle comprising a notch and a suture attachment, the arcuate needle having a central axis, the arcuate needle being disposed within the arcuate needle guide; and a proximal assembly comprising: the body comprising: a proximal assembly comprising a second housing and an actuator connected to the second housing; and a cable having a pawl, wherein when the pawl translates in a first rotational direction about a central axis, the notch and pawl are engaged, and when the pawl translates in a second direction opposite the first rotational direction, the notch and pawl are disengaged, and the backstop and arcuate needle are engaged to prevent the arcuate needle from rotating in the second rotational direction by up to approximately 270 degrees within the arcuate needle guide.

[0025]

[0026] In some embodiments, the pawl may be a spring, a flexure, a dual spring gate, a clutch, or the like.In some embodiments, the pawl is biased by engagement. In some embodiments, the notch is angled in a direction opposite the first direction. In some embodiments, the notch is located on an inner surface of the arcuate needle. In some embodiments, the notch is located on an outer surface of the arcuate needle. In some embodiments, the notch is located on a top surface of the arcuate needle. In some embodiments, the arcuate needle comprises two or more notches. In some embodiments, the endoscope fixation device comprises a press-fit fixation device, a clamp, adhesive, tape, a strap, a set screw, a hook and loop fixation device, a magnet, or any combination thereof. In some embodiments, the endoscope has a distal outer diameter of about 5 mm to about 156 mm. In some embodiments, the system further comprises a cable sheath surrounding at least a portion of the cable. In some embodiments, the system further comprises a cable fixation device removably coupling at least a portion of the cable to the endoscope. In some embodiments, the cable fastener comprises a press-fit fastener, a clasp, a string, a band, a hook-and-loop fastener, tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof. In some embodiments, an angle between a planar central axis of the arcuate needle guide and a distal axis of the endoscope is about 5 degrees to about 85 degrees. In some embodiments, an angle between a planar central axis of the arcuate needle guide and a distal axis of the endoscope is adjustable within a range of about 5 degrees to about 85 degrees. In some embodiments, at least one of the first housing, the second housing, the arcuate needle, and the actuator is comprised of plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof. In some embodiments, the first housing further comprises a cable pulley for guiding the cable. In some embodiments, the arcuate needle further comprises a suture attachment fastener. In some embodiments, the second housing is removably coupled to the endoscope. In some embodiments, the backstop comprises a curved portion, a clasp, a magnet, a clamp, or any combination thereof. In some embodiments, the system comprises two or more backstops.

[0026]

[0027] Another aspect provided herein is an endoscopic suturing platform, the endoscopic suturing platform comprising an endoscopic suturing system and a needle exchange mount removably coupled to the arcuate needle and a tertiary housing. In some embodiments, the needle exchange mount is removably coupled to the arcuate needle by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof. In some embodiments, the needle exchange mount is removably coupled to the tertiary housing portion by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

[0027]

[0028] Another aspect provided herein is an endoscopic suturing platform, the endoscopic suturing platform comprising an endoscopic suturing system and a needle exchange mount removably coupled to the arcuate needle and the first housing. In some embodiments, the needle exchange mount is removably coupled to the arcuate needle by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof. In some embodiments, the needle exchange mount is removably coupled to the first housing by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

[0028]

[0029] Another aspect provided herein is a method, the method including receiving an endoscopic suturing platform, coupling an arcuate needle to a needle exchange mount, coupling a tertiary housing portion to the needle exchange mount to couple the needle exchange mount together with the arcuate needle and the tertiary housing portion to a first housing portion, disconnecting the arcuate needle from the needle exchange mount, and disconnecting the needle exchange mount from the tertiary housing. Disconnecting the needle from the needle exchange mount inserts the needle into the arcuate needle guide.

[0029]

[0030] Another aspect provided herein is a method, the method including receiving an endoscopic suturing platform, coupling an arcuate needle to a needle exchange mount, coupling the needle exchange mount to a first housing, decoupling the arcuate needle from the needle exchange mount, and decoupling the needle exchange mount from the first housing. In some embodiments, decoupling the arcuate needle from the needle exchange mount inserts the needle into an arcuate needle guide.

[0030]

[0031] The novel features of the present disclosure are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized. [Brief explanation of the drawings]

[0031] [Figure 1]

[0032] 1A-1C illustrate an exemplary endoscopic suturing system, according to embodiments herein. [Figure 2]

[0033] FIG. 1 illustrates an exemplary first proximal assembly coupled to an endoscope, according to embodiments herein. [Figure 3]

[0034] FIG. 10 illustrates a second exemplary proximal assembly according to embodiments herein. [Figure 4]

[0035] FIG. 10 illustrates a third exemplary distal assembly according to embodiments herein. [Figure 5]

[0036] 1 illustrates an exemplary first distal assembly on an endoscope, according to embodiments herein. [Figure 6]

[0037] FIG. 10 is a detailed view illustrating an exemplary first distal assembly, according to embodiments herein. [Figure 7]

[0038] FIG. 10 is a detailed view illustrating an example first distal assembly in a first position with a portion of the shuttle guide removed, according to embodiments herein. [Figure 8]

[0039] FIG. 10 is a detailed view illustrating an example first distal assembly in a second position with a portion of the shuttle guide removed, according to embodiments herein. [Figure 9]

[0040] FIG. 10 is a detailed view illustrating an example first distal assembly in a third position with a portion of the shuttle guide removed, according to embodiments herein. [Figure 10]

[0041] FIG. 10 is a detailed view showing an example first distal assembly in a fourth position with a portion of the shuttle guide opaque, according to embodiments herein. [Figure 11]

[0042] FIG. 10 is a detailed view showing an example first distal assembly in a fifth position, with a portion of the shuttle guide opaque, according to embodiments herein. [Figure 12]

[0043] FIG. 10 is a detailed view showing an example first distal assembly in a sixth position with a portion of the shuttle guide opaque, according to embodiments herein. [Figure 13]

[0044] FIG. 10 is a detailed view showing an example first distal assembly in a seventh position with a portion of the shuttle guide opaque, according to embodiments herein. [Figure 14]

[0045] 1A-1C illustrate exemplary arcuate needles, according to embodiments herein. [Figure 15]

[0046] 10A-10C illustrate an exemplary arcuate needle having two notches, according to embodiments herein. [Figure 16]

[0047] 1A-1C illustrate exemplary arch needles and sutures, according to embodiments herein. [Figure 17]

[0048] FIG. 10 is a first exemplary view illustrating an in-situ suture exchange with a first exemplary distal assembly, according to an embodiment herein. [Figure 18]

[0049] FIG. 10 is a second exemplary view showing an in-situ suture exchange with the first exemplary distal assembly, according to embodiments herein. [Figure 19]

[0050] FIG. 19A is an exemplary diagram showing a shuttle with pawls engaged, according to embodiments herein.

[0051] FIG. 19B is an exemplary diagram showing a shuttle with the pawls disengaged, according to embodiments herein. [Figure 20]

[0052] FIG. 2 is a first diagram illustrating an exemplary second distal assembly coupled to an endoscope, according to embodiments herein. [Figure 21]

[0053] FIG. 10 is a second diagram illustrating an exemplary second distal assembly coupled to an endoscope, according to embodiments herein. [Figure 22]

[0054] FIG. 10 is a third diagram illustrating an exemplary second distal assembly coupled to an endoscope, according to embodiments herein. [Figure 23]

[0055] FIG. 10 is a first bottom perspective view of an exemplary second distal assembly without a bottom plate according to embodiments herein. [Figure 24]

[0056] FIG. 10 is a second bottom perspective view of an exemplary second distal assembly without a bottom plate, according to embodiments herein. [Figure 25]

[0057] 10A-10C illustrate an exemplary first housing of a second distal assembly according to embodiments herein. [Figure 26]

[0058] FIG. 10 is a cross-sectional view illustrating an exemplary second distal assembly, according to embodiments herein. [Figure 27]

[0059] FIG. 27A is a bottom cross-sectional view illustrating an exemplary second distal assembly in a first position according to embodiments herein.

[0060] FIG. 27B is a bottom cross-sectional view illustrating an exemplary second distal assembly in a second position according to embodiments herein.

[0061] FIG. 27C is a bottom cross-sectional view illustrating an exemplary second distal assembly in a third position according to embodiments herein.

[0062] FIG. 27D is a bottom cross-sectional view illustrating an exemplary second distal assembly in a fourth position according to embodiments herein.

[0063] FIG. 27E is a bottom cross-sectional view illustrating an exemplary second distal assembly in a fifth position according to embodiments herein.

[0064] FIG. 27F is a bottom cross-sectional view illustrating an exemplary second distal assembly in a sixth position according to embodiments herein. [Figure 28]

[0065] FIG. 10 is a top perspective view of an exemplary removable first housing bottom, according to embodiments herein. [Figure 29]

[0066] FIG. 10 is a bottom perspective view of an exemplary removable first housing bottom, according to embodiments herein. [Figure 30]

[0067] FIG. 30A illustrates an exemplary first cable-claw combination, according to embodiments herein.

[0068] FIG. 30B illustrates an exemplary second cable-claw combination, according to embodiments herein.

[0069] FIG. 30C illustrates an exemplary engaged cable-claw combination, according to embodiments herein. [Figure 31]

[0070] FIG. 31A illustrates an exemplary third distal assembly in a first position, according to embodiments herein.

[0071] FIG. 31B illustrates an exemplary third distal assembly in a second position, according to embodiments herein. [Figure 32]

[0072] FIG. 10 is another view illustrating the exemplary third distal assembly in a second position, according to embodiments herein. [Figure 33]

[0073] FIG. 10 is another view illustrating the exemplary third distal assembly in a second position, according to embodiments herein. [Figure 34]

[0074] FIG. 10 illustrates an exemplary first portion of a first housing of an exemplary third distal assembly in a second position, according to embodiments herein. [Figure 35]

[0075] FIG. 10 is a detailed view illustrating an example first portion of a first housing of an example third distal assembly, according to embodiments herein. [Figure 36]

[0076] FIG. 10 is a detailed view illustrating an example second portion of a first housing of an example third distal assembly, according to embodiments herein. [Figure 37]

[0077] FIG. 10 illustrates a fourth exemplary distal assembly, according to embodiments herein. [Figure 38]

[0078] FIG. 10 is a detailed view showing the cable, pawl, and arch needle of an exemplary fourth distal assembly according to embodiments herein. [Figure 39]

[0079] FIG. 10 is a detailed view showing the cables and pawls of the fourth exemplary distal assembly according to embodiments herein. [Figure 40]

[0080] FIG. 10 is a detailed view illustrating an arcuate needle of an exemplary fourth distal assembly according to embodiments herein. [Figure 41]

[0081] FIG. 10 illustrates a fifth exemplary distal assembly, according to embodiments herein. [Figure 42]

[0082] FIG. 10 is a detailed view illustrating a fifth exemplary distal assembly, according to embodiments herein. [Figure 43]

[0083] FIG. 10 is a detailed view illustrating an exemplary fifth distal assembly with the tertiary housing portion detached from the first housing portion, according to embodiments herein. [Figure 44]

[0084] FIG. 10 is a detailed view showing the secondary housing, cable, pawl, and arcuate needle of the fifth exemplary distal assembly according to embodiments herein. [Figure 45]

[0085] FIG. 10 is a detailed view showing the cables and pawls of the fifth exemplary distal assembly according to embodiments herein. [Figure 46]

[0086] FIG. 10 is a detailed view illustrating an arcuate needle of an exemplary fifth distal assembly, according to embodiments herein. [Figure 47]

[0087] FIG. 10 is a detailed view showing an arcuate needle in a first position within a secondary housing portion of an exemplary fifth distal assembly, according to embodiments herein. [Figure 48]

[0088] FIG. 10 is a detailed view showing the arcuate needle in a second position within the secondary housing portion of the exemplary fifth distal assembly, according to embodiments herein. [Figure 49]

[0089] FIG. 10 is a rear view of an exemplary fifth distal assembly according to embodiments herein. [Figure 50]

[0090] FIG. 10 is a rear view of the fifth exemplary distal assembly with the first housing portion separated from the second housing portion, according to embodiments herein. [Figure 51]

[0091] 10A-10C illustrate an exemplary needle exchange mount coupled to a tertiary housing portion of a fifth distal assembly, according to embodiments herein. [Figure 52]

[0092] FIG. 10 is a detailed view showing an example needle exchange mount coupled to a tertiary housing portion and an arcuate needle of a fifth distal assembly according to embodiments herein. [Figure 53]

[0093] FIG. 53A is a first perspective view of an example distal assembly according to an embodiment herein, where the tertiary housing portion comprises a backstop.

[0094] FIG. 53B is a second perspective view of an example distal assembly according to an embodiment herein, where the tertiary housing portion comprises a backstop. [Figure 54]

[0095] FIG. 1 is a first perspective view of an example tertiary housing portion with a backstop, according to embodiments herein. [Figure 55]

[0096] FIG. 10 is a second perspective view of an exemplary distal assembly with a tertiary housing portion hidden, according to an embodiment herein, wherein the secondary housing portion includes a backstop. [Figure 56]

[0097] FIG. 56A is a second perspective view showing an example distal assembly in a first position with a tertiary housing portion hidden, according to an embodiment herein, where the secondary housing portion includes a backstop.

[0098] FIG. 56B is a second perspective view showing an exemplary distal assembly in a second position where the tertiary housing portion is hidden, according to an embodiment herein, where the secondary housing portion includes a backstop. [Figure 57]

[0099] FIG. 10 is a perspective view illustrating an example secondary housing portion with a backstop, according to embodiments herein. [Figure 58]

[0100] FIG. 58A is a perspective view illustrating an example distal assembly in a first position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion.

[0101] FIG. 58B is a perspective view illustrating an exemplary distal assembly in a second position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion. [Figure 59]

[0102] FIG. 59A is a side view illustrating an example distal assembly in a first position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion.

[0103] FIG. 59B is a side view illustrating an example distal assembly in a second position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion. [Figure 60]

[0104] FIG. 60A is a side view illustrating an example distal assembly in a first position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion by a spring clip.

[0105] FIG. 60B is a side view illustrating an exemplary distal assembly in a second position according to an embodiment herein, where the tertiary housing portion is rotatable relative to the secondary housing portion by a spring clip. [Figure 61]

[0106] FIG. 61A is a perspective view illustrating an example distal assembly in a first position according to an embodiment herein, where the tertiary housing portion is slidable relative to the secondary housing portion.

[0107] FIG. 61B is a perspective view illustrating an example distal assembly in a second position according to an embodiment herein, where the tertiary housing portion is slidable relative to the secondary housing portion. [Figure 62]

[0108] FIG. 62A is a perspective view illustrating an example distal assembly according to an embodiment herein, where the tertiary housing portion is slidable relative to the secondary housing portion.

[0109] FIG. 62B is a perspective view illustrating an example tertiary housing portion that is slidable relative to the secondary housing portion, according to embodiments herein. [Figure 63]

[0110] 10 is an image illustrating a fifth exemplary distal assembly according to embodiments herein. [Figure 64]

[0111] 1 is an image illustrating an exemplary proximal assembly according to embodiments herein. [Figure 65]

[0112] 1 is an image illustrating an exemplary proximal assembly coupled to an endoscope, according to embodiments herein. DETAILED DESCRIPTION OF THE INVENTION

[0032]

[0113] Provided herein are tissue suturing systems, devices, apparatus, and methods for endoscopic suturing of tissue within the body. In some embodiments, the systems, devices, apparatus, and methods herein are used in conjunction with a flexible endoscope to suture tissue. The suturing systems, devices, apparatus, and methods described herein enable full-thickness endoscopic suturing for a variety of gastrointestinal procedures, including, for example, tissue suturing, bariatric surgery, stent fixation, and graft fixation.

[0033]

[0114] To enable optimal perforation during endoscopic suturing operations, tissue must be fully supported. However, some current devices do not provide sufficient support throughout the perforation cycle, thus distorting the tissue before it is fully perforated. Therefore, to achieve such support, these devices often require the simultaneous use of an auxiliary support device, such as a tissue grabber (e.g., grasper, corkscrew), and a dedicated endoscope channel for delivering the support device to the surgical site.

[0034]

[0115] However, such systems have many drawbacks that prevent rapid and optimal suturing. First, the additional endoscope channel increases the outer diameter of the endoscope, thus posing a greater risk to surrounding tissue and resulting in an unnecessarily complicated surgical procedure. In some cases, such tissue grabbers include a long shaft with a helical thread tip. The long, thin shaft required for such helical thread tip grabbers often fails due to insufficient torsional rigidity. Furthermore, such helical thread tip grabbers are limited by their limited threading depth, creating unnecessary perforations in the tissue.

[0035]

[0116] In addition, some devices translate a straight needle in a circular motion to simultaneously support and puncture tissue. However, to overcome the tangential forces applied to the straight needle, such devices are often bulky and excessively large. Furthermore, other currently available devices employ drive mechanisms such as rack-and-pinion and / or crankshafts, but the length and / or stiffness of the drive mechanisms preclude and / or prevent their use with flexible endoscopes. Finally, the plane of motion of such devices often intersects the field of view of the scope camera, which impedes visibility for the surgeon.

[0036]

[0117] Accordingly, provided herein are devices, apparatus, systems, and methods employing an arcuate needle that rotates in a circular or semicircular path through an arcuate needle guide, thereby eliminating the need for an auxiliary support device for suturing as the arcuate needle clamps tissue between gaps within the arcuate needle guide. In some embodiments, the suturing mechanisms of the devices, apparatus, systems, and methods herein are wire-actuated, thereby enabling improved endoscopic flexibility and manipulation. In some embodiments, the devices, apparatus, systems, and methods herein translate the arcuate needle through a distal assembly that is angled relative to the main axis of the endoscope. This relative angular alignment prevents camera obstruction and improves suturing accuracy and ease of use.

[0037] Endoscopic Suturing System

[0118] 1 is a diagram of an exemplary endoscopic suturing system 100 configured to be used with an endoscope 140. As shown, the exemplary endoscopic suturing system 100 includes a distal assembly 120, a proximal assembly 110, and a cable 130. In some embodiments, the endoscopic suturing system 100 further includes a cable fastener 150 that couples at least a portion of the cable 130 to the endoscope 140. In some embodiments, the cable fastener 150 removably couples at least a portion of the cable 130 to the endoscope 140. In some embodiments, the cable fastener 150 secures the cable 130 to the endoscope 140 by wrapping around the cable 130 and the endoscope 140. In some embodiments, the cable fastener 150 secures the cable 130 to the endoscope 140 by being clamped to the cable 130 and the endoscope 140. In some embodiments, the cable fastener 150 secures the cable 130 to the endoscope 140 by removably attaching the cable 130 to the endoscope 140. In some embodiments, the cable fasteners 150 include press-fit fasteners, clamps, adhesive, tape, straps, set screws, hook and loop fasteners, magnets, or any combination thereof. In some embodiments, the endoscopic suturing system 100 includes one, two, three, four, five, six, seven, eight, nine, ten, or more cable fasteners 150.

[0038] Proximal Assembly

[0119] 2 and 3 show diagrams of an exemplary proximal assembly 110 coupled to an endoscope 140. As shown, the exemplary proximal assembly 110 includes a second housing 111 and an actuator 112. In some embodiments, the second housing 111 includes a second housing fixture 111A, an actuator support portion 111B, and a main second housing body 111C. In some embodiments, the main second housing body 111C couples the second housing fixture 111A to the actuator support portion 111B. In some embodiments, the proximal assembly 110 has a length of about 10 mm to about 50 mm. In some embodiments, the proximal assembly 110 has a length of up to about 50 mm.

[0039]

[0120] In some embodiments, second housing 111 is coupled to endoscope 140. In some embodiments, second housing 111 is removably coupled to endoscope 140. In some embodiments, second housing 111 is coupled to endoscope 140 and to endoscopic biopsy port 140A of endoscope 140. In some embodiments, endoscopic biopsy port 140A is an instrument channel port. In some embodiments, second housing 111 is removably coupled to endoscope 140 at a junction between endoscope 140 and endoscope cable 140A. In some embodiments, second housing 111 surrounds a portion of endoscope 140, endoscope cable 140, or both. In some embodiments, second housing 111 partially surrounds a portion of endoscope 140, endoscope cable 140A, or both. In some embodiments, coupling second housing 111 to both endoscope 140 and endoscope cable 140A facilitates improved stability of proximal assembly 110 on endoscope 140.

[0040]

[0121] In some embodiments, second housing fixture 111A and main second housing body 111C are coupled to endoscope 140. In some embodiments, second housing fixture 111A and main second housing body 111C are removably coupled to endoscope 140. In some embodiments, second housing fixture 111A and main second housing body 111C are coupled to endoscope 140 and endoscopic biopsy port 140A of endoscope 140. In some embodiments, second housing fixture 111A and main second housing body 111C are removably coupled to endoscope 140 at a junction between endoscope 140 and endoscope cable 140A. In some embodiments, second housing fixture 111A and main second housing body 111C surround a portion of endoscope 140, endoscope cable 140, or both. In some embodiments, second housing fixture 111A and main second housing body 111C partially surround a portion of endoscope 140, endoscope cable 140A, or both. In some embodiments, coupling of second housing fixture 111A and main second housing body 111C to both endoscope 140 and endoscope cable 140A facilitates improved stability of proximal assembly 110 on endoscope 140. In some embodiments, the fixture of second housing 111A rigidly connects to endoscope 140 without allowing any relative motion between endoscope 140 and second housing 111A.

[0041]

[0122] As shown, main second housing body 111C comprises a first concave portion and a second concave portion. In some embodiments, the first concave portion surrounds a portion of endoscope 140. In some embodiments, the second concave portion surrounds a portion of endoscopic cable 140A. In some embodiments, the first concave portion has an inner diameter equal to or greater than the outer diameter of endoscope 140. In some embodiments, the inner diameter of the first concave portion is about 5 mm to about 50 mm. In some embodiments, the second concave portion has an inner diameter equal to or greater than the outer diameter of endoscopic cable 140A. In some embodiments, the inner diameter of the second concave portion is about 5 mm to about 50 mm. In some embodiments, the angle between the centerline of the first concave portion and the centerline of the second concave portion is about 30 degrees. In some embodiments, the angle between the centerline of the first concave portion and the centerline of the second concave portion is about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees, 70 degrees, 75 degrees, 80 degrees, 85 degrees, 90 degrees, including increments therein. In some embodiments, the angle between the centerline of the first concave portion and the centerline of the second concave portion is from about 5 to about 90 degrees, from about 10 to about 90 degrees, from about 10 to about 80 degrees, from about 20 to about 70 degrees, from about 5 to about 60 degrees, from about 10 to about 60 degrees, from about 20 to about 60 degrees, from about 10 to about 50 degrees, from about 5 to about 45 degrees, from about 10 to about 50 degrees, from about 15 to about 65 degrees, from about 25 to about 65 degrees, from about 30 to about 60 degrees, from 5 to 90 degrees, from 10 to 90 degrees, from 10 to 80 degrees, from 20 to 70 degrees, from 5 to 60 degrees, from 10 to 60 degrees, from 20 to 60 degrees, from 10 to 50 degrees, from 5 to 45 degrees, from about 10 to about 50 degrees, from 15 to about 65 degrees, from 25 to about 65 degrees, from 30 to about 60 degrees, from 5 to 90 degrees, from 10 to 90 degrees, from 10 to 80 degrees, from 20 to 70 degrees, from 5 to 60 degrees, from 10 to 60 degrees, from 20 to 60 degrees, from 10 to 50 degrees, from 5 to 50 degrees, from 5 to 6 ... to 45 degrees, 10 to 50 degrees, 15 to 65 degrees, 25 to 65 degrees, or 30 to 60 degrees. In some embodiments, at least one of the first concave portion or the second concave portion of the main second housing body 111C has a uniform thickness.

[0042]

[0123] In some embodiments, the primary second housing body 111C includes a fastening mechanism that couples to the second housing fastener 111A. As shown, the fastening mechanism of the primary second housing body 111C includes a plurality of raised ridges. Alternatively, in some embodiments, the fastening mechanism of the primary second housing body 111C includes a clasp, string, band, hook-and-loop fastener, tape, strap, magnet, cinch, press fit, set screw, adhesive, or any combination thereof.

[0043]

[0124] In some embodiments, the second housing fixture 111A is coupled to a fastening mechanism of the main second housing body 111C, thereby securing the proximal assembly 110 to the endoscope 140. As can be seen, the exemplary second housing fixture 111A comprises a strap extending from the main second housing body 111C. In some embodiments, the second housing fixture 111A and the main second housing body 111C are coupled by a hinge (not shown), where the second housing fixture 111A rotates about the main second housing body 111C via the hinge. In some embodiments, the second housing fixture 111A comprises a flexible strap permanently attached to the main second housing body 111C. In some embodiments, the second housing fixture 111A comprises a flexible strap overmolded onto the main second housing body 111C. In some embodiments, at least a portion of the second housing fixture 111A is flexible. Further, as shown, the terminal end of the strap of the second housing fixture 111A includes a hook that engages and disengages with the locking mechanism of the main second housing body 111C. Additionally, as shown, in some embodiments, the locking mechanism of the main second housing body 111C includes a protruding portion for being grasped by a user during engagement and disengagement with the locking mechanism of the main second housing body 111C. In some embodiments, the strap of the second housing fixture 111A includes a hook that engages and disengages with the locking mechanism of the main second housing body 111C. In some embodiments, the strap of the second housing fixture 111A and the locking mechanism of the main second housing body 111C enable the second housing 111 to be secured to endoscopes 140 of various sizes. In some embodiments, the hook of the second housing fixture 111A and

[0044]

[0125] In some embodiments, second housing 111 includes one, two, three, four, five, six, seven, eight, nine, ten, or more second housing fixtures 111A. Alternatively, second housing 111 is not coupled to endoscope 140. In some embodiments, proximal assembly 110 is configured to be used as a handheld assembly. In some embodiments, proximal assembly 110 is configured to be mounted on a surface, a rod, a stand, or any combination thereof.

[0045]

[0126] In some embodiments, the wheel 113 is constrained to rotate in at least one degree of freedom relative to the second housing 111. In some embodiments, the actuator support portion 111B comprises a hole to accommodate the pin 114. In some embodiments, the actuator support portion 111B surrounds at least a portion of the actuator 112. As can be seen, the exemplary actuator 112 comprises a wheel 113 that rotates about the pin 114 within the second housing 111. In some embodiments, the actuator 112 is free to rotate about the pin 114 within the second housing 111. In some embodiments, the second housing 111, the pin 114, or the wheel 113 includes a bearing that allows the wheel 113 to rotate about the pin 114 within the second housing 111. In some embodiments, at least one of the wheel 113 or the actuator support portion 111B includes a lock, where the lock temporarily locks the rotation of the wheel 113 about the pin 114 in a single position. In some embodiments, at least one of the second housing 111, the pin 114, or the wheel 113 includes a recess, a ridge, a valley, a spring, or any combination thereof, that engages and disengages upon rotation of the wheel 113 about the pin 114 to enable manual advancement of the wheel 113. In some embodiments, the recess, the ridge, the valley, the spring, or any combination thereof, that engages and disengages upon rotation of the wheel 113 about the pin 114 to provide tactile feedback indicating an increment in the angle of rotation. Additionally, in some embodiments, the actuator 112 further comprises a spring, a recessed portion, a magnet, or any combination thereof to bias the actuator 112 to one or more positions relative to the second housing 111.

[0046]

[0127] Alternatively, in some embodiments, the second housing 111 does not have the pin 114, where the wheel 113 rotates about a protrusion within the actuator support portion 111B. In some embodiments, the wheel 113 includes the pin 114 or protrusion, where the wheel 113 and the pin 114 or protrusion rotate about a corresponding hole within the actuator support portion 111B. Alternatively, in some embodiments, the wheel 113 is constrained to rotate relative to the second housing 111 via a circular channel, a spring, a cam, a pin, a screw, a bolt, or any combination thereof. In some embodiments, the pin 114 is removable for cleaning the wheel 113. As shown in FIG. 3 , the wheel 113 is circular. In some embodiments, the circular wheel 113 has an outer diameter. Alternatively, in some embodiments, the wheel 113 has a shape including a triangle, a square, a pentagon, a hexagon, or any other polygon.

[0047]

[0128] As shown, the example actuator 112 includes a knob 119 that allows a user to rotate the wheel 113 about the second housing 111. In some embodiments, the knob 119 further functions as an indicator of the position of the actuator 112 relative to the second housing 111. In some embodiments, the knob 119 prevents the wheel 113 from rotating more than 360 degrees in the primary direction 131 or the wheel 113 from rotating more than 360 degrees in a secondary direction opposite the primary direction 131. In some embodiments, the wheel 113 rotates a maximum of approximately 360 degrees in the primary direction 131 and a maximum of approximately 360 degrees in the secondary direction opposite the primary direction 131. In some embodiments, the wheel 113 rotates in the primary direction 131 at an angle of at most about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 110 degrees, about 120 degrees, about 130 degrees, about 140 degrees, about 150 degrees, about 160 degrees, about 170 degrees, about 180 degrees, about 190 degrees, about 200 degrees, about 210 degrees, about 220 degrees, about 230 degrees, about 240 degrees, about 250 degrees, about 260 degrees, about 270 degrees, about 280 degrees, about 290 degrees, about 300 degrees, about 310 degrees, about 320 degrees, about 330 degrees, about 340 degrees, about 350 degrees, or about 360 degrees. degrees, and in a secondary direction opposite the primary direction 131, rotates by at most about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 70 degrees, about 80 degrees, about 90 degrees, about 110 degrees, about 120 degrees, about 130 degrees, about 140 degrees, about 150 degrees, about 160 degrees, about 170 degrees, about 180 degrees, about 190 degrees, about 200 degrees, about 210 degrees, about 220 degrees, about 230 degrees, about 240 degrees, about 250 degrees, about 260 degrees, about 270 degrees, about 280 degrees, about 290 degrees, about 300 degrees, about 310 degrees, about 320 degrees, about 330 degrees, about 340 degrees, about 350 degrees, or about 360 degrees. In some embodiments, the actuator 112 further comprises an indicator that indicates its position relative to the second housing 111. Alternatively, in some embodiments, the actuator 112 The invention may comprise or further comprise a leash, wheel, clamp, knot, post, gear, cog, chain, or any combination thereof.

[0048]

[0129] As shown, the exemplary wheel 113 includes a first channel 115 that receives a first portion of the cable 132 and a second channel 116 that receives a second cable portion 133. In some embodiments, at least one of the first channel 115 or the second channel 116 has a circular cross-section. In some embodiments, the wheel 113 does not include the second channel 116. In such embodiments, the first channel 115 includes a single helical channel. In some embodiments, at least one of the first channel 115 or the second channel 116 has an inner width that is equal to or greater than the width of the cable 130. In some embodiments, the radius of the first channel 115 is equal to the radius of the second channel 116. In some embodiments, the radius of the first channel 115 is greater than the radius of the second channel 116. In some embodiments, the radius of the first channel 115 is less than the radius of the second channel 116. In some embodiments, the circumference of the first channel is equal to the circumference of the second channel 116. In some embodiments, the circumference of the first channel 115 is greater than the circumference of the second channel 116. In some embodiments, the circumference of the first channel 115 is less than the circumference of the second channel 116. In some embodiments, the first channel 115 and the second channel 116 are concentric. In some embodiments, the first channel 115 and the second channel 116 are non-concentric. In some embodiments, the first channel 115 and the second channel 116 overlap.

[0049]

[0130] In some embodiments, actuator 112 further comprises a first fastener 118 coupling first cable portion 132 to wheel 113 and a second fastener (not shown) coupling second cable portion 130 to actuator 112. In some embodiments, first fastener 118 maintains first cable portion 133 within first channel 115. In some embodiments, second fastener maintains second cable portion 133 within second channel 116. In some embodiments, first fastener 118 prevents wheel 113 from rotating more than 360 degrees in primary direction 131 or wheel 113 from rotating more than 360 degrees in a secondary direction opposite primary direction 131. In some embodiments, proximal assembly 110 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more fasteners. In some embodiments, the wheel 113 does not include the first fastener 118 or the second fastener. In some embodiments, the wheel 113 includes a knob, fastener, or protruding portion that couples the first cable portion 132, the second cable portion 133, or both, to the wheel 113. In some embodiments, the first cable portion 132 and the second cable portion 133 are connected, where the cable 130 includes one or more components. In some embodiments, the cable 130 includes two or more components. In some embodiments, the first cable portion 132 and the second cable portion 133 are not connected, where the cable 130 includes two or more components. In some embodiments, at least one of the first cable portion 132 or the second cable portion 133 is always under tension during rotation of the wheel 113 of the actuator 112. In some embodiments, at least one of the first cable portion 132 or the second cable portion 133 has no slack during rotation of the wheel 113 of the actuator 112. In some embodiments, at least one of the first cable portion 132 or the second cable portion 133 is under tension when the wheel 113 of the actuator 112 is rotated in the primary direction 131 .In some embodiments, at least one of the first cable portion 132 or the second cable portion 133 is under tension when the wheel 113 of the actuator 112 is rotated in a secondary direction opposite the primary direction 131 .

[0050]

[0131] 3 , when the actuator 112 is rotated in the primary direction 131, the first cable portion 132 is translated a first distance away from the second housing 111 and the second cable portion 133 is translated a second distance toward the second housing 111. In some embodiments, when the actuator 112 is rotated in a secondary direction opposite the primary direction 132, the first cable portion 132 is translated a third distance toward the second housing 111 and the second cable portion 133 is translated a fourth distance away from the second housing 111. In some embodiments, the first distance, the second distance, the third distance, and the fourth distance are equal. In some embodiments, at least two of the first distance, the second distance, the third distance, or the fourth distance are equal. In some embodiments, the first distance is equal to the third distance and the second distance is equal to the fourth distance.

[0051]

[0132] As seen in FIG. 3 , in some embodiments, endoscopic suturing system 100 further includes a sheath 130A that surrounds at least a portion of cable 130. In some embodiments, cable 130 is free to translate back and forth in one direction within sheath 130A. In some embodiments, cable 130 and sheath 130A comprise Bowden cables. In some embodiments, cable 130 includes a multi-strand cable, a single-strand cable, a rope, a thread, a string, a wire, or any combination thereof. In some embodiments, cable 130 includes one, two, three, four, five, six, seven, eight, nine, ten, or more cables. In some embodiments, at least a portion of cable 130 is not covered by cable sheath 130A. In some embodiments, cable 130 is rigid. In some embodiments, cable 130 is not elastic. In some embodiments, cable sheath 130A comprises a hollow tube that protects cable 130 therein. In some embodiments, cable sheath 130A is rigid. In some embodiments, the cable sheath 130 is not elastic. In some embodiments, the cable 130 allows for increased endoscopic flexibility and manipulation of the needle 122.

[0052]

[0133] As shown, second housing 111 includes a proximal sheath fastener 117 that couples sheath 130A to second housing 111. As shown, sheath fastener 117 is connected to actuator support portion 111B of second housing 111. Alternatively, in some embodiments, sheath fastener 117 is connected to any portion of second housing 111. In some embodiments, proximal sheath fastener 117 fixes a portion of sheath 130A relative to second housing 111, thereby allowing cable 130 to move within sheath 130A as wheel 113 rotates. In some embodiments, proximal sheath fastener 117 prevents wheel 113 from rotating more than 360 degrees in primary direction 131 or from rotating more than 360 degrees in a second direction opposite primary direction 131. As shown, the exemplary proximal sheath fastener 117 includes a clamp. In some embodiments, the clamp comprises a first plate, a second plate, and one or more screws that clamp the cable 130 between the first and second plates. Alternatively, in some embodiments, the proximal sheath fastener 117 comprises a screw, a fastener, tape, a bolt, a nut, or any combination thereof. In some embodiments, the proximal assembly 110 comprises at least one proximal sheath fastener 117 for the first cable portion 132 and at least one proximal sheath fastener 117 for the second cable portion 133. In some embodiments, the proximal assembly 110 comprises a single proximal sheath fastener 117 for both the first cable portion 132 and the second cable portion 133. In some embodiments, the proximal assembly 110 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more proximal sheath fasteners 117.

[0053]

[0134] In some embodiments, cable 130 is made of fabric, metal, plastic, carbon, or any combination thereof. In some embodiments, at least one of second housing 111, actuator 112, wheel 113, pin 114, proximal sheath retainer 117, first retainer 118, or sheath 130A is made of plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof. In some embodiments, the actuator does not include at least one of a crank, gear, rack, or pinion. Figures 64 and 65 show images of an example proximal assembly.

[0054]

[0135] In some embodiments, the length, composition, configuration, or any combination thereof, of cable 130, cable anchor 150, sheath 130A, actuator 112, or any combination thereof, allows for precise actuation of the needle, improving endoscopic flexibility and manipulation. In some embodiments, the diameter of cable 130 and sheath 130A is minimized to allow for the use of smaller endoscope channels.

[0055] First Distal Assembly

[0136] 4-6 show diagrams of an exemplary first distal assembly 120. As shown, the exemplary first distal assembly 120 includes a first housing 121 and an arcuate needle 122 within the first housing 121. In some embodiments, the first housing 121 is coupled to an endoscope 140. In some embodiments, tissue is supported against the arcuate needle 122 throughout the suturing process. In some embodiments, the first distal assembly 120 does not include an anchor exchange catheter. In some embodiments, the first distal assembly 120 does not require a dedicated grabber to maintain tissue in contact with the arcuate needle 122. In some embodiments, the lack of a dedicated grabber allows for the use of a standard endoscope 140 without an additional dedicated working channel.

[0056]

[0137] 5, the needle axis 501 is tilted relative to the distal axis (or main axis) 502 of the endoscope 140. In some embodiments, the needle axis 501 is tilted in one direction relative to the distal axis 502 of the endoscope 140. In some embodiments, the needle axis 501 and the distal axis 502 of the endoscope 140 are not parallel or perpendicular. In some embodiments, the angle between the needle axis 501 and the distal axis 502 of the endoscope 140 is from about 5 degrees to about 85 degrees. In some embodiments, the angle between the needle axis 501 and the distal axis 502 of the endoscope 140 is adjustable within a range from about 5 degrees to about 85 degrees. In some embodiments, a particular angle between the needle axis 501 and the distal axis 502 of the endoscope 140 allows the camera of the endoscope 140 to view the entry point, exit point, or both, of the arcuate needle and the tissue being sutured. In some embodiments, the needle axis 501 is defined as the axis perpendicular to the plane of symmetry of the arcuate needle 123 and coincident with the center of the radius of the arcuate needle 123. In some embodiments, the distal axis 502 of the endoscope 140 is defined as the central axis or main axis of the distal portion of the endoscope 140. In some embodiments, the distal axis 502 of the endoscope 140 is defined as the central axis of the endoscope fixture 121A of the first housing 112. In some embodiments, the angle between the central axis 501 of the arcuate needle guide 121B and the distal axis 502 of the endoscope 140 is defined as a maximum, minimum, or average angle.

[0057]

[0138] In some embodiments, the distal assembly includes an arcuate needle guide 121B configured to house at least a portion of the arcuate needle 122. In some embodiments, the devices, apparatus, and systems herein actuate the arcuate needle 122 through the arcuate needle guide 121B.

[0058]

[0139] In some embodiments, the arcuate needle guide 121B has a first terminal point and a second terminal point opposite the first terminal point, where a gap 604 is formed between the first and second terminal points. In some embodiments, according to FIG. 6 , the first terminal point is tangent to the first pin fixture 603, and the second terminal point is tangent to the opposing second pin fixture 603 in the first distal assembly 120. In some embodiments, the first and second terminal points are separated by an angle of less than about 180 degrees, less than 170 degrees, less than 160 degrees, less than 150 degrees, less than 145 degrees, less than 120 degrees, or less than 100 degrees. In some embodiments, the first and second terminal points are separated by an angle of about 100 degrees to about 180 degrees. In some embodiments, the separation angle between the first and second termination points is measured as the angle between a first axis that is perpendicular to the needle axis 501 and coincides with a point tangent to the first termination point, and a second axis that is perpendicular to the needle axis 501 and coincides with a point tangent to the second termination point. In some embodiments, the gap 604 receives tissue to be sutured by the arched needle 122. In some embodiments, the gap 604 allows the arched needle 122 to clamp the tissue, thereby eliminating the need for an auxiliary support device.

[0059]

[0140] In some embodiments, first housing 121 is coupled to endoscope 140 by endoscope fixture 121A. In some embodiments, first distal assembly 120 comprises one, two, three, four, five, six, seven, eight, nine, ten, or more endoscope fixtures 121A. In some embodiments, endoscope fixture 121A couples first housing 121 to endoscope 140. In some embodiments, endoscope fixture 121A removably couples first housing 121 to endoscope 140. As shown, endoscope fixture 121A comprises a press-fit fixture. In some embodiments, press-fit endoscope fixture 121A is attached to endoscope 140 by firmly pressing press-fit endoscope fixture 121A onto the distal end of endoscope 140. In some embodiments, the press-fit endoscope fixture 121A is attached to the endoscope 140 by firmly pressing the press-fit endoscope fixture 121A onto the distal end of the endoscope 140 and rotating it. In some embodiments, the press-fit endoscope fixture 121A is detached from the endoscope 140 by pulling the press-fit endoscope fixture 121A tightly and away from the distal end of the endoscope 140. In some embodiments, the press-fit endoscope fixture 121A is detached from the endoscope 140 by pulling the press-fit endoscope fixture 121A tightly and rotating it away from the distal end of the endoscope 140. Alternatively, in some embodiments, the endoscope fixture 121A comprises a clamp, adhesive, tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof.

[0060]

[0141] As shown, in some embodiments, endoscope fixture 121A is circular. In some embodiments, endoscope 140 has a distal outer diameter of about 5 mm to about 16 mm. Accordingly, in some embodiments, endoscope fixture 121A has an inner diameter of about 5 mm to about 16 mm. In some embodiments, endoscope fixture 121A has a minimum inner diameter of about 5 mm. In some embodiments, endoscope fixture 121A has a maximum inner diameter of about 16 mm. In some embodiments, press-fit endoscope fixture 121A has a diameter equal to or smaller than the diameter of endoscope 140. In some embodiments, endoscope fixture 121A has a diameter equal to or larger than the diameter of endoscope 140. In some embodiments, endoscope fixture 121A is tapered and has a first inner diameter and a second inner diameter, where the first inner diameter is distal to the second inner diameter. In some embodiments, the first inner diameter is larger than the second inner diameter. In some embodiments, the second inner diameter is greater than the first inner diameter. In some embodiments, the diameter of the endoscope fixation device 121A is measured as a maximum, minimum, or average inner width. In some embodiments, The diameter of endoscope 140 is measured as the maximum, minimum, or average outer width. Alternatively, in some embodiments, endoscope fixture 121A has a cross-sectional shape that includes a triangle, square, hexagon, or any other polygon. In some embodiments, endoscope fixture 121A has an internal length of about 10 mm to about 30 mm. In some embodiments, the internal length of endoscope fixture 121A is measured as the minimum, maximum, or average length from the distal end of endoscope fixture 121A to the proximal end of endoscope fixture 121A. In some embodiments, the internal length of endoscope fixture 121A is measured as the minimum, maximum, or average perpendicular length from the distal end of endoscope fixture 121A to the proximal end of endoscope fixture 121A. In some embodiments, the number and / or configuration of endoscope fixtures 121A establish a rigid connection with endoscope 140 to enable accurate translation of arcuate needle 122.

[0061]

[0142] As shown in FIG. 4 , the example first distal assembly 120 further includes a distal sheath fastener 128 that couples a portion of the sheath 130A to the first housing 121. As shown, the first housing 121 includes a distal sheath fastener 117 that couples the sheath 130A to the first housing 121. In some embodiments, the distal sheath fastener 117 secures a portion of the sheath 130A relative to the first housing 121, thereby allowing the cable 130 to move within the sheath 130A as the wheel rotates. As shown, the example distal sheath fastener 128 includes a clamp. In some embodiments, the distal sheath fastener 128 includes a plate and one or more sheath fastener screws 128A that clamp the cable sheath 130A between the plate and the first housing 121. Alternatively, in some embodiments, distal sheath fastener 128 comprises a screw, a fastener, tape, or any combination thereof. In some embodiments, first housing 112 comprises at least one distal sheath fastener 128 for first cable portion 132 and at least one distal sheath fastener 128 for second cable portion 1333. In some embodiments, first housing 112 comprises distal sheath fasteners 128 for both first cable portion 132 and second cable portion 133. In some embodiments, a portion of cable sheath 130A extends into first housing 121 past the termination point of distal sheath fastener 128. In some embodiments, distal assembly 120 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more distal sheath fasteners 128. Alternatively, in some embodiments, distal sheath fastener 128 comprises a clamp, fastener, band, hook and loop fastener, adhesive, or any combination thereof. In some embodiments, cable sheath 130A allows for improved endoscopic flexibility and manipulation with precise needle actuation. In some embodiments, the diameter of cable 130 and sheath 130A is minimized to allow for the use of smaller endoscope channels.

[0062]

[0143] 6-9 show detailed views of an exemplary first distal assembly 120. According to FIG. 6, the exemplary first housing 121 includes a primary first housing portion 601, a secondary first housing portion 602, and a pin fastener 603. In some embodiments, the secondary first housing portion 602 fits within the primary first housing portion 601. In some embodiments, the primary first housing portion 601 and the secondary first housing portion 602 are joined by the pin fastener 603. In some embodiments, the primary first housing portion 601 and the secondary first housing portion 602 are removably joined by the pin fastener 603. In some embodiments, the primary first housing portion 601 and the secondary first housing portion 602 are made of the same material. In some embodiments, the primary first housing portion 601 and the secondary first housing portion 602 are made of different materials. As shown, the exemplary pin fixture 603 comprises a press-fit fixture, where the press-fit fixture secures the primary first housing portion 601 and the secondary first housing portion 602. The pin fasteners 603 have outer diameters larger than the diameters of the corresponding holes in the first housing portion 602. Alternatively, in some embodiments, the pin fasteners 603 include screws, bolts, threaded formations, nuts, rivets, adhesives, pulleys, bearings, welds, or any combination thereof. As shown, the example first housing 121 includes two pin fasteners 603. Alternatively, the example first housing 121 includes one, two, three, four, five, six, seven, eight, nine, ten, or more pin fasteners 603.

[0063]

[0144] Additionally, in some embodiments, the first distal assembly 120 comprises an arcuate needle 122 disposed within an arcuate needle guide 121B within the first housing 121. In some embodiments, at least one of the primary first housing portion 601 or the secondary first housing portion 602 comprises the arcuate needle guide 121B. In some embodiments, the arcuate needle 122 slides freely within the arcuate needle guide 121B. In some embodiments, the arcuate needle guide 121B limits the rotation of the arcuate needle 122 within one degree of freedom. In some embodiments, the arcuate needle guide 121B limits the rotation of the arcuate needle 122 within at least one rotational degree of freedom. As can be seen, the illustrative arcuate needle guide 121B surrounds at least a portion of the arcuate needle 122. In some embodiments, the illustrated arcuate needle guide 121B surrounds at least a portion of the arcuate needle 122 when disposed within the first housing 121. In some embodiments, the arcuate needle guide 121B has an inner width that is greater than a thickness of the arcuate needle 122. In some embodiments, the arcuate needle guide 121B has a cross-sectional shape that includes a circle, a square, a rectangle, or any other polygon. In some embodiments, a gap 604 is formed within the first distal assembly 120 between a first terminal point of the arcuate needle guide 121B and a second, opposite terminal point of the arcuate needle guide 121B. As seen herein, the arcuate needle guide 121B surrounds approximately 280 degrees of the cross sectional circumference of the arcuate needle 122. Alternatively, in some embodiments, the arcuate needle guide 121B encircles, including increments therein, about 100 degrees, 120 degrees, 140 degrees, 160 degrees, 180 degrees, 200 degrees, 220 degrees, 240 degrees, 260 degrees, 280 degrees, 300 degrees, 320 degrees, or more of the cross-sectional circumference of the arcuate needle 122. In some embodiments, the arcuate needle guide 121B encircles at least about 100 degrees, 120 degrees, 140 degrees, 160 degrees, 180 degrees, 200 degrees, 220 degrees, 240 degrees, 260 degrees, 280 degrees, 300 degrees, 320 degrees, or more of the cross-sectional circumference of the arcuate needle 122.

[0064]

[0145] 7-9, the exemplary first distal assembly 120 further includes a shuttle 123 having a pawl 124. As shown, the exemplary shuttle 123 translates within a shuttle guide 121C within the first housing 121. In some embodiments, at least one of the shuttle 123 or the shuttle guide 121C within the first housing 121 is arcuate. In some embodiments, the shuttle 123 slides within the shuttle guide 121C. In some embodiments, the shuttle 123 translates within the shuttle guide 121C through at least one rotational degree. In some embodiments, the shuttle 123 translates within the shuttle guide 121C through one rotational degree within a 270-degree arc. In some embodiments, the shuttle 123 translates within the shuttle guide 121C through an arc of one degree of rotation that exceeds 90, 100, 110, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, or more degrees of rotation. In some embodiments, at least one of the shuttle 123 or shuttle guide 121C has a cross-sectional shape, including a circle, a square, a rectangle, or any other polygon.

[0065]

[0146] In some embodiments, at least one of the primary first housing portion 601 or the secondary first housing portion 602 includes a shuttle guide 121C. In this embodiment, the shuttle 123 slides within the shuttle guide 121C of the distal assembly 120. As shown, the shuttle 123 is arcuate in order to slide within the arcuate shuttle guide 121C. In some embodiments, the primary first housing portion 601 constrains the bottom surface of the shuttle 123, and the secondary first housing portion 602 constrains a portion of the inner, outer, and top surfaces of the shuttle 123. Alternatively, in some embodiments, at least one of the primary first housing portion 601 or the secondary first housing portion 602 constrains one or more of the bottom, inner, outer, and top surfaces of the shuttle 123. In some embodiments, the shuttle 123 is constrained by at least one of the primary first housing portion 601 or the secondary first housing portion 602 as it translates within the shuttle guide 121C. As shown, a bottom surface of shuttle 123 contacts a portion of primary first housing portion 601, while inner and outer portions of shuttle 123 contact a portion of secondary first housing portion 602. In some embodiments, shuttle 123 contacts at least one of primary first housing portion 601 or secondary first housing portion 602 as it translates within shuttle guide 121C. As shown, an arcuate channel between shuttle guide 121C and arcuate needle guide 121B provides clearance for pawl 124 to contact arcuate needle 122 as shuttle 123 translates through shuttle guide 121C. In some embodiments, the arcuate channel has a width that is greater than the width of pawl 124 but less than the width of arcuate needle 122.

[0066]

[0147] In some embodiments, the inner surface of the shuttle 123 is defined as the surface of the shuttle 123 closest to the needle axis 501. In some embodiments, the outer surface of the shuttle 123 is defined as the surface of the shuttle 123 furthest from the needle axis 501. In some embodiments, the top surface of the shuttle 123 is defined as the surface of the shuttle 123 closest to the arcuate needle 122. In some embodiments, the bottom surface of the shuttle 123 is defined as the surface of the shuttle 123 furthest from the arcuate needle 122.

[0067]

[0148] In some embodiments, the arc length of the shuttle guide 121C is equal to the distance traveled by at least one of the first or second cable portions during rotation of the actuation wheel minus the width of the shuttle 123. In some embodiments, the shuttle 123 moves within the shuttle guide 121C by the distance traveled by at least one of the first or second cable portions during rotation of the actuation wheel. In some embodiments, the ratio between the length of the shuttle 123 and the arc length of the shuttle guide 121C is from about 1:3 to about 1:15. In some embodiments, the ratio between the length of the shuttle 123 and the arc length of the shuttle guide 121C is at least about 1:3. In some embodiments, the ratio between the length of the shuttle 123 and the arc length of the shuttle guide 121C is at most about 1:15. In some embodiments, the ratio between the arc length of the shuttle 123 and the diameter of at least one of the first or second channels of the actuator wheel is from about 2:1 to about 1:5. In some embodiments, the ratio between the arc length of the shuttle guide 121C and the diameter of at least one of the first or second channels of the actuator wheel is at least about 2: 1. In some embodiments, the ratio between the arc length of the shuttle guide 121C and the diameter of at least one of the first or second channels of the actuator wheel is at most about 1:5.

[0068]

[0149] 8, the example shuttle 123 further comprises a cable attachment 127 that is connected to the cable 130. As shown, the cable attachment 127 comprises a cavity that receives and secures a portion of the cable 130. Alternatively, in some embodiments, the cable attachment 127 may comprise a clamp, hole, screw, bolt, nut, or the like. In some embodiments, the cable attachment 127 comprises a terminated cable attachment, where the cable terminates at the cable attachment 127. In some embodiments, the cable attachment 127 comprises a non-terminated cable attachment, where the cable passes through and is coupled to the cable attachment 127. In some embodiments, the shuttle 123 comprises one, two, three, four, five, six, seven, eight, nine, ten, or more cable attachments 127. As can be seen, the exemplary shuttle 123 is rigidly connected to the cable 130 at the cable attachments 127, such that tension on the cable 130 causes the shuttle 123 to translate in the direction of the tension.

[0069]

[0150] In some embodiments, shuttle 123 comprises pawls 124, cushion 126, or both. In some embodiments, shuttle 123 comprises cavity 123A that receives pawls 124, cushion 126, or both. In some embodiments, cavity 123A has an inner width that is greater than the outer width of pawls 124, the outside of cushion 126, or both. In some embodiments, cavity 123A has a depth that terminates within shuttle 123. In some embodiments, cavity 123A extends through shuttle 123. In some embodiments, cavity 123A has a cross-sectional shape, including a square, a circle, a triangle, a hexagon, or any other polygon.

[0070]

[0151] In some embodiments, pawl 124 is biased in a direction to engage notch 122A of arcuate needle 122. In some embodiments, pawl 124 is biased in a first direction 1000. In some embodiments, pawl 124 comprises a pivot 127 for rotating about shuttle 123. In some embodiments, pivot 127 comprises a pin protruding element of pawl 124. In some embodiments, pivot 127 comprises a pin rigidly attached to pawl 124, which rotates about a hole in shuttle 123. In some embodiments, pivot 127 comprises a pin rigidly attached to shuttle 123, which rotates about a hole in pawl 124. Alternatively, in some embodiments, pivot 127 comprises a recessed portion, a slot, a thread, or any combination thereof, in pawl 124, shuttle 123, or both.

[0071]

[0152] In some embodiments, pawl 124 is biased toward engagement by cushion 126. In some embodiments, cushion 126 is resilient. In some embodiments, cushion 126 comprises a spring. In some embodiments, cushion 126 urges pawl 124 in a second direction opposite first rotational direction 1000. In some embodiments, cushion 126 urges pawl 124 to move pawl 124 upwardly out of cavity 123A for engagement with notch 122A of arcuate needle 122. In some embodiments, the position of pivot 127 relative to the end point of cavity 123A, in combination with the position of cushion 126, allows the pawl to be biased toward engagement. In some embodiments, cushion 126 urges pawl 124 against the end point of cavity 123A of shuttle 123 when pawl 124 is engaged. In some embodiments, when pawl 124 is disengaged, arcuate needle 122 presses pawl 124 against cushion 126, causing the pawl to move upward into cavity 123A and away from the end of cavity 123A of shuttle 123. In some embodiments, an upper surface of pawl 124 is angled toward one end of shuttle 123. In some embodiments, an upper surface of pawl 124 is angled upward in a second rotational direction opposite first rotational direction 1000. In some embodiments, an upper surface of pawl 124 is angled to engage with an angled portion of the arcuate needle. In some embodiments, pawl 124 further comprises a spring, a curved portion, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, first distal assembly 120 comprises one, two, There may be three, four, five, six, seven, eight, nine, ten or more claws 124 .

[0072]

[0153] In some embodiments, the cushion 126 is integrated into the pawl 124. In some embodiments, the cushion 126 is integrated into the shuttle 123. In some embodiments, the cushion 126 is integrated into the cavity 123A of the shuttle 123. In some embodiments, the shuttle 123 does not include the cushion 126. In some embodiments, the shuttle 123 does not include the cushion 126, where the pawl 124 includes a flexure, spring, dual spring gate, cushion, piston, rod, pin, teeth, or any combination thereof, to bias the pawl 124 against the arcuate needle. In some embodiments, the shuttle 123 does not include the pawl 124 or the cushion 126, where the shuttle 123 includes a flexure, spring, dual spring gate, cushion, piston, rod, pin, teeth, or any combination thereof, to engage and disengage the arcuate needle.

[0073]

[0154] 7, the exemplary first housing 121 includes a cable pulley 121D that guides the cable 130 from the proximal assembly, through the shuttle guide 121C, to the shuttle 123, and out of the first housing 121. In some embodiments, at least one of the primary first housing portion 601, the secondary first housing portion 602, or the pin fixture 603 of the first housing 121 includes the cable pulley 121D. In some embodiments, the first housing 121 includes one, two, three, four, five, six, seven, eight, nine, ten, or more cable pulleys 121D. In some embodiments, the cable pulley 121D includes a bearing, a rod, a curved surface, or any combination thereof. In some embodiments, the cable pulley 121D includes a rigid portion of the first housing 121. Alternatively, in some embodiments, the cable pulley 121D rotates within the first housing 121. Alternatively, in some embodiments, the cable pulley 121D rotates within the primary first housing part 601, the secondary first housing part 602, or both. In some embodiments, at least one of the primary first housing part 601 or the secondary first housing part 602 further comprises one or more cable guides that guide the cable 130 towards and away from the cable pulley 121D.

[0074]

[0155] 10-13 illustrate the progression of the arcuate needle 122 as it is translated through the arcuate needle guide 121B by the shuttle 123 and pawl 124. According to FIG. 10, in a first position, the arcuate needle 122 is fully contained within the arcuate needle guide 121B within the first housing 121. As the cable 130 pulls the shuttle 123 within the shuttle guide 121C in a first rotational direction 1000 relative to the first housing 121, according to FIG. 11, the pawl 124 engages the notch 122A in the arcuate needle 122, causing a portion of the arcuate needle 123 to extend out of the first housing 121. When shuttle 123 can no longer move further in shuttle guide 121C of first housing 121 in first rotational direction 1000, cable 130 pulls shuttle 123 in a second rotational direction opposite first rotational direction 1000, resulting in pawl 124 engaging suture end 1201 of arcuate needle 122. Cable 130 is then pulled in first rotational direction 1000, resulting in shuttle 123 translating in first rotational direction 1000, which in turn pushes pawl 124 against suture end 1201 of arcuate needle 122, according to FIG. 12 , resulting in most of arcuate needle 122 emerging from first housing 121 and only a portion of pointed end 1101 of arcuate needle 122 and suture end 1201 remaining within first housing 121. After the shuttle 123 can no longer move further in the first rotation direction 1000 within the shuttle guide 121C of the first housing 121, as shown in FIG. According to FIG. 1, cable 130 pulls shuttle 123 in a second rotational direction through shuttle guide 121C of first housing 121, causing pawl 124 to re-engage notch 122A in arcuate needle 122. Cable 130 then pulls shuttle 123 in a second rotational direction within shuttle guide 121C of first housing 121, causing arcuate needle 122 to translate in first rotational direction 100 back into first housing 121, thereby performing one suture.

[0075]

[0156] Thus, one suturing operation includes pulling cable 130 in a first direction 1000, pulling cable 130 in a second direction opposite the first direction 1000, pulling cable 130 a second time in the first direction 1000, pulling cable 130 a second time in the second direction 1000, pulling cable 130 a third time in the first direction 1000, and pulling cable 130 a third time in the second direction. As shown, the first rotational direction 1000 is counterclockwise relative to the first housing 121. Alternatively, in some embodiments, the first rotational direction 1000 is clockwise relative to the first housing 121.

[0076]

[0157] 3, 4, and 10 , pulling cable 130 in a first rotational direction 1000 includes pulling primary cable portion 132 toward second housing 111 of proximal assembly 110. In some embodiments, pulling cable 130 in a first rotational direction 1000 includes rotating wheel 113 of actuator 112 in a secondary direction opposite primary direction 131. In some embodiments, pulling cable 130 in a second rotational direction opposite first rotational direction 1000 includes pulling secondary cable portion 133 toward second housing 111 of proximal assembly 110. In some embodiments, pulling cable 130 in a second rotational direction opposite first rotational direction 1000 includes rotating wheel 113 of actuator 112 in primary direction 131. In some embodiments, translating the shuttle 123 in the first rotational direction 1000 comprises pulling the primary cable portion 132 toward the second housing 111 of the proximal assembly 110. In some embodiments, translating the shuttle 123 in the first rotational direction 1000 comprises rotating the wheel 113 of the actuator 112 in a secondary direction opposite the primary direction 131. In some embodiments, translating the shuttle 123 in a second rotational direction opposite the first rotational direction 1000 comprises pulling the secondary cable portion 133 toward the second housing 111 of the proximal assembly 110. In some embodiments, translating the shuttle 123 in the second rotational direction opposite the first rotational direction 1000 comprises rotating the wheel 113 of the actuator 112 in the primary direction 131.

[0077]

[0158] In some embodiments, when pulled by cable 130 in the first direction 1000 or the second direction, shuttle 123 translates within shuttle guide 121C one or more degrees of rotation. In some embodiments, when pulled by cable 130 in the first direction 1000 or the second direction, shuttle 123 translates within shuttle guide 121C one degree of rotation within a 270-degree arc. In some embodiments, when pulled by cable 130 in the first direction 1000 or the second direction, shuttle 123 translates within shuttle guide 121C one arc of rotation within a range of 90, 100, 110, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, or more degrees of rotation, including increments therein.

[0078]

[0159] In some embodiments, at least one of the first housing 111, the arcuate needle 112, the shuttle 123, the pawl 124, the shuttle 125, the cushion 126, the primary first housing portion 601, the secondary first housing portion 602, or the pin fixture 603. At least one of the components is constructed from plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof.

[0079] Arched needles and sutures

[0160] 14-18 show diagrams of an exemplary arched needle 122 and suture 125. Referring to FIGS. 14 and 15, in some embodiments, the arched needle 122 has a notch 122A, a pointed end 1101, and a suture end 1201. In some embodiments, the notch 122A is angled in a direction opposite to the first rotational direction. Alternatively, in some embodiments, the notch 122A is angled in the first rotational direction. In some embodiments, the notch 122A is angled at an angle of about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees, or more, including increments therein. In some embodiments, the notch 122A is angled at an angle of at least about 5 degrees. As shown, the angle between the notch 122A of the exemplary arched needle 122 and the suture end 1201 is approximately 180 degrees. Alternatively, in some embodiments, the angle between the notch 122A of the exemplary arched needle 122 and the suture end 1201 is approximately 90 degrees, 100 degrees, 120 degrees, 140 degrees, 160 degrees, 180 degrees, 200 degrees, 220 degrees, 240 degrees, 260 degrees, 2800 degrees, or more, including increments therein. In some embodiments, the angle between the notch 122A of the exemplary arched needle 122 and the suture end 1201 is at least approximately 90 degrees.

[0080]

[0161] In some embodiments, the outer diameter of the arched needle 122 is from about 5 mm to about 20 mm. In some embodiments, the outer diameter of the arched needle 122 is at least about 5 mm. In some embodiments, the outer diameter of the arched needle 122 is at most about 20 mm. In some embodiments, the thickness 1510 of the arched needle 122 is from about 0.5 mm to about 2 mm. In some embodiments, the thickness 1510 of the arched needle 122 is at least about 0.5 mm. In some embodiments, the thickness 1510 of the arched needle 122 is at most about 2 mm. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122 is from about 3:1 to about 15:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122 is at least about 3:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122 is at most about 15:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122 is about 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 10:1, 11:1, 12:1, 13:1, 14:1, or 15:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122 is at least about 3:1. In some embodiments, the outer diameter of the arched needle 122 is measured as the maximum distance between two points on the surface of the arched needle 122. In some embodiments, the outer diameter of the arched needle 122 is measured as the maximum outer diameter of the arched needle 122. In some embodiments, the width of the arched needle 122 is measured as the thickness 1510 of the arched needle 122. In some embodiments, the thickness 1510 of the arched needle 122 is measured as the thickness 1510 of the arched needle 122 that is not within the pointed end 1101, the suture end 1201, or the notch 122 A. In some embodiments, the thickness 1510 of the arched needle 122 is measured as the maximum, minimum, or average thickness 1510 of the arched needle 122.

[0081]

[0162] In some embodiments, the pointed end 1101 is oriented at an angle of about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, or more, including increments therein. In some embodiments, the pointed end 1101 is oriented at an angle of at least about 5 degrees. As shown, the exemplary suture end 120 is flat. Alternatively, in some embodiments, the suture end 120 is rounded, tapered, or angled.

[0082]

[0163] As shown, in some embodiments, the arched needle 122 has two notches 122A. In some embodiments, the arched needle 122 has two, three, four, five, six, seven, eight, nine, ten, or more notches 122A. In some embodiments, the arched needle 122 has more than two notches 122A. As shown, each notch 122A is spaced apart by an angle of approximately 180 degrees around the arched needle 122.

[0083]

[0164] In some embodiments, the notches 122A are spaced apart at an angle of about 10 degrees to about 180 degrees around the arcuate needle 122. In some embodiments, the notches 122A are spaced apart at an angle of about 10 degrees to about 20 degrees, about 10 degrees to about 30 degrees, about 10 degrees to about 40 degrees, about 10 degrees to about 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 10 degrees to about 140 degrees, about 10 degrees to about 160 degrees, about 10 degrees to about 180 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 20 degrees to about 60 degrees, about 2 ...20 degrees to about 90 degrees, about 20 degrees to about 90 degrees, about 20 degrees to about 100 degrees, about 20 degrees to about 120 degrees, about 10 degrees to about 140 degrees, about 10 degrees to about 160 degrees, about 10 degrees to about 180 degrees, about 20 degrees to about 30 degrees, about 20 degrees to about 40 degrees, about 20 degrees to about 50 degrees, about 0 degrees to approximately 80 degrees, approximately 20 degrees to approximately 100 degrees, approximately 20 degrees to approximately 120 degrees, approximately 20 degrees to approximately 140 degrees, approximately 20 degrees to approximately 160 degrees, approximately 20 degrees to approximately 180 degrees, approximately 30 degrees to approximately 40 degrees, approximately 30 degrees to approximately 50 degrees, approximately 30 degrees to approximately 60 degrees, approximately 30 degrees to approximately 80 degrees, approximately 30 degrees to approximately 100 degrees, approximately 30 degrees to approximately 120 degrees, approximately 30 degrees to approximately 140 degrees, approximately 30 degrees to approximately 160 degrees, approximately 30 degrees to approximately 180 degrees, approximately 40 degrees to approximately 50 degrees, approximately 40 degrees to approximately 60 degrees, approximately 40 degrees to approximately 80 degrees, approximately 40 degrees to approximately 100 degrees, approximately 40 degrees to approximately 120 degrees, approximately 40 degrees to approximately 140 degrees, approximately 40 degrees to approximately 160 degrees, approximately 40 degrees to approximately 180 degrees, approximately 50 degrees to approximately 60 degrees, approximately 50 degrees to approximately 80 degrees, approximately 50 degrees to approximately 100 degrees, approximately 50 degrees to approximately 120 degrees, approximately 50 degrees to approximately 140 degrees, approximately 50 degrees to approximately 160 degrees, approximately 50 degrees to approximately 180 degrees, approximately 60 degrees to approximately 80 degrees, approximately 60 degrees to approximately 100 degrees, approximately 60 degrees to approximately 120 degrees, approximately 60 degrees to approximately 140 degrees, approximately 60 degrees to approximately 160 degrees, approximately 60 degrees to approximately The angles may be 180 degrees, about 80 degrees to about 100 degrees, about 80 degrees to about 120 degrees, about 80 degrees to about 140 degrees, about 80 degrees to about 160 degrees, about 80 degrees to about 180 degrees, about 100 degrees to about 120 degrees, about 100 degrees to about 140 degrees, about 100 degrees to about 160 degrees, about 100 degrees to about 180 degrees, about 120 degrees to about 140 degrees, about 120 degrees to about 160 degrees, about 120 degrees to about 180 degrees, about 140 degrees to about 160 degrees, about 140 degrees to about 180 degrees, or about 160 degrees to about 180 degrees. In some embodiments, the notches 122A are spaced around the arcuate needle 122 at angles of about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, about 160 degrees, or about 180 degrees.In some embodiments, the notches 122A are spaced apart at an angle of at least about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, or about 160 degrees around the arcuate needle 122. In some embodiments, the notches 122A are spaced apart at an angle of at most about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, about 160 degrees, or about 180 degrees around the arcuate needle 122.

[0084]

[0165] 15, the ratio between the thickness 15150 of the arched needle 122 and the depth 1520 of the notch 122A is from about 2:1 to about 15:1. In some embodiments, the ratio between the thickness 1510 of the arched needle 122 and the depth 1520 of the notch 122A is at least about 2:1. The ratio between the thickness 15150 of the arched needle 122 and the depth 1520 of the notch 122A is at most about 15:1. As shown, in some embodiments, the depth 1520 of the notch 122 is measured as the maximum vertical distance between the surface of the notch and the outer surface of the arched needle 122.

[0085]

[0166] 16, the suture end 1201 of the arched needle includes a primary suture attachment 122D that couples the suture 125 to the arched needle 122. Additionally, in some embodiments, the suture 125 is attached to the primary suture attachment 122D. In some embodiments, primary suture attachment 122D and secondary suture attachment 125A mate with primary suture attachment 122D. In some embodiments, primary suture attachment 122D and secondary suture attachment 125A mate releasably. In some embodiments, primary suture attachment 122D and secondary suture attachment 125A mate releasably so that suture 125 does not detach from arched needle 122 during suturing. In some embodiments, primary suture attachment 122D and secondary suture attachment 125A detachably connect and / or detach in situ.

[0086]

[0167] As shown, exemplary primary suture attachment 122D comprises an open channel having a first channel portion and a second channel portion, where the first channel portion passes through suture end 1201 of arcuate needle 122 and the second channel portion is spaced from the suture end by a distance greater than its proximal width. As shown, the width of the second channel portion is greater than the width of the first channel portion. In some embodiments, the ratio between the width of the first channel portion and the width of the second channel portion is from about 1.1:1 to about 3:1. In some embodiments, the ratio between the width of the first channel portion and the width of the second channel portion is at least about 1.1:1. In some embodiments, the proximal width partially encases the suture. In some embodiments, the first channel portion partially encases secondary suture attachment 125A. In some embodiments, the first channel portion is equal to or greater than the width of suture 125. In some embodiments, the central plane of the first channel portion and the central plane of the second channel portion are coplanar. In some embodiments, at least one of the first channel portion or the second channel portion comprises a circular channel. In some embodiments, a center point of the circular surface of the first channel portion, a center point of the circular surface of the circular second channel portion, or both, is aligned with the arcuate central axis of the arcuate needle 122.

[0087]

[0168] As shown, secondary suture attachment 125A comprises a knotted portion or a bulbous portion. In some embodiments, the thickness of suture 125 is less than the thickness of suture attachment 125A. In some embodiments, the ratio between the thickness of suture 125 and the thickness of suture attachment 125A is about 1.1:1 to about 1:3.

[0088]

[0169] Alternatively, by way of example, at least one of primary suture attachment 122D or secondary suture attachment 125A may comprise a fastener, a string, a band, a hook and loop fastener, a tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

[0089]

[0170] 17 and 18, primary suture attachment 122D in arcuate needle 122 and secondary suture attachment 125A of exemplary suture 125 are engaged, detached, or both in vitro by pincers 1701 employed within working channel 1801 of an endoscope. This feature allows for quick and easy replacement of suture 125 during procedures requiring suturing in two or more locations. As shown, secondary suture attachment 125A is located on the inner surface of arcuate needle 122, thereby allowing pincers 1701 to connect and disconnect suture 125 to and from arcuate needle 122.

[0090] Shuttle Assembly

[0171] FIG. 19A shows an exemplary view of shuttle 123 with pawl 124 engaged. FIG. 19B shows an exemplary view of shuttle 123 with pawl 124 disengaged. Additionally, as shown, pawl 124 rotates within shuttle 123 about pivot 129. In some embodiments, pawl 124 may be supported by a spring, a flexure, a dual action spring, or the like. The first distal assembly 120 may comprise one, two, three, four, five, six, seven, eight, nine, ten, or more pawls 124. In some embodiments, the first distal assembly 120 comprises one, two, three, four, five, six, seven, eight, nine, ten, or more pawls 124. In some embodiments, the shuttle slides within a shuttle guide of the distal assembly. As can be seen, the shuttle 123 is arcuate so that it slides within the shuttle guide.

[0091]

[0172] In some embodiments, shuttle 123 includes pawl 124, cushion 126, or both. In some embodiments, pawl 124 rotates within shuttle 123 about pivot 127. In some embodiments, shuttle 123 includes a cavity that receives pawl 124. In some embodiments, pawl 124 is biased into engagement. In some embodiments, pawl 124 is biased into engagement by cushion 126. In some embodiments, cushion 126 urges pawl 124 to move pawl 124 upward to engage notch 122A of arcuate needle 122. In some embodiments, the position of pivot 127 relative to the end point of cavity 123A, in combination with the position of cushion 126, allows the pawl to be biased into engagement. In some embodiments, cushion 126 urges pawl 124 against the end point of cavity 123A of shuttle 123 when pawl 124 is engaged. In some embodiments, when pawl 124 is disengaged, arcuate needle 122 presses pawl 124 against cushion 126, moving it away from the end of cavity 123A in shuttle 123. In some embodiments, the upper surface of pawl 124 is angled toward one end of shuttle 123. In some embodiments, the upper surface of pawl 124 is angled to engage the angled portion of the arcuate needle.

[0092]

[0173] In some embodiments, the cushion 126 is integrated into the pawl 124. In some embodiments, the cushion 126 is integrated into the shuttle 123. In some embodiments, the shuttle 123 does not include the cushion 126. In some embodiments, the shuttle 123 does not include the cushion 126, where the pawl 124 includes a flexure, spring, dual spring gate, cushion, piston, rod, pin, teeth, or any combination thereof for biasing the pawl 124. In some embodiments, the shuttle 123 does not include the pawl 124 or the cushion 126, where the shuttle 123 includes a flexure, spring, dual spring gate, cushion, piston, rod, pin, teeth, or any combination thereof for engaging and disengaging with the arched needle.

[0093]

[0174] In some embodiments, the illustrated shuttle 123 further comprises a cable attachment 127 that connects to a cable. In some embodiments, the cable attachment 127 comprises a clamp, a hole, a screw, a bolt, a nut, a clip, a pin, or any combination thereof. In some embodiments, the cable attachment 127 comprises a terminated cable attachment, where the cable terminates at the cable attachment 127. In some embodiments, the cable attachment 127 comprises a non-terminated cable attachment, where the cable passes through the cable attachment 127 and is coupled to the cable attachment 127. In some embodiments, the shuttle 123 comprises one, two, three, four, five, six, seven, eight, nine, ten, or more cable attachments 127. In some embodiments, the shuttle 123 slides within a shuttle guide of the distal assembly. As can be seen, the shuttle 123 is arcuate so that it slides within the shuttle guide.

[0094] Second Distal Assembly

[0175] 20-30C show diagrams of an exemplary second distal assembly 2110 and cable 2130 with prongs 2124. In some embodiments, the second distal assembly 212 2121B. In some embodiments, the cable 2130 comprises a sheath that surrounds at least a portion of the cable 2130.

[0095]

[0176] 21-25 and 28, the primary housing portion 2121A and the secondary housing portion 2121B are connected by housing fasteners 2140. In some embodiments, the primary housing portion 2121A and the secondary housing portion 2121B are connected by one, two, three, four, five, six, seven, eight, nine, ten, or more housing fasteners 2140. As shown, the housing fasteners 2140 comprise screws that pass through clearance holes in the secondary housing portion 2121B to secure the threaded formations 2140A within the primary housing portion 2121A. Alternatively, in some embodiments, the housing fasteners 2140 comprise bolts, rivets, nuts, welds, adhesives, or any combination thereof within at least one of the primary housing portion 2121A or the secondary housing portion 2121B. In some embodiments, the first housing 2121 does not include a primary housing portion 2121A or a secondary housing portion 2121B. In some embodiments, the first housing 2121 further includes a tertiary housing portion or more. In some embodiments, at least one of the primary housing portion 2121A or the secondary housing portion 2121B includes one or more cable guides that guide the cables 2130 toward and away from the first housing 2121. In some embodiments, the primary housing portion 2121A and the secondary housing portion 2121B are made of the same material. In some embodiments, the primary housing portion 2121A and the secondary housing portion 2121B are made of different materials.

[0096]

[0177] In some embodiments, at least one of the primary housing portion 2121A or the secondary housing portion 2121B includes an endoscope fixture 2401 that couples the second distal assembly 2120 to the endoscope 2150. In some embodiments, the endoscope fixture 2401 removably couples the first housing 121 to the endoscope 2150. As shown, the endoscope fixture 2401 includes a press-fit fixture. In some embodiments, the press-fit endoscope fixture 2401 is coupled to the endoscope 2150 by firmly pressing the press-fit endoscope fixture 2401 onto the distal end of the endoscope 2150. In some embodiments, the press-fit endoscope fixture 2401 is coupled to the endoscope 2150 by firmly pressing the press-fit endoscope fixture 2401 onto the distal end of the endoscope 2150 and rotating it. In some embodiments, the press-fit endoscope fixture 2401 is detached from the endoscope 2150 by tugging the press-fit endoscope fixture 2401 away from the distal end of the endoscope 2150. In some embodiments, the press-fit endoscope fixture 2401 is detached from the endoscope 2150 by tugging and twisting the press-fit endoscope fixture 2401 away from the distal end of the endoscope 2150.

[0097]

[0178] As shown, in some embodiments, endoscope fixture 2401 is circular. In some embodiments, endoscope 2150 has a distal outer diameter of about 5 mm to about 16 mm. Accordingly, in some embodiments, endoscope fixture 2401 has an inner diameter of about 5 mm to about 16 mm. In some embodiments, endoscope fixture 2401 has a minimum inner diameter of about 5 mm. In some embodiments, endoscope fixture 2401 has a maximum inner diameter of about 16 mm. In some embodiments, press-fit endoscope fixture 2401 has a diameter equal to or smaller than the diameter of endoscope 2150. In some embodiments, endoscope fixture 2401 has a diameter equal to or larger than the diameter of endoscope 2150. In some embodiments, endoscope fixture 2401 is tapered and has a first inner diameter and a second inner diameter, where the first inner diameter is distal to the second inner diameter. In some embodiments, the first inner diameter is larger than the second inner diameter. In some embodiments, the second inner diameter is larger than the first inner diameter. In some embodiments, the diameter of the endoscope fixture 2401 is measured as a maximum, minimum, or average inner width. In some embodiments, the diameter of the endoscope 2150 is measured as a maximum, minimum, or average outer width. Alternatively, in some embodiments, the endoscope fixture 2401 has a cross-sectional shape comprising a triangle, a square, a hexagon, or any other polygon. Alternatively, in some embodiments, the endoscope fixture 2401 comprises a clamp, adhesive, tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof. In some embodiments, the first distal fixture 120 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more endoscope fixtures 2401.

[0098]

[0179] 20 , the angle between the needle axis 2160A and the distal endoscope axis 2160B is between about 5 degrees and about 85 degrees. In some embodiments, the angle between the central axis 2121BA of the arcuate needle guide and the distal endoscope axis 2160B is adjustable within a range of about 5 degrees to about 85 degrees. In some embodiments, the needle axis 2160A is defined as an axis that is perpendicular to the plane of symmetry of the arcuate needle 123 and coincides with the center of the radius of the arcuate needle 123. In some embodiments, the distal endoscope axis 2160B is defined as the central axis of the distal portion of the endoscope 2150. In some embodiments, the distal endoscope axis 2160B is defined as the central axis of the endoscope fixture 2140 of the first housing 2121A. In some embodiments, the angle between the central axis 2160A of the arcuate needle guide and the distal endoscope axis 2160B is defined as a maximum, minimum, or average angle.

[0099]

[0180] 25 and 26, in some embodiments, the primary housing portion 2121A includes the pulley 2121AA and the secondary housing portion 2121B includes the pulley hole 2121BB. Alternatively, the secondary housing portion 2121B includes the pulley 2121AA and the primary housing portion 2121A includes the pulley hole 2121BB. As shown, the primary housing portion 2121A includes two pulleys 2121AA. Alternatively, in some embodiments, at least one of the primary housing portion 2121A or the secondary housing portion 2121B includes three or more pulleys 2121AA. In some embodiments, the pulley 2121AA supports and guides the cable 2130 as it moves through the first housing 2121. In some embodiments, at least a portion of the pulley 2121AA fits into the pulley hole 2121BB. In some embodiments, at least a portion of the pulley 2121AA is press-fit into the pulley hole 2121BB. In some embodiments, at least a portion of the pulley 2121AA is snap-fit ​​into the pulley hole 2121BB, thereby aligning the primary housing part 2121A with the secondary housing part 2121B. As shown, the pulley 2121AA and the pulley hole 2121BB have cross-sectional shapes that include a circle. Alternatively, in some embodiments, at least one of the pulley 2121AA and the pulley hole 2121BB has a cross-sectional shape that includes a triangle, square, pentagon, hexagon, or any other polygon. In some embodiments, the pulley 2121AA rotates relative to at least one of the primary housing part 2121A and the secondary housing part 2121B. In some embodiments, the pulley 2121AA is fixed relative to at least one of the primary housing part 2121A or the secondary housing part 2121B. In some embodiments, the pulley 2121AA comprises a bearing, a bar, a curved surface, or any combination thereof.

[0100]

[0181] As shown, the first housing 2121 includes a distal sheath retainer that couples the sheath to the first housing 2121. In some embodiments, at least one of the primary housing portion 2121A or the secondary housing portion 2121B is a portion of the sheath. The first housing 2121 further comprises a distal sheath fastener coupling the cable 130 to the first housing 2121. In some embodiments, the distal sheath fastener secures a portion of the sheath relative to the first housing 2121, thereby allowing the cable 130 to move within the sheath as the wheel rotates. As shown, the exemplary distal sheath fastener comprises a clamp. In some embodiments, the distal sheath fastener comprises a plate and one or more sheath fastener screws that fasten the cable sheath between the plate and the first housing 2121. Alternatively, in some embodiments, the distal sheath fastener comprises a screw, a fastener, a tape, or any combination thereof. In some embodiments, the first housing 2121 comprises at least one distal sheath fastener for the first cable portion and at least one distal sheath fastener for the second cable portion. In some embodiments, the first housing 2121 comprises a single distal sheath fastener for both the first and second cable portions. In some embodiments, a portion of the cable sheath extends past the termination points of the distal sheath fasteners and into the first housing 2121. In some embodiments, the first housing 2121 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more distal sheath fasteners. Alternatively, in some embodiments, the distal sheath fasteners comprise clamps, fasteners, bands, hook and loop fasteners, adhesive, or any combination thereof.

[0101]

[0182] In some embodiments, the first housing 2121 has an arcuate needle guide 2121BA. In some embodiments, at least one of the primary housing portion 2121A or the secondary housing portion 2121B has an arcuate needle guide 2121BA. In some embodiments, the arcuate needle 2122 slides freely within the arcuate needle guide 2121BA. In some embodiments, the arcuate needle guide 2121BA limits the rotation of the arcuate needle 2122 within one degree of freedom. In some embodiments, the arcuate needle guide 2121BA limits the rotation of the arcuate needle 2122 within at least one degree of freedom of rotation. As can be seen, the illustrative arcuate needle guide 2121BA surrounds at least a portion of the arcuate needle 2122. In some embodiments, the arcuate needle guide 2121BA has an inner width that is greater than the thickness 1510 of the arcuate needle 2122. In some embodiments, at least one of the arcuate needle 2122 or arcuate needle guide 2121BA has a cross-sectional shape that includes a circle, a square, a rectangle, or any other polygon.

[0102]

[0183] In some embodiments, a gap 2170 is formed in the second distal assembly 2120 between a first termination point of the arcuate needle guide 2121BA and a second, opposite termination point of the arcuate needle guide 2121BA. In some embodiments, a gap 2170 is formed in the second distal assembly 2120 between the first pulley hole 2121BB and the second, opposite pulley hole 2121BB. In some embodiments, the gap 2170 receives tissue to be sutured by the arcuate needle 2122. In some embodiments, the tissue is supported in contact with the arcuate needle 2122 throughout the suturing process. In some embodiments, the second distal assembly 2120 does not include an anchor exchange catheter.

[0103]

[0184] 26 , in some embodiments, the arched catheter 2122 has a notch 2122A. In some embodiments, the arched needle 2122 has two, three, four, five, six, seven, eight, nine, ten, or more notches 2122A. In some embodiments, when the cable 2130 translates in a first rotational direction 2600 about the first housing portion 2121A, the second housing portion 2121B, or both, the notches 2122A and the pawl 2124 are engaged. In some embodiments, when the cable 2130 translates in an opposite direction to the first rotational direction 2600, the notches 2122A and the pawl 2124 are engaged. 122A and pawl 2124 are disengaged. In some embodiments, notch 2130 is angled in a direction opposite to first rotational direction 2600. In some embodiments, the angled notch 2130 ensures proper seating of second pawl portion 2124B within notch 2130. In some embodiments, notch 2130 is angled at an angle of about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, 65 degrees, or more, including increments therein. As shown, in some embodiments, arched needle 2122 has two notches 2122A, where each notch 2122A is spaced apart by an angle of about 180 degrees around arched needle 2122.

[0104]

[0185] In some embodiments, the outer diameter of the arched needle 2122 is from about 5 mm to about 20 mm. In some embodiments, the outer diameter of the arched needle 2122 is at least about 5 mm. In some embodiments, the outer diameter of the arched needle 2122 is at most about 20 mm. In some embodiments, the thickness 1510 of the arched needle 2122 is from about 0.5 mm to about 2 mm. In some embodiments, the thickness 1510 of the arched needle 2122 is at least about 0.5 mm. In some embodiments, the thickness 1510 of the arched needle 2122 is at most about 2 mm. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 2122 is from about 3:1 to about 15:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 122, including increments therein, is about 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 10:1, 11:1, 12:1, 13:1, 14:1, or 15:1. In some embodiments, the ratio between the outer diameter and the thickness 1510 of the arched needle 2122 is at least about 3:1. In some embodiments, the outer diameter of the arched needle 2122 is measured as the maximum distance between two points on the surface of the arched needle 2122. In some embodiments, the outer diameter of the arched needle 2122 is measured as the maximum outer diameter of the arched needle 2122. In some embodiments, the width of the arched needle 2122 is measured as the thickness 1510 of the arched needle 2122. In some embodiments, the width of the arched needle 2122 is measured as the thickness 1510 of the arched needle 2122 that is not at the pointed end, suture end, or within the notch 2122 A. In some embodiments, the width of the arched needle 2122 is measured as the maximum, minimum, or average thickness 1510 of the arched needle 2122.

[0105]

[0186] In some embodiments, the notches 2122A are spaced apart at an angle of about 10 degrees to about 180 degrees around the arcuate needle 2122. In some embodiments, the notches 2122A are spaced apart at an angle of about 10 degrees to about 20 degrees, about 10 degrees to about 30 degrees, about 10 degrees to about 40 degrees, about 10 degrees to about 50 degrees, about 10 degrees to about 60 degrees, about 10 degrees to about 80 degrees, about 10 degrees to about 100 degrees, about 10 degrees to about 120 degrees, about 10 degrees to about 140 degrees, about 10 degrees to about 160 degrees, about 10 degrees to about 180 degrees, about 2 ... 0 degrees to approximately 30 degrees, approximately 20 degrees to approximately 40 degrees, approximately 20 degrees to approximately 50 degrees, approximately 20 degrees to approximately 60 degrees, approximately 20 degrees to approximately 80 degrees, approximately 20 degrees to approximately 100 degrees, approximately 20 degrees to approximately 120 degrees, approximately 20 degrees to approximately 140 degrees, approximately 20 degrees to approximately 160 degrees, approximately 20 degrees to approximately 180 degrees, approximately 30 degrees to approximately 40 degrees, approximately 30 degrees to approximately 50 degrees, approximately 30 degrees to approximately 60 degrees, approximately 30 degrees to approximately 80 degrees, approximately 30 degrees to approximately 1 00 degrees, approximately 30 degrees to approximately 120 degrees, approximately 30 degrees to approximately 140 degrees, approximately 30 degrees to approximately 160 degrees, approximately 30 degrees to approximately 180 degrees, approximately 40 degrees to approximately 50 degrees, approximately 40 degrees to approximately 60 degrees, approximately 40 degrees to approximately 80 degrees, approximately 40 degrees to approximately 100 degrees, approximately 40 degrees to approximately 120 degrees, approximately 40 degrees to approximately 140 degrees, approximately 40 degrees to approximately 160 degrees, approximately 40 degrees to approximately 180 degrees, approximately 50 degrees to approximately 60 degrees, approximately 50 degrees to approximately 80 degrees, about 50 degrees to about 100 degrees, about 50 degrees to about 120 degrees, about 50 degrees to about 140 degrees, about 50 degrees to about 160 degrees, about 50 degrees to about 180 degrees, about 60 degrees to about 80 degrees, about 60 degrees to about 100 degrees, about 60 degrees to about 120 degrees, about 60 degrees to about 140 degrees, about 60 degrees to about 160 degrees, about 60 degrees to about 180 degrees, about 80 degrees to about 100 degrees, about 80 degrees to about 120 degrees, about 80 degrees to about 1 The angles are 40 degrees, about 80 degrees to about 160 degrees, about 80 degrees to about 180 degrees, about 100 degrees to about 120 degrees, about 100 degrees to about 140 degrees, about 100 degrees to about 160 degrees, about 100 degrees to about 180 degrees, about 120 degrees to about 140 degrees, about 120 degrees to about 160 degrees, about 120 degrees to about 180 degrees, about 140 degrees to about 160 degrees, about 140 degrees to about 180 degrees, or about 160 degrees to about 180 degrees. In some embodiments, the notches 2122A are spaced apart at an angle of about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, about 160 degrees, or about 180 degrees around the arched needle 2122. In some embodiments, the notches 2122A are spaced apart at an angle of at least about 10 degrees, about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, or about 160 degrees around the arched needle 2122. In some embodiments, the notches 2122A are spaced apart around the arcuate needle 2122 at angles of up to about 20 degrees, about 30 degrees, about 40 degrees, about 50 degrees, about 60 degrees, about 80 degrees, about 100 degrees, about 120 degrees, about 140 degrees, about 160 degrees, or about 180 degrees.

[0106]

[0187] As shown in FIGS. 23-25 ​​(without second housing portion 2121B), cable 2130 having pawl 2124 enters first housing 2121, wraps around first pulley 2121AA, wraps around arcuate needle 2122, wraps around second pulley 2121AA, and exits through first housing 2121. As shown, cable 2130 includes flattened portion 2130A. In some embodiments, flattened portion 2130A improves the stability of cable 2130 as it wraps around pulley 2121AA. Additionally, in some embodiments, pawl 2124 is located on the flattened portion of cable 2130A. In some embodiments, the flattened portion of cable 2130A is manufactured by mechanically flattening a portion of cable 2130A or by applying a flat material to cable 2130. In some embodiments, pawl 2124 is attached to cable 2130. In some embodiments, a pawl 2124 is coupled to a flat portion 2130A of the cable.

[0107]

[0188] 24 , the claw 2124 comprises a first claw portion 2124A and a second claw portion 2124B, where the first claw portion 2124A is attached to the cable 2130 or a flat portion 2130A of the cable, and the second claw portion 2124B is not coupled to the cable 2130 or the flat portion 2130A of the cable. In some embodiments, the claw 2124 comprises a curved portion. In some embodiments, the second claw portion 2124B is curved inward toward the arch needle 2122 at rest and curves around the intersection between the second claw portion 2124B and the first claw portion 2124A. In some embodiments, when the arched needle 2122 contacts the second claw portion 2124B, the second claw portion 2124B bends outward away from the arched needle 2122 around the intersection between the second claw portion 2124B and the first claw portion 2124A. As shown in FIG. 26 , the distal end of the second claw portion 2124B contacts and presses against the notch 2122A of the arched needle 2122, thereby translating the arched needle 2122 in the first direction 2600. Additionally or alternatively, the distal end of the second claw portion 2124B contacts and presses against the suture end 2122B of the arched needle 2122, thereby translating the arched needle 2122 in the first direction 2600. Alternatively, in some embodiments, the pawl 2124 comprises a spring, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, the pawl 2124 is biased by engagement.

[0108]

[0189] 27A-F illustrate an exemplary second distal assembly in a first position, a second position, a third position, a fourth position, a fifth position, and a sixth position, respectively. According to FIG. 27A, suturing using the second distal assembly involves rotating the pawl 2124 within the secondary housing portion 2121B to an end position in a second rotational direction opposite the first rotational direction 2600, with the arched needle 2122 fully enclosed within the secondary housing portion 2121B. 27B-C , the cable 2130 is translated to move the engaged arcuate needle 2122 and pawl 2124 in the first rotational direction 2600 within the secondary housing portion 2121B to a terminal position of the pawl 2124 in the first rotational direction 2600. This translation of the cable 2130 and pawl 2124 thus moves a portion of the arcuate needle 2122 away from the secondary housing portion 2121B, thereby performing the first suture. 27D, cable 2130 is then translated back to its terminal position in the second rotational direction within secondary housing portion 2121B, thereby automatically engaging the second notch in arcuate needle 2122. As seen in FIGS. 27E-F, translation of cable 2130 and pawl 2124 in the first direction 2600 then returns arcuate needle 2122 to its original position within secondary housing portion 2121B, and further translation of cable 2130 and pawl 2124 in the second direction returns the pawl to its terminal position in the second rotational direction within secondary housing portion 2121B, according to FIG. Subsequent translation of cable 2130 in a first direction 2600, then in a second direction opposite the first direction 2600, then in the first direction 2600, then in the second direction completes one suturing, and repeating this process allows for repeated suturing.

[0109]

[0190] 29 shows the arcuate needle 2122 within the arcuate needle guide 2121BA of the secondary housing portion 2121B. As shown in FIG. 28, the arcuate needle guide 2121BA surrounds a portion of the arcuate needle 2122. As seen herein, the arcuate needle guide 2121BA surrounds approximately 280 degrees of the cross-sectional circumference of the arcuate needle 2122. Alternatively, in some embodiments, the arcuate needle guide 2121BA surrounds approximately 100 degrees, 120 degrees, 140 degrees, 160 degrees, 180 degrees, 200 degrees, 220 degrees, 240 degrees, 260 degrees, 280 degrees, 300 degrees, 320 degrees, or more of the cross-sectional circumference of the arcuate needle 2122, including increments therein.

[0110]

[0191] 30A-C, the cable and pawl comprises a single cable pawl 3000A, 3000B comprising a flat portion 2124B with a tab 2124A. As shown, the tab 2124A comprises a curved portion. Alternatively, in some embodiments, the tab 2124A comprises a recess, a spring, or any combination thereof. In some embodiments, the tab 2124A engages and disengages from a notch in the arcuate needle in a manner similar to the pawl. As shown, in some embodiments, the tab 2124A has an extended position in which the tab 2124A is at rest and protrudes from the flat portion 2124B at an angle. In some embodiments, the tab 2124A projects from the flat portion 2124A at an angle of about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, or more, including increments therein. As shown in FIG. 30C , in some embodiments, the tab 2124A engages with the notch 2122A of the arched needle 2122 when in the deployed position. In some embodiments, when engaged, the distal tip of the tab 2124A presses against the notch 2122A of the arched needle 2122. In some embodiments, the tab 2124A has a pushed-in position, in which the tab 2124A and the flat portion 2124B are generally coplanar. In some embodiments, in the pushed-in position, the tab 2124A is clamped by the arched needle 2122 against the flat portion 2124B. In some embodiments, when in the pushed-in position, the tab 2124A disengages from the notch 2122A of the arcuate needle 2122. In some embodiments, the tab 2124A is repeatedly disengaged from and engaged with the notch of the arcuate needle, thereby preventing repeated clamping. 30A, cable claw 3000A is formed in a sheet of material that is attached to cable 2130A. Alternatively, in some embodiments, cable claw 3000A is formed from a single continuous piece of material, as shown in FIG. 30B.

[0111]

[0192] In some embodiments, at least one of the primary housing portion 2121A, the pulley 2121AA, the secondary housing portion 2121B, the cable 2130, the claw 2124, the tab 2124A, or the single cable claw 3000A, 300B is constructed from metal, plastic, wood, carbon fiber, ceramic, or any combination thereof.

[0112] Angle adjustable primary housing

[0193] 31A-36 show diagrams of an example angle-adjustable first housing 3120 comprising a primary angle-adjustable first housing 3121A, a secondary angle-adjustable housing 3121B, and a tertiary angle-adjustable housing 3121C. In some embodiments, the angle-adjustable first housing 3120 further comprises a fourth or more tilting housing. As shown, the secondary angle-adjustable housing 3121B and the tertiary angle-adjustable housing 3121C are rigidly attached to one another, where the secondary angle-adjustable housing 3121B and the tertiary angle-adjustable housing 3121C rotate relative to the primary angle-adjustable housing 3121A about an angle adjustment axis 3151. In some embodiments, the secondary angle-adjustable housing 3121B and the tertiary angle-adjustable housing 3121C are a single component. In some embodiments, the angle adjustment axis 3151 is perpendicular to the distal endoscope axis 3152. In some embodiments, the angle adjustment axis 3151 does not intersect with the distal endoscope axis 3152. In some embodiments, the secondary angle adjustable housing 3121B and the tertiary angle adjustable housing 3121C are rigidly attached to one another by fasteners. In some embodiments, the fasteners include press fit fasteners, screws, nuts, bolts, hook and loop fasteners, adhesive, welds, or any combination thereof.

[0113]

[0194] 31A-B, the primary angle adjustable housing 3121A includes an endoscope fixture 3120 that couples the primary angle adjustable housing 3121A to the endoscope 3140. In some embodiments, the endoscope fixture 3120 removably couples the primary angle adjustable housing 3121A to the endoscope 3140. As shown, the endoscope fixture 3120 includes a screw and the primary angle adjustable housing 3121A includes a threaded structure or threaded insert that receives the screw, such that the threaded structure or threaded insert in the endoscope fixture 3120 and the primary angle adjustable housing 3121A are clamped around the distal end of the endoscope 3140, thereby securing the primary angle adjustable housing 3121A to the endoscope 3140. As shown, the primary angle adjustable housing 3121A includes a slot configured to disengage the endoscope fixture 3120 from the remainder of the angle adjustable housing 3121A, allowing the angle adjustable housing 3121A to deform upon tightening of the screws. Alternatively, in some embodiments, the primary angle adjustable housing 3121A does not include a slot.

[0114]

[0195] As shown, in some embodiments, the endoscope fixture 3120 is circular. In some embodiments, the endoscope 3140 has a distal outer diameter of about 5 mm to about 16 mm. Accordingly, in some embodiments, the endoscope fixture 3120 has an inner diameter of about 5 mm to about 16 mm. In some embodiments, the endoscope fixture 3120 has a minimum inner diameter of about 5 mm. In some embodiments, the endoscope fixture 3120 has a maximum inner diameter of about 16 mm. In some embodiments, the endoscope fixture 3120 is a press-fit type. In some embodiments, the press-fit type endoscope fixture 3120 has a diameter equal to or smaller than the diameter of the endoscope 3140. In some embodiments, the endoscope fixture 3120 is 20 has a diameter equal to or larger than the diameter of the endoscope 3140. In some embodiments, the endoscope fixture 3120 is tapered and has a first inner diameter and a second inner diameter, where the first inner diameter is distal to the second inner diameter. In some embodiments, the first inner diameter is larger than the second inner diameter. In some embodiments, the second inner diameter is larger than the first inner diameter. In some embodiments, the diameter of the endoscope fixture 3120 is measured as a maximum, minimum, or average inner width. In some embodiments, the diameter of the endoscope 3140 is measured as a maximum, minimum, or average outer width. Alternatively, in some embodiments, the endoscope fixture 3120 has a cross-sectional shape comprising a triangle, square, hexagon, or any other polygon.

[0115]

[0196] Alternatively, in some embodiments, the endoscope fixture 3120 comprises a press-fit fixture. In some embodiments, the press-fit endoscope fixture 3120 is attached to the endoscope 3140 by firmly pressing the press-fit endoscope fixture 3120 onto the distal end of the endoscope 3140. In some embodiments, the press-fit endoscope fixture 3120 is attached to the endoscope 3140 by firmly pressing the press-fit endoscope fixture 3120 onto the distal end of the endoscope 3140 and rotating. In some embodiments, the press-fit endoscope fixture 3120 is detached from the endoscope 3140 by pulling the press-fit endoscope fixture 3120 tightly away from the distal end of the endoscope 3120. Alternatively, in some embodiments, the endoscope fixture 3120 comprises a clamp, adhesive, tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof. In some embodiments, the first distal assembly 120 comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more endoscope fixations 3120.

[0116]

[0197] Additionally, as shown, at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C secures the cable sheath of the cable 3130. In some embodiments, at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C includes an aperture for receiving the cable sheath of the cable 3130. In some embodiments, the cable sheath of the cable 3130 is clamped between the secondary angle adjustable housing 3121B and the tertiary angle adjustable housing 3121C. In some embodiments, the cable sheath of the cable 3130 is coupled to at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C by adhesive, clamps, fasteners, hook and loop fasteners, or any combination thereof.

[0117]

[0198] 32-36, an exemplary primary angle-adjustable housing 3121A includes a tilt mechanism 3121AA, and an exemplary secondary angle-adjustable housing 3121B includes a secondary tilt mechanism 3121BA, where the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA couple the primary angle-adjustable housing 3121A and the secondary angle-adjustable housing 3121B. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle-adjustable housing 3121B or the tertiary angle-adjustable housing 3121C to rotate relative to the primary angle-adjustable housing 3121A. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C to rotate about the angle adjustment axis 3151 relative to the primary angle adjustable housing 3121A. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C to rotate about 300 degrees relative to the primary angle adjustable housing 3121A. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C to rotate about 300 degrees relative to the primary angle adjustable housing 3121A. At least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C may be rotated relative to the primary angle adjustable housing 3121A such that the angle between the arcuate needle axis 3153 and the distal endoscope axis 3152 increases from about 0 degrees (where the arcuate needle 3153 and the distal endoscope axis 3152 are parallel) to about 300 degrees. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA may be rotated relative to the primary angle adjustable housing 3121A such that the angle between the arcuate needle axis 3153 and the distal endoscope axis 3152 increases continuously from about 0 degrees to about 300 degrees. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle-adjustable housing 3121B or the tertiary angle-adjustable housing 3121C to be rotated relative to the primary angle-adjustable housing 3121A, such that the angle between the arcuate needle axis 3153 and the distal endoscope axis 3152 increases in discrete increments from approximately 0 degrees to approximately 300 degrees. In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C to be rotated relative to the primary angle adjustable housing 3121A, such that the angle between the arcuate needle axis 3153 and the distal endoscope axis 3152 increases from about 0 degrees to about 300 degrees in discrete increments of about 1 degree, 2 degrees, 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, 50 degrees, 55 degrees, 60 degrees, or more.In some embodiments, the primary tilt mechanism 3121AA and the secondary tilt mechanism 3121BA enable at least one of the secondary angle adjustable housing 3121B or the tertiary angle adjustable housing 3121C to rotate relative to the primary angle adjustable housing 3121A, such that the angle between the arcuate needle axis 3153 and the distal endoscope axis 3152 increases in discrete increments of at least about 1 degree. In some embodiments, the arcuate needle axis 3153 and the distal endoscope axis 3152 are coincident. In some embodiments, the arcuate needle axis 3153 and the distal endoscope axis 3152 are misaligned.

[0118]

[0199] 35 and 36 , in one embodiment, the primary tilt mechanism 3121AA comprises a clamp having a knurled interior surface, and the secondary tilt mechanism 3121BA comprises a knob having a knurled exterior surface. As shown, the secondary tilt mechanism 3121BA has 19 peaks and valleys, such that engagement of one peak on the primary tilt mechanism 3121AA with one valley on the secondary tilt mechanism 3121BA defines a particular angle between the arcuate needle shaft 3153 and the distal endoscope shaft 3152. As shown, the primary tilt mechanism 3121AA has three peaks and valleys, such that engagement of one peak on the secondary tilt mechanism 3121BA with one valley on the primary tilt mechanism 3121AA defines a particular angle between the arcuate needle shaft 3153 and the distal endoscope shaft 3152. Alternatively, in some embodiments, at least one of the primary tilt feature 3121AA or the secondary tilt feature 3121BA comprises 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 23, 24, 25, or more peaks and valleys. Alternatively, in some embodiments, the primary tilt feature 3121AA does not comprise the primary tilt housing 3121A. Alternatively, in some embodiments, the secondary angle adjustable housing 3121B does not comprise the secondary tilt housing 3121BA.

[0119]

[0200] In some embodiments, the clamp of the primary tilt mechanism 3121A is tightened by fixing the screw 3151 to tighten the clamp and prevent rotation of the secondary angle adjustable housing 3121B about the angle adjustment axis 3151 relative to the primary tilt housing 3121A. 3121A。 In some embodiments, the clamp of the primary tilt mechanism 3121AA is tightened during surgical use. Alternatively, in some embodiments, rotation between the primary tiltable housing 3121A and the secondary tiltable housing 3121B is achieved via a clamp, pin, screw, knob, fastener, band, magnet, or combination thereof.

[0120]

[0201] As can be seen, the secondary angle-adjustable housing 3121B includes a gap 3601 between the secondary tilt mechanism 3121BA and the remainder of the secondary angle-adjustable housing 3121B. In some embodiments, the gap 3601 receives a portion of the primary angle-adjustable housing 3121A when the secondary angle-adjustable housing 3121B rotates about the primary angle-adjustable housing 3121A. In some embodiments, the width of the gap 3601 is greater than the thickness of the primary tilt mechanism 3121AA.

[0121] 4th and 5th Endoscopic Suturing Systems

[0202] 37-40, a fourth exemplary endoscopic suturing system 4000 is provided herein. According to FIG. 39, in some embodiments, the claw 4124A of the fourth exemplary endoscopic suturing system 4000 extends downwardly from the flat portion of the cable 4130A. In some embodiments, the claw 4124A extends distally from the flat portion of the cable 4130A. In some embodiments, the claw 4124A and the flat portion of the cable 4130A are formed from a single piece of material. In some embodiments, the claw 4124A and the flat portion of the cable 4130A are formed from two or more pieces of material. In some embodiments, the claw 4124A and the flat portion of the cable 4130A are permanently connected. In some embodiments, the claw 4124A and the flat portion of the cable 4130A are permanently connected by a weld, adhesive, epoxy, screws, nuts, rivets, or any combination thereof. In some embodiments, the claws 4124A and / or the flat portion of the cable 4130A are formed of a material having a minimum yield strength of about 140,000 and / or a minimum tensile strength of about 185,000. In some embodiments, the thickness of the claws 4124A and / or the flat portion of the cable 4130A is between 0.001 inches and 0.010 inches. In some embodiments, the bend radius of the claws 4124A and / or the flat portion of the cable 4130A is between 0.010 inches and 0.10 inches. In some embodiments, the claws 4124A and / or the flat portion of the cable 4130A has a width between 0.01 inches and 0.10 inches. According to FIG. 40, in some embodiments, the notch of the arched needle 4122 is located on the outer surface of the arched needle.

[0122]

[0203] 41-52 and 63-65, a fifth exemplary endoscopic suturing system 5000 is provided herein. In some embodiments, according to FIGS. 41-43, a first housing 5120 comprises a primary housing portion 5121A, a secondary housing portion 5121B, and a tertiary housing portion 5121C. In some embodiments, the primary housing portion 5121A comprises an endoscope fixation device. In some embodiments, the primary housing portion 5121A comprises a first primary housing portion 5121A configured to be attached to a first endoscope size and a second primary housing portion 5121A configured to be attached to a second endoscope size. In some embodiments, the secondary housing portion 5121B comprises an arcuate needle 5122 guide. In some embodiments, the second housing portion is removably coupled to the primary housing portion 5121A. In some embodiments, the tertiary housing portion 5121C comprises an arcuate needle guide cover. In some embodiments, the third The tertiary housing portion 5121C is rotatably or slidably coupled to the second housing portion. In some embodiments, the tertiary housing portion 5121C is removably coupled to the primary housing portion 5121A.

[0123]

[0204] In some embodiments, the arcuate needle 5122 is received between the arcuate needle 5122 guide and the tertiary housing portion 5121C. In some embodiments, the arcuate needle 5122 is received between the arcuate needle 5122 guide and the tertiary housing portion 5121C when the tertiary housing is coupled to the primary housing portion 5121A. As shown in FIG. 43 , in some embodiments, the tertiary housing portion 5121C is removably coupled to the primary housing portion 5121A with a clip 5121C. In some embodiments, the tertiary housing portion 5121C is removably coupled to the primary housing portion 5121A with a screw, nut, protrusion, groove, knob, cam, or any combination thereof. 50, in some embodiments, the tertiary housing portion 5121C is removably coupled to the secondary housing portion 5121B by a protrusion in the secondary housing portion 5121B, a groove in the primary housing portion 5121A, and a screw connecting the primary housing portion 5121A and the secondary housing portion 5121B. Alternatively, in some embodiments, the tertiary housing portion 5121C is removably coupled to the secondary housing portion 5121B by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

[0124]

[0205] 45, in some embodiments, the pawl 5124A extends upward from the flat portion 5124B of the cable 5130A. In some embodiments, the pawl 5124A extends proximally from the flat portion 5124B of the cable 5130A. In some embodiments, the pawl 5124A extends proximally from the flat portion 5124B of the cable 5130A. In some embodiments, the notch 5122A of the arched needle 5122 is located on an outer surface of the arched needle 5122. Alternatively, in some embodiments, the notch 5122A is located on a top surface of the arched needle 5122. In some embodiments, the arched needle 5122 includes two or more notches 5122A.

[0125]

[0206] In some embodiments, when the cable translates in a first rotational direction about the central axis, the notch 5122A and the pawl 5124A are engaged, where when the cable translates opposite the first rotational direction, the notch 5122A and the pawl 5124A are disengaged. In some embodiments, the pawl 5124A comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof. In some embodiments, the pawl 5124A is biased upon engagement. In some embodiments, the notch 5122A is angled in a direction opposite the first direction.

[0126]

[0207] 47 and 48, the arcuate needle 5122 guide comprises a backstop 5303. In some embodiments, the backstop 5303 and the arcuate needle 5122 are engaged to prevent the arcuate needle 5122 from rotating in the second rotational direction within the arcuate needle 5122 guide by up to about 270 degrees. In some embodiments, the backstop 5303 comprises a curved portion, a catch, a magnet, a clasp, or any combination thereof. In some embodiments, the system comprises two or more backstops 5303.

[0127]

[0208] 47 illustrates the example arched needle 5122 and second housing portion in a first position, where at least a majority of the arched needle 5122 is contained within the secondary housing portion 5121B. As shown, a first backstop 5303 contacts a surface of the arched needle 5122 proximal to the tip of the needle 5122 to prevent the arched needle 5122 from rotating in a second direction. As further shown, the first backstop 5303 contacts a surface of the arched needle 5122 proximal to the tip of the needle 5122 to prevent the arched needle 5122 from rotating in a second direction. A second backstop 5303 contacts a portion of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in a second direction away from the tip of the needle 5122 toward the suture 5400 .

[0128]

[0209] FIG. 48 illustrates an example arched needle 5122 and second housing portion in a second position, where the arched needle 5122 is rotated approximately 180 degrees from the first position. As shown, a first backstop 5303 contacts a portion of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in the second direction from the tip of the needle 5122 toward the suture 5400. Additionally, as shown, in some embodiments, a second backstop 5303 contacts a surface of the arched needle 5122 proximal to the tip of the needle 5122 to prevent the arched needle 5122 from rotating in the second direction. FIG. 63 illustrates an image of an example fifth distal assembly.

[0129] 6th and 7th Endoscopic Suture Systems

[0210] 53A-54 illustrate a sixth exemplary endoscopic suturing system 6000 in which the tertiary housing portion 5121C includes a first backstop 6303A and a second backstop 6303B. As shown, the first backstop 6303A contacts a portion of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in a second direction from the tip of the arched needle 5122 toward the suture 5400. Additionally, as shown, in some embodiments, the second backstop 6303B contacts a surface of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in the second direction.

[0130]

[0211] 55-57 illustrate a seventh exemplary endoscopic suturing system 7000 in which the secondary housing portion 5121B includes a first backstop 7303A and a second backstop 7303B. As shown, the first backstop 7303A contacts a portion of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in the second direction from the tip of the arched needle 5122 toward the suture 5400. Additionally, as shown, in some embodiments, the second backstop 7303B contacts a surface of the arched needle 5122 proximal to the suture 5400 to prevent the arched needle 5122 from rotating in the second direction.

[0131]

[0212] In some embodiments, according to FIGS. 58A-60B, the tertiary housing portion 5121C is rotatably coupled to the secondary housing portion 5121B. In some embodiments, the secondary housing portion 5121B comprises a secondary fastener 5121BA, wherein the tertiary housing portion 5121C comprises a tertiary fastener 5121CA removably coupled to the secondary fastener 5121BA. In some embodiments, the secondary fastener 5121CA and / or the tertiary fastener 5121BA comprise a clasp, a pin, a curved portion, a clasp, a threaded formation, or any combination thereof. In some embodiments, according to FIGS. 60A and 60B, at least one surface of the tertiary housing portion 5121C comprises a gripping formation 5121CB. In some embodiments, according to FIG. 60B, the tertiary housing portion 5121C is rotatably coupled to the secondary housing portion 5121B by a spring hinge 5121D.

[0132]

[0213] In some embodiments, according to Figures 61A-62B, sliding the tertiary housing portion 5121C relative to the secondary housing portion 5121B in one or more directions decouples the tertiary housing portion 5121C from the secondary housing portion 5121B. In some embodiments, the secondary housing portion 5121B includes a secondary sliding fastener 5121BC, and the tertiary housing portion 5121C decouples the secondary housing portion 5121B from the secondary housing portion 5121B. 62A, the secondary housing portion 5121B includes a tertiary sliding fixture 5121CC for connecting the secondary housing portion 5121B and the tertiary housing portion 5121C. In some embodiments, the sliding fixture includes a protrusion, a groove, a dovetail joint, a clasp, a bend, a notch, or any combination thereof. In some embodiments, according to FIG. 62A, the secondary housing portion 5121B includes an aperture 5121BD for viewing the arcuate needle 5122.

[0133] Endoscopic Suturing Platform

[0214] 51 and 52 , an endoscopic suturing platform is provided herein. As shown, in some embodiments, the endoscopic suturing platform comprises an endoscopic suturing system and a needle exchange mount 5200. In some embodiments, the needle exchange mount 5200 is removably coupled to the arcuate needle 5122 and the tertiary housing 5121C. In some embodiments, the needle exchange mount 5200 is removably coupled to the arcuate needle 5122 by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof. In some embodiments, the needle exchange mount 5200 is removably coupled to the tertiary housing portion 5121C by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

[0134] Methods for using an endoscopic suturing platform

[0215] Another aspect provided herein is a method, the method including receiving an endoscopic suturing platform, coupling an arcuate needle to a needle exchange mount, coupling a tertiary housing portion to the needle exchange mount, coupling the needle exchange mount together with the arcuate needle and the tertiary housing portion to the first housing portion and the second housing portion, decoupling the arcuate needle from the needle exchange mount, and decoupling the needle exchange mount from the tertiary housing. In some embodiments, decoupling the arcuate needle from the needle exchange mount inserts the needle into an arcuate needle guide.

[0135]

[0216] Another aspect provided herein is a method, the method including receiving an endoscopic suturing platform, coupling an arcuate needle to a needle exchange mount, coupling the needle exchange mount to a first housing, decoupling the arcuate needle from the needle exchange mount, and decoupling the needle exchange mount from the first housing. In some embodiments, decoupling the arcuate needle from the needle exchange mount inserts the needle into an arcuate needle guide. Terms and Definitions

[0217] Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

[0136]

[0218] As used herein, the singular forms "a," "an," and "the" include plural referents unless otherwise indicated. Any reference herein to "or" is intended to encompass "and / or" unless otherwise indicated.

[0137]

[0219] As used herein, the term "about" means an amount that is closer to 10%, 5%, or 1% of the amount being referred to, including increases therein.

[0138]

[0220] As used herein, the term "about" when referring to a percentage means an amount that is approximately 10%, 5%, or 1% of the referenced percentage, including increases therein.

[0139]

[0221] As used herein, "at least one," "one or more," and " The phrase "and / or" is an open-ended expression that is both conjunctive and disjunctive in its operating sense. For example, the phrases "at least one of A, B, and C," "at least one of A, B, or C," "one or more of A, B, and C," "one or more of A, B, or C," and "A, B, and / or C" mean A only, B only, C only, A and B, A and C, B and C, or A, B, and C, respectively.

[0140]

[0222] The term "arc" as used herein refers to an arc of a circle or a portion of a circle. In some embodiments, the term "arc" as used herein refers to a parabolic arc shape, an elliptical arc shape, a rounded arc shape, a semicircular arc shape, a C-shaped arc shape, or a horseshoe arc shape.

Claims

1. 1. An endoscopic suturing system comprising: (a) a distal assembly comprising: (i) a first housing comprising: (A) a primary housing portion including an endoscope fixture, the endoscope fixture attaching the first housing portion to an endoscope; (B) a secondary housing portion comprising an arcuate needle guide, the second housing portion being removably coupled to the primary housing portion; (C) a tertiary housing portion comprising an arcuate needle guide cover, the tertiary housing portion being removably coupled to the second housing portion and removably coupled to the primary housing portion; a first housing comprising: (ii) an arcuate needle having a notch and a suture attachment, said arcuate needle having a central axis, said arcuate needle being disposed within said arcuate needle guide; a distal assembly comprising: (b) a proximal assembly comprising: (i) a second housing; (ii) an actuator connected to the second housing; a proximal assembly comprising: (c) a cable having a claw: the notch and the pawl are engaged when the cable translates in a first rotational direction about the central axis, and the notch and the pawl are disengaged when the cable translates opposite to the first rotational direction. Cable and An endoscopic suturing system comprising:

2. The system of claim 1 , wherein the pawl comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof.

3. The system of claim 1 or 2, wherein the pawl is biased by engagement.

4. The system of claim 1 , 2 or 3 , wherein the notch is angled in a direction opposite the first direction.

5. The system of claim 1 , wherein the notch is located on an inner surface of the arcuate needle.

6. The system of claim 1 , wherein the notch is located on an outer surface of the arcuate needle.

7. The system of claim 1 , wherein the notch is located on a top surface of the arcuate needle.

8. The system of claim 1 , wherein the arcuate needle comprises two or more notches.

9. The endoscope fixture may be a press-fit fixture, a clamp, adhesive, tape, a strap, or a set screw.

9. The system of claim 1, comprising a hook and loop fastener, a magnet, or any combination thereof.

10. 10. The system of claim 1, wherein the endoscope has a distal outer diameter of about 5 mm to about 156 mm.

11. The system of claim 1 , further comprising a cable sheath surrounding at least a portion of the cable.

12. The system of claim 11 , further comprising a cable lock that removably couples at least a portion of the cable to the endoscope.

13. 13. The system of claim 12, wherein the cable fastener comprises a press fit fastener, a clip, a string, a band, a hook and loop fastener, a tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

14. 14. The system of claim 1, wherein the angle between the planar central axis of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 85 degrees.

15. 15. The system of claim 14, wherein the angle between the central axis of the plane of the arcuate needle guide and the distal axis of the endoscope is adjustable within a range of about 5 degrees to about 85 degrees.

16. 16. The system of claim 1, wherein at least one of the first housing, the second housing, the arcuate needle, and the actuator is constructed from plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof.

17. 17. The system of claim 1, wherein the first housing further comprises a cable pulley for guiding the cable.

18. 18. The system of any one of claims 1 to 17, wherein the arcuate needle further comprises a suture attachment fixture.

19. 19. The system of claim 1, wherein the second housing is removably coupled to the endoscope.

20. 20. The system of claim 1, wherein the secondary housing portion is removably coupled to the primary housing portion by screws, nuts, protrusions, grooves, clips, knobs, cams, or any combination thereof.

21. 21. The system of claim 1, wherein the arcuate needle is contained between the arcuate needle guide and the tertiary housing portion when the tertiary housing is coupled to the primary housing portion.

22. 22. The system of claim 1, wherein the tertiary housing portion is removably coupled to the primary housing portion by screws, nuts, protrusions, grooves, clips, knobs, cams, or any combination thereof.

23. 23. The system of claim 1, wherein the tertiary housing portion is further removably coupled to the secondary housing portion.

24. 24. The system of claim 23, wherein the tertiary housing portion is removably coupled to the secondary housing portion by screws, nuts, protrusions, grooves, clips, knobs, cams, or any combination thereof.

25. 1. An endoscopic suturing system comprising: (a) a distal assembly comprising: (i) a first housing comprising an arcuate needle guide and an endoscope fixture, the endoscope fixture attaching the first housing to an endoscope, the arcuate needle guide comprising a backstop; (ii) an arcuate needle having a notch and a suture attachment, said arcuate needle having a central axis, said arcuate needle being disposed within said arcuate needle guide; a distal assembly comprising: (b) a proximal assembly comprising: (i) a second housing; (ii) an actuator connected to the second housing; a proximal assembly comprising: (c) a cable having a claw: when the pawl translates in a first rotational direction about the central axis, the notch and the pawl are engaged, and when the pawl translates in a second direction opposite the first rotational direction, the notch and the pawl are disengaged and the backstop and the arcuate needle are engaged to prevent the arcuate needle from rotating in the second rotational direction within the arcuate needle guide by up to about 270 degrees. Cable and An endoscopic suturing system comprising:

26. 1. An endoscopic suturing system comprising: (a) a distal assembly comprising: (i) a first housing including an arcuate needle guide and an endoscope fixture, the endoscope fixture attaching the first housing to an endoscope; (ii) an arcuate needle having a notch and a suture attachment, said arcuate needle having a central axis, said arcuate needle being disposed within said arcuate needle guide; (iii) an arcuate needle guide cover, the arcuate needle guide cover removably attached to the first housing, the arcuate needle guide cover comprising a backstop; and a distal assembly comprising: (b) a proximal assembly comprising: (i) a second housing; (ii) an actuator connected to the second housing; a proximal assembly comprising: (c) a cable having a claw: when the pawl translates in a first rotational direction about the central axis, the notch and the pawl are engaged, and when the pawl translates in a second direction opposite the first rotational direction, the notch and the pawl are disengaged and the backstop and the needle are engaged to prevent the arcuate needle from rotating in the second rotational direction within the arcuate needle guide by up to about 270 degrees. Cable and An endoscopic suturing system comprising:

27. 27. The system of claim 25 or 26, wherein the pawl comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof.

28. 28. The system of claim 25, 26, or 27, wherein the pawl is biased by engagement.

29. 29. The system of any one of claims 25 to 28, wherein the notch is angled in a direction opposite the first direction.

30. 30. The system of any one of claims 25 to 29, wherein the notch is located on an inner surface of the arcuate needle.

31. 30. The system of any one of claims 25 to 29, wherein the notch is located on an outer surface of the arcuate needle.

32. 30. The system of any one of claims 25 to 29, wherein the notch is located on a top surface of the arcuate needle.

33. 33. The system of any one of claims 25 to 32, wherein the arcuate needle comprises two or more notches.

34. 34. The system of any one of claims 25 to 33, wherein the endoscope fastener comprises a press fit fastener, a clamp, adhesive, tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof.

35. 35. The system of any one of claims 25 to 34, wherein the endoscope has a distal outer diameter of about 5 mm to about 156 mm.

36. 36. The system of any one of claims 25 to 35, further comprising a cable sheath surrounding at least a portion of the cable.

37. 37. The system of claim 36, further comprising a cable lock that removably couples at least a portion of the cable to the endoscope.

38. 38. The system of claim 37, wherein the cable fastener comprises a press fit fastener, a clip, a string, a band, a hook and loop fastener, a tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

39. 39. The system of any one of claims 25 to 38, wherein the angle between the planar central axis of the arcuate needle guide and the distal axis of the endoscope is from about 5 degrees to about 85 degrees.

40. 40. The system of claim 39, wherein the angle between the central axis of the arcuate needle guide and the proximal axis of the endoscope is adjustable within a range of about 5 degrees to about 85 degrees.

41. 41. The system of any one of claims 25-40, wherein at least one of the first housing, the second housing, the arcuate needle, and the actuator is constructed from plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof.

42. 42. The system of any one of claims 25 to 41, wherein the first housing further comprises a cable pulley for guiding the cable.

43. 43. The system of any one of claims 25 to 42, wherein the arcuate needle further comprises a suture attachment fixture.

44. 44. The system of any one of claims 25 to 43, wherein the second housing is removably coupled to the endoscope.

45. 45. The system of any one of claims 25 to 44, wherein the backstop comprises a curved portion, a catch, a magnet, a clasp, or any combination thereof.

46. 46. ​​The system of any one of claims 25 to 45, comprising two or more backstops.

47. 1. An endoscopic suturing platform comprising: (a) an endoscopic suturing system according to any one of claims 1 to 24; (b) a needle exchange mount removably coupled to the arcuate needle and the tertiary housing; An endoscopic suturing platform comprising:

48. 48. The platform of claim 47, wherein the needle exchange mount is removably coupled to the arcuate needle by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

49. 49. The platform of claim 47 or 48, wherein the needle exchange mount is removably coupled to the tertiary housing portion by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

50. 1. An endoscopic suturing platform comprising: (a) an endoscopic suturing platform according to any one of claims 25 to 46; (b) a needle exchange mount removably coupled to the arcuate needle and the first housing; An endoscopic suturing platform comprising:

51. 51. The platform of claim 50, wherein the needle exchange mount is removably coupled to the arcuate needle by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

52. 52. The platform of claim 50 or 51, wherein the needle exchange mount is removably coupled to the first housing by a screw, nut, protrusion, groove, clip, knob, cam, or any combination thereof.

53. (a) receiving an endoscopic suturing platform according to any one of claims 47 to 49; (b) coupling the arcuate needle to the needle exchange mount; (c) connecting the tertiary housing portion to the needle exchange mount to connect the needle exchange mount together with the arcuate needle and the tertiary housing portion to the first housing portion; (d) disconnecting the arcuate needle from the needle exchange mount; (e) disconnecting the needle exchange mount from the tertiary housing; A method comprising:

54. 54. The method of claim 53, wherein the step of disconnecting the arcuate needle from the needle exchange mount includes inserting the needle into the arcuate needle guide.

55. (a) receiving an endoscopic suturing platform according to any one of claims 50 to 52; (b) coupling the arcuate needle to the needle exchange mount; (c) coupling the arcuate needle guide cover to the needle exchange mount and coupling the needle exchange mount together with the arcuate needle and the arcuate needle guide cover to the first housing; (d) disconnecting the arcuate needle from the needle exchange mount; (e) disconnecting the needle exchange mount from the arcuate needle guide cover and the first housing; A method comprising:

56. 56. The method of claim 55, wherein the step of disconnecting the arcuate needle from the needle exchange mount includes inserting the needle into the arcuate needle guide.

Images