Suture-Based Closure Devices

Abstract

The medical device includes a sewing ring defining an arcuate channel extending therethrough. A first arcuate needle passer is slidably disposed within a first side of the arcuate channel and a second arcuate needle passer is slidably disposed within a second side of the arcuate channel. A suture shuttle is configured to be passable between the first and second arcuate needle passers and releasably securable to the first and second arcuate needle passers.

Description

[Technical field]

[0001] The present disclosure relates to devices for suturing tissue, and more particularly to devices that cooperate with an endoscope or similar device for endoscopically suturing tissue. [Background technology]

[0002] Various endoscopic procedures may result in injuries (or wounds) that are too large for hemostatic clips to easily bridge and help close the injury. Examples of such endoscopic procedures include removal of large lesions, tunneling under the mucosal layer, full-thickness removal of tissue, treatment of other organs by passing outside the gastrointestinal tract, and repair of post-operative problems such as post-operative leakage, failed surgical staple lines, and anastomotic leakage. Endoscopic procedures also include bariatric revision procedures. Known devices and methods for endoscopically closing large injuries each have certain advantages and disadvantages. Summary of the Invention

[0003] The present disclosure relates to several alternative designs, materials, and methods of devices for endoscopically closing large lesions. In one example, a suturing device includes a mounting structure connectable to a distal end of an endoscope. A sewing ring is secured to the mounting structure and defines an arcuate channel extending within the sewing ring from a first open end to a second open end, the sewing ring including a first region proximate the first open end and a second region proximate the second open end. A first arcuate needle passer is slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue piercing member and a first control end. A second arcuate needle passer is slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue piercing member and a second control end. The suture shuttle is reversibly securable to each of the first and second arcuate needle passers such that the suture shuttle can pass therebetween.

[0004] Alternatively or additionally, the suture shuttle may include a shuttle body defining a straight lumen extending therethrough, the shuttle body configured to fit at least partially within the first region and / or the second region.

[0005] Alternatively or additionally, the suture shuttle may be releasably securable to the first arcuate needle passer via an interference fit between the first arcuate tissue penetrating member and the straight lumen.

[0006] Alternatively or additionally, the suture shuttle may be releasably securable to the second arcuate needle passer via an interference fit between the second arcuate tissue penetrating member and the straight lumen.

[0007] Alternatively or additionally, the suturing device may further include a first control element operably coupled to the first control end such that translation of the first control element moves the first arcuate needle passer within the arcuate channel, and a second control element operably coupled to the second control end such that translation of the second control element moves the second arcuate needle passer within the arcuate channel.

[0008] Alternatively or additionally, the sewing ring may extend in a circular manner from a first open end to a second open end, the first open end and the second open end being spaced apart a distance that allows tissue to extend therebetween.

[0009] Alternatively or additionally, the first arcuate needle passer may be configured such that a portion of the first arcuate needle passer remains within the arcuate channel as the first arcuate tissue piercing member traverses from the first open end toward the second open end.

[0010] Alternatively or additionally, the second arcuate needle passer may be configured such that a portion of the second arcuate needle passer remains within the arcuate channel when the second arcuate tissue piercing member traverses from the second open end toward the first open end.

[0011] Alternatively or additionally, the first region and the second region each include one or more slits formed therein. When the suture shuttle is fixed relative to the first arcuate needle passer, the second region is capable of bending when the suture shuttle is forced into the second region by the first arcuate needle passer. When the suture shuttle is fixed relative to the second arcuate needle passer, the first region is capable of bending when the suture shuttle is forced into the first region by the second arcuate needle passer.

[0012] Alternatively or additionally, the suturing device may further include a first latch mechanism disposed proximate the first open end, the first latch mechanism configured to releasably secure the suture shuttle at least partially within the first region.

[0013] Alternatively or additionally, the suturing device may further include a second latch mechanism disposed proximate the second open end, the second latch mechanism configured to releasably secure the suture shuttle at least partially within the second region.

[0014] In another example, a suturing device includes a mounting structure connectable to a distal end of an endoscope. A C-shaped sewing ring is secured to the mounting structure, the sewing ring defining an arcuate channel extending within the sewing ring from a first open end to a second open end. A first arcuate needle passer is slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue piercing member and a first control end. A second arcuate needle passer is slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue piercing member and a second control end. The first control element is operably coupled to the first control end such that translation of the first control element moves the first arcuate needle passer within the arcuate channel, and the second control element is operably coupled to the second control end such that translation of the second control element moves the second arcuate needle passer within the arcuate channel. A suture shuttle is reversibly securable to each of the first and second arcuate needle passers such that the suture shuttle can pass therebetween.

[0015] Alternatively or additionally, the suture shuttle may include a shuttle body defining a straight lumen extending therethrough, the shuttle body configured to fit at least partially within the first region and / or the second region.

[0016] Alternatively or additionally, the suture shuttle may be releasably securable to the first arcuate needle passer via an interference fit between the first arcuate tissue penetrating member and the straight lumen.

[0017] Alternatively or additionally, the suture shuttle may be releasably securable to the second arcuate needle passer via an interference fit between the second arcuate tissue penetrating member and the straight lumen.

[0018] Alternatively or additionally, the first arcuate needle passer may be configured such that a portion of the first arcuate needle passer remains within the arcuate channel as the first arcuate tissue piercing member traverses from the first open end toward the second open end.

[0019] Alternatively or additionally, the second arcuate needle passer may be configured such that a portion of the second arcuate needle passer remains within the arcuate channel when the second arcuate tissue piercing member traverses from the second open end toward the first open end.

[0020] In another example, the suturing device includes a mounting structure connectable to a distal end of an endoscope. A sewing ring is secured to the mounting structure, the sewing ring defining an arcuate channel extending within the sewing ring from a first open end to a second open end, the sewing ring including a first region proximate the first open end and a second region proximate the second open end. The suture shuttle includes a shuttle body defining a straight lumen extending therethrough, the shuttle body configured to fit at least partially within the first region and / or the second region. A first arcuate needle passer is slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue piercing member and a first control end, the first arcuate tissue piercing member releasably forming an interference fit within the straight lumen. A second arcuate needle passer is slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue penetrating member and a second control end, the second arcuate tissue penetrating member releasably forming an interference fit within the straight lumen.

[0021] Alternatively or additionally, the first arcuate needle passer may be configured such that a portion of the first arcuate needle passer remains within the arcuate channel as the first arcuate tissue piercing member traverses from the first open end toward the second open end.

[0022] Alternatively or additionally, the second arcuate needle passer may be configured such that a portion of the second arcuate needle passer remains within the arcuate channel when the second arcuate tissue piercing member traverses from the second open end toward the first open end.

[0023] The above summary of some embodiments is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The following figures and detailed description more particularly exemplify these embodiments. [Brief description of the drawings]

[0024] The present disclosure may be more fully understood from consideration of the following description in conjunction with the accompanying drawings, in which: [Figure 1] FIG. 1 is a perspective view of an exemplary assembly including an exemplary suturing device secured to a distal end of an endoscope. [Diagram 2] 2 is a partial cutaway top view of the exemplary suturing device of FIG. 1. FIG. [Diagram 3] FIG. 3 is a schematic cross-sectional view illustrating an interference fit between a needle passer and a suture shuttle, both of which form part of the exemplary suturing device of FIG. [Figure 4] 4 is a partial cutaway view of a portion of the exemplary suturing device of FIG. [Diagram 5] 5-7 are partial cutaway views of the exemplary suturing device of FIG. 1 illustrating step-by-step how the suture shuttle is passed from a first arcuate needle passer to a second arcuate needle passer. [Figure 6] 5-7 are partial cutaway views of the exemplary suturing device of FIG. 1 illustrating step-by-step how the suture shuttle is passed from a first arcuate needle passer to a second arcuate needle passer. [Figure 7] 5-7 are partial cutaway views of the exemplary suturing device of FIG. 1 illustrating step-by-step how the suture shuttle is passed from a first arcuate needle passer to a second arcuate needle passer. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0025] While the present disclosure is amenable to various modifications and alternative forms, details of which have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure.

[0026] For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification. Definitions of certain terms are provided below and shall apply, unless a different definition is given in the claims or elsewhere in this specification.

[0027] All numerical values ​​are assumed to be modified herein by the term "about", whether or not expressly indicated. The term "about" generally refers to a range of numbers that one of ordinary skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the term "about" can be expressed as including numbers that are rounded to the nearest significant figure.

[0028] The recitation of numerical ranges by endpoints includes all numbers within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5). Although some suitable dimensions, ranges and / or values ​​for various components, features and / or specifications are disclosed, those skilled in the art inspired by this disclosure will understand that the desired dimensions, ranges and / or values ​​may deviate from those expressly disclosed.

[0029] As used in this specification and the appended claims, the singular forms "a," "an," and "the" include or refer to both singular and plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term "or" is generally used to include "and / or" unless the content clearly dictates otherwise.

[0030] The following detailed description should be read with reference to the drawings, in which like elements in different drawings are numbered the same. The detailed description and the drawings, which are not necessarily to scale, depict exemplary embodiments and are not intended to limit the scope of the disclosure. The illustrated exemplary embodiments are intended as examples only. Selected features of any exemplary embodiment may be incorporated into additional embodiments, unless expressly stated to the contrary.

[0031] The present disclosure relates to devices configured to be used in combination with an endoscope or similar delivery device to close wounds within the body. In some examples, the suturing devices described herein may be configured to be used in combination with a single or dual working channel endoscope within a single working channel or available channels of an endoscope, and in some cases may be operated by a single individual, although in some cases a second individual may be involved.

[0032] FIG. 1 is a perspective view of an exemplary assembly 10 including an exemplary suturing device 12 secured to an endoscope 14. In general, a first device adapted to be secured to a second device includes a first device secured directly to the second device, and also includes a first device secured to the second device using one or more intervening structures. The suturing device 12 may be used in combination with a variety of different endoscopes 14, including, but not limited to, endoscopes 14 having a main working channel with a diameter of 2.8 millimeters (mm), a diameter of 3.2 mm, or a diameter of 3.7 mm. It is also understood that the suturing device 10 may be used with any of endoscopes, colonoscopes, gastroscopes, duodenoscopes, bronchoscopes, ureteroscopes, catheters, medical devices, and the like. The suturing device 12 is easy to use, since it requires only a single manipulation by the user at the proximal end to create a stitch. A tissue capture device such as a helix or grasper is not required, but may be used if desired.

[0033] As shown, the exemplary suturing device 12 includes an end cap ring 16 configured to secure the suturing device 12 relative to the endoscope 14. For example, the end cap ring 16 may be any over-the-scope connector. In some examples, the suturing device 12 may instead include other structures or mechanisms (not shown) adapted to secure the suturing device 12 relative to the endoscope 14. The suturing device 12 includes a C-shaped suturing ring 18. As will be shown with respect to subsequent figures, the C-shaped suturing ring 18 is adapted to allow a pair of arcuate needle passers to slide within the C-shaped suturing ring 18 to shuttle a suture shuttle (not visible in FIG. 1 ) between the pair of arcuate needle passers.

[0034] The C-shaped sewing ring 18 can be considered to be arranged to trace a circle, except for the missing portion of the circle as shown between the first open end 20 and the second open end 22. The missing portion of the circle can be considered to define an area 24 within which tissue to be sutured can be accommodated. In some instances, the relative dimensions of the C-shaped sewing ring 18, including the relative distance between the first open end 20 and the second open end 22, may be altered to accommodate different tissues, different relative needle passer sizes, and the like. The C-shaped sewing ring 18 can be considered to include a first side 28 and a second side 30. The first side 28 of the C-shaped sewing ring 18 is to the right (in the orientation shown) and the second side 30 of the C-shaped sewing ring is to the left.

[0035] Additionally, as shown, the C-shaped sewing ring 18 can be considered to form a particular arc angle with respect to the end cap ring 16. This is merely exemplary, as the C-shaped sewing ring 18 can be positioned at any desired angle with respect to the end cap ring 16. The angle can vary. In some cases, the location of the working area 24 can be changed with respect to the working channel of the endoscope. The C-shaped sewing ring 18 can be mounted in any desired position with respect to the end cap 16. In some cases, the relative position of the C-shaped sewing ring 18 may be adjusted after delivery. In some cases, the suturing device 12 can be fixed with respect to the endoscope 14 such that the area 24 is centered, or at least substantially centered, with respect to the main working channel 26 of the endoscope 14, although this is not required in all cases. Although additional tools are not required for use of the suturing device 12, in some cases, it may be desirable to provide a tool through the working channel 26 that can reach the area 24. For example, it may be desirable to use a helix or other grasper to help pull tissue toward region 24 or to hold tissue against region 24 while suturing. Thus, region 24 may also be considered a working space for suturing device 12.

[0036] The sewing ring 18 can be considered to have a first region 32 disposed proximate the first open end 20 and a second region 34 disposed proximate the second open end 22. The first region 32 and the second region 34 each include one or more latch mechanisms configured to assist in releasably securing a suture shuttle 36 (better shown in FIG. 2) within either the first region 32 or the second region 34. In the illustrated orientation, the second region 34 can be seen to include a first latch mechanism 38 and a second latch mechanism 40. It will be understood that the first open end 20 includes similar first and second latch mechanisms, although not seen in the illustrated orientation. The first latch mechanism 38 can be considered to be at least partially defined on a pair of slits 38a and 38b extending from the second open end 22 through the second region 34. In some cases, the first latch mechanism 38 may instead be provided by other latch mechanisms that may include, for example, a plunger and a spring. The second latch mechanism 40 may be considered to be at least partially defined by a pair of slits 40a and 40b extending from the second open end 22 into the second region 34. In some cases, the second latch mechanism 40 may instead be provided by other latch mechanisms that may include, for example, a plunger and a spring. The first latch mechanism 42 is partially visible at the first open end 20 and is at least partially defined by a pair of slots 42a and 42b. The suture 44 extends from the working channel 26 of the endoscope 14 and extends to the suture shuttle 36.

[0037] 2 is a partial cutaway top view of the assembly 10 with a portion of the sewing ring 12 cut away to reveal further details of the suturing device 12. The suturing device 12 includes a first arcuate needle passer 52 disposed within the first side 28 of the sewing ring 12 and a second arcuate needle passer 54 disposed within the second side 30 of the sewing ring 12. As seen in FIG. 2, the sewing ring 12 defines an arcuate channel 56 within which the first arcuate needle passer 52 and the second arcuate needle passer 54 may move. In some cases, the first and second arcuate needle passers 52, 54 may have an overall diameter that is approximately the same as the inner diameter of the arcuate channel 56, allowing the first and second arcuate needle passers 52, 54 to move within the arcuate channel 56 while preventing the first and second arcuate needle passers 52, 54 from moving in any direction other than back and forth within the arcuate channel 56.

[0038] The first arcuate needle passer 52 includes a first tissue piercing member 58 and a first control end 60. The second arcuate needle passer 54 includes a second tissue piercing member 62 and a second control end 64. The first tissue piercing member 58 and the second tissue piercing member 62 can be viewed as tapering to a point, which facilitates advancing the first arcuate needle passer 52 and the second arcuate needle passer 54 through tissue. A first control element 66 can be viewed as operably associated with the first control end 60 and extending proximally through the first tubular member 68. A second control element 70 can be viewed as operably associated with the second control end 64 and extending proximally through the second tubular member 72. The first control element 66 and the second control element 70 can extend proximally to a handle (not shown) and can be individually actuated. In some cases, pulling the first control element 66 can pull the first arcuate needle passer 52 back further away from the second open end 20, while pushing the first control element 66 can move the first arcuate needle passer 52 toward the second open end 22. Pulling the second control element 70 can pull the second arcuate needle passer 54 back away from the first open end 20, while pushing the second control element 70 can move the second arcuate needle passer 54 toward the first open end 20. The first control element 66 and the second control element 70 can be individually actuable, for example. It will be appreciated that in some cases other actuation mechanisms can be used, including gears or levers, such that a directional force applied to the handle end can be opposite to a force applied to the distal end.

[0039] The suture shuttle 36 is configured to be able to move back and forth between the first region 32 and the second region 34 by alternately using the first arcuate needle passer 52 to capture and move the suture shuttle 36 from the first region 32 across the working region 24 to the second region 34, and using the second arcuate needle passer 54 to capture and move the suture shuttle 36 from the second region 34 across the working region 24 to the first region 32. It will be appreciated that with the tissue drawn into the working region 24, such as with a grasper, the suture 44 can be pulled back and forth through the tissue being sutured.

[0040] FIG. 3 is a schematic cross-sectional view illustrating an interference fit between an arcuate needle passer 80 having an arcuate tissue piercing member 82 and a suture shuttle 36. The arcuate needle passer 80 can be considered to represent, for example, either the first arcuate needle passer 52 or the second arcuate needle passer 54. The suture shuttle 36 includes an annular groove 84 extending circumferentially around the suture shuttle 36 and is configured to receive a suture 44 therein. The suture 44 can be wrapped, for example, around the annular groove 84 and then tied to itself to secure the suture 44 relative to the suture shuttle 36. In some cases, the suture 44 can remain secured to the suture shuttle 36, and the suture shuttle 36 can be used in terminating the suture within the tissue. In some cases, depending on the particular tissue being sutured, the suture shuttle 36 can be used in combination with a pledget in securing and terminating the suture. The suture shuttle 36 can be considered to be configured to be atraumatic, which can be beneficial when used to terminate sutures within tissue, since the suture shuttle 36 remains within the patient.

[0041] The suture shuttle 36 includes a straight lumen 86 extending therethrough. As shown, the arcuate tissue piercing member 82, which may be considered to represent the first arcuate tissue piercing member 58 and / or the second arcuate tissue piercing member 62, is not straight, but has a curvature. As a result, the arcuate tissue piercing member 82 may be considered to form an interference fit with the straight lumen 86. Points 88 and 90 indicate where an interference fit may be formed if either the arcuate tissue piercing member 82 or the inner surface of the straight lumen 86 must yield. The interference fit is sufficient to hold the suture shuttle 36 against the arcuate tissue piercing member 82, and thus against the arcuate needle passer 80.

[0042] The suture shuttle 36 includes a suture shuttle body 92 including a first tapered end 94 and a second tapered end 96. In the orientation shown, it can be seen that the first tapered end 94 is generally aligned with the terminal end 98 of the arcuate tissue piercing member 82. It will be understood that if the arcuate needle passer 80 enters the straight lumen 86 from the opposite direction as shown, the second tapered end 96 will be generally aligned with the terminal end 98.

[0043] 4 is a partial cutaway view of a portion of an exemplary suturing device 12. In particular, FIG. 4 shows a portion of the second side 30, including the second arcuate needle passer 54. The second latch mechanism 40, defined at least partially on the slots 40a and 40b, can be seen to include an angled surface 100 that engages the second tapered end 96 of the suture shuttle body 92. After the suture shuttle 36 is forced into the second region 34, the retention force exerted on the suture shuttle 36 by the angled surface 100 exceeds the interference fit between the first tissue piercing member 58 and the straight lumen 86, and thus the first arcuate needle passer 52 can be withdrawn, leaving the suture shuttle 36 in the position shown in FIG. It will be appreciated that each of the latch mechanisms, including latch mechanism 38 at second open end 22, latch mechanism 42 at first open end 20, and the latch mechanism not visible at first open end 20, each have an inclined surface, such as inclined surface 100.

[0044] 5-7 are partial cutaway views of the exemplary suturing device 12 of FIG. 1, showing step-by-step how the suture shuttle 36 is passed back and forth. In FIG. 5, the suture shuttle 36 is pushed into the working region 24 by the first control element 66 (not shown in FIG. 5). As described above, the arcuate channel 56 has an inner diameter that fits snugly against the outer diameter of the first arcuate needle passer 52 such that the first arcuate needle passer 52 is held aligned as the first tissue penetrating member 58 extends through the working region 24 and through any tissue within the working region 24. The suture shuttle 36 can be pushed across the working region 24 into the second region 22. The latch mechanisms 38 and 40 of the second region 34 engage the suture shuttle 36, as seen in FIG. 6. The first arcuate needle passer 52 can then be withdrawn while leaving the suture shuttle 36 fixed within the region 34, as shown in Figure 7. It will be appreciated that this process can be repeated in the opposite direction. Once the suture has been placed through the tissue, the suturing device 12 can be repositioned to place a stitch going in the opposite direction.

[0045] It should be understood that a variety of different materials may be used in forming the devices described herein. In some cases, a variety of different metals may be used. Illustrative, but non-limiting examples of suitable metals include titanium, stainless steel, magnesium, cobalt chrome, and the like. In some cases, the first control element 46 and the second control element may be made of Nitinol. In some embodiments, for example, the devices described herein may include any suitable polymeric material, including biocompatible materials such as polyurethane or silicone. Suitable polymers include PEEK (polyetheretherketone) and polycarbonate. Other suitable polymers include polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, e.g., DELRIN® available from DuPont), polyether block esters, polyurethanes (e.g., Polyurethane 85A), polypropylene (PP), polyvinyl chloride (PVC), polyetheresters (e.g., ARNITEL® available from DSM Engineering Plastics), ether or ester based copolymers (e.g., butylene / poly(alkylene ether) phthalates and / or other polyester elastomers such as HYTREL® available from DuPont), polyamides (e.g., DURETHAN® or Elf® available from Bayer), and the like.Atochem's CRISTAMID®), elastomeric polyamides, block polyamide / ethers, polyether block amides (PEBA, available, for example, under the trade name PEBAX®), ethylene vinyl acetate copolymers (EVA), silicones, polyethylene (PE), Marlex high density polyethylene, Marlex low density polyethylene, linear low density polyethylene (e.g., REXELL®), polyesters, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyether ether ketone (PEEK), polyimides (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polyparaphenylene terephthalamide (e.g., KEVLAR®), polysulfones, nylons, nylon-12 (e.g., EMS American Such materials include, but are not limited to, polyvinyl alcohol, polyolefins, polystyrene, epoxies, polyvinylidene chloride (PVdC), poly(styrene-b-isobutylene-b-styrene) (e.g., SIBS and / or SIBS 50A), polycarbonates, ionomers, biocompatible polymers, other suitable materials, or mixtures, combinations, copolymers, polymer / metal composites, and the like.

[0046] Those skilled in the art will recognize that the present disclosure may be manifested in a variety of forms other than the specific embodiments described and contemplated herein, and therefore changes may be made in form and detail without departing from the scope and spirit of the present disclosure as set forth in the appended claims.

Claims

1. 1. A medical device comprising: a mounting structure connectable to a distal end of an endoscope; a sewing ring secured to the mounting structure, the sewing ring defining an arcuate channel extending therein from a first open end to a second open end and including a first region proximate the first open end and a second region proximate the second open end; a first arcuate needle passer slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue penetrating member and a first control end; a second arcuate needle passer slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue penetrating member and a second control end; Suture Shuttle and the suture shuttle is reversibly securable to each of the first and second arcuate needle passers such that the suture shuttle can pass between the first and second arcuate needle passers; A medical device, wherein the suture shuttle includes a shuttle body defining a straight lumen extending therethrough, the suture shuttle being releasably securable to the first arcuate needle passer via an interference fit between the first arcuate tissue piercing member and the straight lumen.

2. The medical device of claim 1, wherein the shuttle body is configured to at least partially fit within the first region and / or the second region.

3. The medical device of claim 1 , wherein the suture shuttle is releasably securable to the second arcuate needle passer via an interference fit between the second arcuate tissue penetrating member and the straight lumen.

4. a first control element operably coupled to the first control end such that translation of the first control element moves the first arcuate needle passer within the arcuate channel; a second control element operably coupled to the second control end such that translation of the second control element moves the second arcuate needle passer within the arcuate channel; The medical device of any one of claims 1 to 3, further comprising:

5. 4. The medical device of claim 1, wherein the sewing ring extends in a circular manner from the first open end to the second open end, the first open end and the second open end being spaced apart a distance that allows tissue to extend between the first open end and the second open end.

6. 4. The medical device of claim 1, wherein the first arcuate needle passer is configured such that a portion of the first arcuate needle passer remains within the arcuate channel as the first arcuate tissue piercing member traverses from the first open end toward the second open end.

7. 4. The medical device of claim 1, wherein the second arcuate needle passer is configured such that a portion of the second arcuate needle passer remains within the arcuate channel as the second arcuate tissue piercing member traverses from the second open end toward the first open end.

8. the first region and the second region each include one or more slits formed therein; when the suture shuttle is secured to the first arcuate needle passer, the second region is capable of bending when the suture shuttle is forced into the second region by the first arcuate needle passer; 4. The medical device of claim 1, wherein when the suture shuttle is secured to the second arcuate needle passer, the first region is capable of bending when the suture shuttle is pushed into the first region by the second arcuate needle passer.

9. 4. The medical device of claim 1, further comprising a first latch mechanism disposed proximate the first open end, the first latch mechanism configured to releasably secure the suture shuttle at least partially within the first region.

10. 4. The medical device of claim 1, further comprising a second latch mechanism disposed proximate the second open end, the second latch mechanism configured to releasably secure the suture shuttle at least partially within the second region.

11. 1. A medical device comprising: a mounting structure connectable to a distal end of an endoscope; a C-shaped sewing ring secured to the mounting structure, the C-shaped sewing ring defining an arcuate channel extending within the sewing ring from a first open end to a second open end; a first arcuate needle passer slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue penetrating member and a first control end; a second arcuate needle passer slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue penetrating member and a second control end; a first control element operably coupled to the first control end such that translation of the first control element moves the first arcuate needle passer within the arcuate channel; a second control element operably coupled to the second control end such that translation of the second control element moves the second arcuate needle passer within the arcuate channel; and Suture Shuttle and the suture shuttle is reversibly securable to each of the first and second arcuate needle passers such that the suture shuttle can pass between the first and second arcuate needle passers; A medical device, wherein the suture shuttle includes a shuttle body defining a straight lumen extending therethrough, the suture shuttle being releasably securable to the first arcuate needle passer via an interference fit between the first arcuate tissue piercing member and the straight lumen.

12. 1. A medical device comprising: a mounting structure connectable to a distal end of an endoscope; a sewing ring secured to the mounting structure, the sewing ring defining an arcuate channel extending therein from a first open end to a second open end and including a first region proximate the first open end and a second region proximate the second open end; a suture shuttle including a shuttle body defining a linear lumen extending therethrough, the shuttle body configured to fit at least partially within the first region and / or the second region; a first arcuate needle passer slidably disposed within a first side of the arcuate channel, the first arcuate needle passer including a first arcuate tissue penetrating member and a first control end, the first arcuate tissue penetrating member releasably forming an interference fit within the straight lumen; a second arcuate needle passer slidably disposed within a second side of the arcuate channel, the second arcuate needle passer including a second arcuate tissue penetrating member and a second control end, the second arcuate tissue penetrating member releasably forming an interference fit within the straight lumen; A medical device comprising:

13. 13. The medical device of claim 12, wherein the first arcuate needle passer is configured such that a portion of the first arcuate needle passer remains within the arcuate channel as the first arcuate tissue penetrating member traverses from the first open end toward the second open end.

14. 14. The medical device of claim 12 or 13, wherein the second arcuate needle passer is configured such that a portion of the second arcuate needle passer remains within the arcuate channel as the second arcuate tissue piercing member traverses from the second open end toward the first open end.

Images