Suturing device

Abstract

A suturing device includes a needle head, which includes a needle, a needle actuator, a housing and a suture holder. The needle includes a proximal end and a distal end having a needle point and a suture catch adjacent to the needle point. The needle actuator is connected to the needle and is configured to transition the needle between a retracted position and a suture capture position. The housing covers the needle when the needle is in the retracted position and includes an opening through which the needle extends when the needle is in the suture capture position. The suture holder is attached to the housing and is configured to hold a suture for capture by the suture catch when the needle is moved from the suture capture position toward the retracted position.

Description

SUTURING DEVICEFIELD

[0001] Embodiments of the present disclosure generally relate to surgical devices and procedures and, more particularly, to suturing devices for delivering sutures within a patient's body.BACKGROUND

[0002] Suturing in deep and narrow spaces is a technically challenging but critical aspect of most surgical procedures. These surgical procedures often require extensive dissection of tissues and require appropriate tools that are designed for gaining access to certain organs / anatomical structure.

[0003] Suturing devices are generally used in such corrective surgeries or implant procedures to return the bodily tissue back to a normal or improved anatomical position. Such devices generally utilize a needle head that facilitates the delivery of a suture through the tissue to be sutured. Examples of suturing devices are disclosed in U.S. Patent Nos. 5,741,277 and 9,451,952.SUMMARY

[0004] Embodiments of the present disclosure are directed to a suturing device and methods of operating a suturing device. One embodiment of the suturing device includes a needle head, which includes a needle, a needle actuator, a housing and a suture holder. The needle includes a proximal end and a distal end having a needle point and a suture catch adjacent to the needle point. The needle actuator is connected to the needle and is configured to transition the needle between a retracted position and a suture capture position. The housing covers the needle when the needle is in the retracted position and includes an opening through which the needle extends when the needle is in the suture capture position. The suture holder is attached to the housing and is configured to hold a suture for capture by the suture catch when the needle is moved from the suture capture position toward the retracted position.

[0005] In some embodiments, a support arm having a proximal end and a distal end, which is attached to the needle head, a handle is attached to the proximal end of the support arm, and an actuating member is connected to the needle actuator. The actuating member is configured to move between first and second positions to drive the needle actuator and movement of the needle. When the actuating member is in the first position, the needle actuator positions the needle in the retracted position, and when the actuating member is in the second position, the needle actuator positions the needle in the retracted position.

[0006] In some embodiments, the needle actuator is configured to rotate the needle about an axis between the retracted and suture capture positions.

[0007] In some embodiments, the needle includes a first guide member that extends between the proximal and distal ends of the needle and the actuating member includes a distal end having a pivotable connection to the proximal end of the needle, the pivotable connection defining the axis, and a second guide member attached to the distal end of the support arm. The first and second guide members are configured to cooperate to guide movement of the needle between the retracted and suture capture positions.

[0008] In some embodiments, the first guide member includes a slot, and the second guide member comprises a pin that is received within the slot, the pin being supported by the housing across the opening.

[0009] In some embodiments, the actuating member slides relative to the support arm between the first and second positions. When the actuating member is in the first position, the axis is displaced a first distance from the second guide member, and when the actuating member is in the second position, the axis is displaced a second distance from the second guide member that is less than the first distance.

[0010] In some embodiments, the needle is connected to a rotatable member that is configured to rotate about the axis, a distal end of the actuating member engages the rotatable member, and movement of the actuating member relative to the housing between the first and second positions drives rotation of the rotatable member and the needle about the axis and moves the needle between the retracted and suture capture positions.

[0011] In some embodiments, the rotatable member includes an external surface having first gear teeth, a distal end of the actuating member includes second gear teeth, and movement of the actuating member relative to the housing drives rotation of the rotatable member and the needle about the axis through engagement between the first and second gear teeth.

[0012] In some embodiments, the proximal end of the needle is connected to the rotatable member through an arm.

[0013] In some embodiments, the needle catch comprises a notch that is configured to hook a suture supported in the suture holder during movement of the needle from the suture capture position toward the retracted position.

[0014] In one example of the method of operating a suturing device, the suturing device includes a needle head, a needle actuator, a housing and a suture holder. The needle includes a proximal end and a distal end, the distal end of the needle including a needle point and a suture catch adjacent to the needle point. The needle actuator is connected to the needle and is configured to move the needle between a retracted position and a suture capture position. The housing covers the needle when the needle is in the retracted position and includes an opening. In the method, a suture is supported using the suture holder. With the needle in the retracted position, the needle head is fed through tissue of a patient. The needle is moved from the retracted position through the opening and the tissue to the suture capture position using the needle actuator. The suture at the suture holder is hooked with the suture catch during movement of the needle from the suture capture position toward the retracted position. The suture is pulled through the tissue during movement of the needle to the retracted position.

[0015] In some embodiments of the method, the suturing device includes a support arm having a proximal end and a distal end, which is attached to the needle head, a handle attached to the proximal end of the support arm, and an actuating member configured to move between first and second positions to drive the needle actuator and movement of the needle between the retracted and suture capture positions. When the actuating member is in the first position, the needle actuator positions the needle in the retracted position, and when the actuating member is in the second position, the needle actuator positions the needle in the retracted position. Moving the needle from the retractedposition through the opening and the tissue to the suture capture position includes moving the actuating member from the first position to the second position, hooking the suture at the suture holder with the suture catch includes moving the actuating member from the second position toward the first position, and pulling the suture through the tissue includes moving the actuating member to the first position.

[0016] In some embodiments of the method, movement of the needle between the retracted position and the suture capture position includes rotating the needle about an axis.

[0017] In some embodiments of the method, the needle includes a first guide member extending between the proximal and distal ends of the needle, and the actuating member includes a distal end having a pivotable connection to the proximal end of the needle, the pivotable connection defining the axis, and a second guide member attached to the distal end of the support arm. The first and second guide members are configured to cooperate to guide movement of the needle between the retracted and suture capture positions.

[0018] In some embodiments of the method, the first guide member includes a slot, and the second guide member comprises a pin that is received within the slot, the pin being supported by the housing across the opening.

[0019] In some embodiments of the method, the actuating member slides relative to the support arm between the first and second positions. When the actuating member is in the first position, the axis is displaced a first distance from the second guide member, and when the actuating member is in the second position, the axis is displaced a second distance from the second guide member that is less than the first distance.

[0020] In some embodiments of the method, the needle is connected to a rotatable member that is configured to rotate about the axis, a distal end of the actuating member engages the rotatable member, and movement of the actuating member relative to the housing between the first and second positions drives rotation of the rotatable member and the needle about the axis and moves the needle between the retracted and suture capture positions.

[0021] In some embodiments of the method, the rotatable member includes an external surface having first gear teeth, a distal end of the actuating member includes second gear teeth, and movement of the actuating member relative to the housing drives rotation ofthe rotatable member and the needle about the axis through engagement between the first and second gear teeth.

[0022] This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. The claimed subject matter is not limited to implementations that solve any or all disadvantages noted in the Background.BRIEF DESCRIPTION OF THE DRAWINGS

[0023] FIG. 1 is a simplified diagram of a suturing device, in accordance with embodiments of the present disclosure.

[0024] FIG. 2 is a simplified front cross-sectional view of a suture holder of the suturing device of FIG. 1, in accordance with embodiments of the present disclosure.

[0025] FIG. 3 is a simplified side view of a suturing device, in accordance with embodiments of the present disclosure.

[0026] FIGS. 4 A and 4B are simplified side views of the distal end of the suturing device of FIG. 2 when the needle is respectfully in retracted and suture capture positions, in accordance with embodiments of the present disclosure.

[0027] FIG. 5 is a simplified cross-sectional view of the suturing device of FIG. 3 taken generally along line 5-5, in accordance with embodiments of the present disclosure.

[0028] FIGS. 6A and 6B are isometric views of a suturing device having a needle head with a needle in a retracted position, and FIGS. 6C-G are side views of the needle head with a portion of a housing removed to expose the inner workings and different positions of the needle, in accordance with embodiments of the present disclosure.DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

[0029] Embodiments of the present disclosure are described more fully hereinafter with reference to the accompanying drawings. Elements that arc identified using the same or similar reference characters refer to the same or similar elements. The various embodiments of the present disclosure may, however, be embodied in many differentforms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the present disclosure to those skilled in the art.

[0030] FIG. 1 is a simplified diagram of a suturing device 100, in accordance with embodiments of the present disclosure. The device 100 generally may include a handle 102 and an actuator mechanism 104 at a proximal end 106. A distal end 108 of the device 100 may include a needle head 110 comprising a needle 112, and a suture holder 114.

[0031] The needle head 110 includes a needle actuator 115, which may be controlled using the actuator mechanism 104 to drive movement of the needle 112 between a retracted or delivery position (hereinafter “retracted position”) 116 to a suture capture position 118 (shaded). Intermediary positions of the needle 112 are shown in phantom lines, hi some embodiments, the needle actuator 115 is configured to rotate the needle 112 about an axis 117 between the retracted position 116 and the suture capture position 118.

[0032] In some embodiments, the retracted position 116 of the needle 112 generally places the distal end of the needle 112 in a forward-facing orientation. The suture capture position 118 generally places a suture catch 119 (e.g., a notch) of the needle 112, which is located adjacent to the needle point 121, in position to hook or grab a suture 120 that is supported by the suture holder 114. The suture catch 119 may be formed to provide this suture capture function without grabbing bodily tissue 123 as the needle 112 is moved from the suture capture position 118 back to the retracted position 116.

[0033] FIG. 2 is a simplified front cross-sectional view of an example of the suture holder 114 of FIG. 1, in accordance with embodiments of the present disclosure. In the shown example, the suture holder 114 includes a pair of supports 122 that extend from a support arm 124 of the device. Each support 122 includes an opening 126 through which the suture 120 is fed. A gap 128 between the supports 122 receives the needle 112 in the suture capture position 118. When the needle 112 is moved back toward the retracted position 116, the suture catch 119 hooks or grabs the suture and pulls the suture 120 along with it.

[0034] In some embodiments, the needle head 110 includes a housing 128 having an interior cavity that receives the needle 112 when in the retracted position 116 andsubstantially covers the needle 112, as indicated in FIG. 1. This allows the needle point 121 to avoid contacting the bodily tissue 123 during movement of needle head 110 through the bodily tissue 123. The housing 128 may include an opening 129 through which the needle 112 is discharged when the needle 112 is moved to the suture capture position 118. The housing 128 may also include a tactile indicator 130, such as a bump, a detent, an embossed / debossed line, etc. on an exterior surface, which may be used by the surgeon to locate the opening 129 during a suturing operation, for example.

[0035] In some embodiments, the actuator mechanism 104 includes an actuating member 132 that is connected to or engages the needle actuator 104. The actuating member 132 includes a first position corresponding to the retracted position 116 of the needle 112, and a second position corresponding to the suture capture position 118 of the needle 112. Thus, the needle 112 is positioned in the retracted position 116 when the actuating member 132 is in the first position, and the needle 112 is positioned in the suture capture position 118 when the actuating member 132 is in the second position.

[0036] During an example suturing operation, an incision is made through a bodily tissue 123 to be sutured, and the needle head 110 of the device 100 is inserted through the incision with the needle 112 in the retracted position 116. This positions the needle point 121 on a first side of the bodily tissue 123 (e.g., a ligament), and positions the suture holder 114 on an opposing second side of the bodily tissue 123, as indicated in FIG. 1. The actuating member 132 is then driven from the first position to the second position by the surgeon, which drives movement of the needle 112 from the retracted position 116, through the bodily tissue 123 and to the suture capture position 118, as indicated in FIG. 1. The actuating member 132 may then be driven from the second position to the first position to drive movement of the needle 112 from the suture capture position 118 to the retracted position 116. During this movement, the suture catch 119 hooks the suture 120 supported in the suture holder 114 and pulls the suture 120 through the bodily tissue 123 from the second side to the first side. With the suture 120 extending through the bodily tissue 123, the surgeon may then move the needle head 110 and the hooked suture 120 to another location and continue with the suturing operation. For example, the needle head 110 may be retracted through the incision to create a loop of the suture 120 around thebodily tissue 123. This process may be repeated as necessary to complete the desired suturing operation.

[0037] FIG. 3 is a simplified side view of a suturing device 100 having a needle head 110A, in accordance with embodiments of the present disclosure. FIGS. 4A and 4B are simplified side views of the needle head 110A of the device 100 when the needle 112 is respectfully in the retracted position 116 and suture capture position 118, in accordance with embodiments of the present disclosure.

[0038] In some embodiments, a proximal end 133 of the needle 112 is rotatably attached to an actuating member 132 through a pivotable connection or joint 134 of the needle actuator 115, which defines the axis 117 about which the needle 112 rotates. The joint 134 providing the rotatable attachment may be formed using a pin or another suitable connection.

[0039] The needle actuator 115 may include a pin 136 at a distal end 138 of the support arm 124 that extends through a slot 140 in the needle 112, as best shown in FIGS. 4A and 4B. Due to the curved structure of the needle 112 and the slot 140, the pin 136 drives rotation of the needle 112 about the axis of the joint 134 as the needle 112 is extended from the delivery position 116 (FIG. 4A), in which the pin 136 extends through a distal end of the slot 140, to the suture capture position 118 (FIG. 4B), in which the pin 136 extends through a proximal end of the slot 140. For example, as the actuator mechanism 104 drives the actuating member 132 from its first position (phantom lines) away from the handle 102 relative to the support arm 124 to the second position (solid lines), the needle is driven by the needle actuator 115 from the retracted position 116 toward the suture capture position 118 (solid lines). During this movement, the engagement between the pin 136 and the slot 140 directs the distal end 142 of the needle 112 and the suture catch 119 (FIG. 4A) in a downward direction which drives clockwise rotation of the proximal end 133 of the needle 112 about the axis 117 until the needle 112 reaches the suture capture position 118, as indicated in FIG. 3. Thus, the axis 117 of the joint 134 is positioned a closer distance to the guide member or pin 136 when the needle is in the suture capture position 118 than when the needle is in the retracted position 116, as shown in FIG. 3.

[0040] The user may then move the actuating member 132 from the second position in a rearward direction toward the first position using the actuator mechanism 104 to pull the proximal end 133 of the needle 112 toward the handle 102 relative to the support arm 124 and transition the needle 112 away from the suture capture position 118 toward the retracted position 116. This movement allows the suture catch 119 to capture the suture 120 within the suture holder 114 and pull the suture 120 back through a bodily tissue until the needle 112 is returned to or near the retracted position 116.

[0041] The actuator mechanism 104 may take on any suitable form. In one embodiment, the actuator mechanism 104 includes a scissor-like structure formed by arms 150 and 152, which are rotatably coupled at a joint 154, as shown in FIG. 3. The arm 150 is rotatably coupled to the actuating member 132 at a joint 156 and the arm 152 is rotatably coupled to the support arm 124 or another component of the device 100 having a fixed relation to the support arm 124, such as the handle 102, at a joint 158. The arm 150 may include a thumb loop 160 at a distal end 162. This configuration allows the user to hold the device 100 and operate the actuator mechanism 104 using a single hand.

[0042] For example, the user may hold the handle 102 in one hand while the thumb of the hand extends through the thumb loop 160. The actuating member 132 may be driven to slide toward the handle 102 and the first position by extending the thumb loop 160 and the arm 150 away from the handle 102 using the user’s thumb. This drives the needle 112 toward the retracted position 116. The actuating member 132 may also be driven to slide away from the handle 102 toward the second position by pulling the thumb loop 160 and the arm 150 toward the handle 102 using the user’s thumb. This drives the needle 112 toward the suture capture position 118.

[0043] The actuating member 132 and the support arm 124 may include cooperating structures that maintain a sliding connection therebetween. These cooperating structures may take on any suitable form. In one example, the support arm 124 may comprise a channel 166 and the actuating member 132 may include a cooperating structure 168 that is received within the channel 166, as illustrated in FIG. 5, which is a simplified cross- sectional view of the device 100 of FIG. 3 taken generally along line 5-5. The structure 168 may include a vertical member 170 that extends through an opening 172 to the channel 166. A cross member 174 of the structure 168 secures the actuating member 132to the support arm 124 during sliding movement of the actuating member 132 relative to the support arm 124. It is understood that this arrangement may be reversed where the actuating member 132 includes the channel 166, and the support arm 124 includes the structure 168.

[0044] FIGS. 6A-G respectively illustrate a distal end portion of a suturing device 100 having a needle head 11 OB, in accordance with embodiments of the invention, during different states of operation. FIGS. 6A and 6B are isometric views of the needle head 110B with the needle 112 in the retracted position 116, and FIGS. 6C-G are side views of the needle head HOB with a portion of the housing 128 removed to expose the inner workings and different positions of the needle 112.

[0045] The housing may substantially (e.g., 85-95%) or completely cover or enclose the needle 112 when in the retracted position 116, as shown in FIGS. 6A, 6B and 6C. Using a suitable actuator mechanism 104, the needle 112 may be deployed through an opening 129 in the housing 128 (FIG. 6D), such as after the needle head 110B is positioned within bodily tissue 123 of a patient, and extended through the bodily tissue 123 to the suture capture position 118 (FIG. 6E). The needle 112 may then hook the suture 120 with the suture catch 119 as it is transitioned back toward the retracted position 116 to pull the suture 120 through the bodily tissue 123, as shown in FIGS. 6E-G.

[0046] The actuator mechanism 104 of the needle head HOB may take on any suitable form. In one example, the actuator mechanism 104 includes a support arm 124 in the form of a hollow tube that is attached to the housing 128, and an actuating member 132 in the form of a rod that may be contained within the support arm 124. The actuating member 132 may be configured to slide relative to the support arm 124 and the housing 128 along an axis of the support arm 124. This sliding movement of the actuator arm 132 may be driven by a user using any suitable technique, such as that described above.

[0047] In some embodiments, the proximal end of the needle 112 is attached to a radial arm 180, which is attached to the housing 128 through a rotatable member 182 (e.g., hub, axel, etc.), which defines the axis 117. The radial arm 180 may have a fixed orientation relative to the needle 112.

[0048] As the actuating member 124 slides relative to the housing 128, a cooperating connection 184 between the actuating member 124 and the rotatable member 182 drivesrotation of the rotatable member 182, the radial arm 180 and the needle 112 about the axis 117. For example, as the actuating member 124 is moved from its first position toward or into the housing 128 to a second position, the cooperating connection 184 between the actuating member 124 and the radial arm 180 drives rotation of the rotatable member 182, the radial arm 180 and the needle 112 about the axis 117. This moves the needle 112 from the retracted position 116 toward the suture capture position 118, as shown in FIGS. 6D and 6E. As the actuating member 184 moves from its second position toward its first position by sliding out or away from of the housing 180, the cooperating connection 184 drives rotation of the rotatable member 182, the radial arm 180 and the needle 112 in the opposite direction about the axis 117 to move the needle 112 back toward the retracted position 116, as shown in FIGS. 6F and 6G.

[0049] The cooperating connection 184 may take on any suitable form. In one example, the cooperating connection 184 comprises a rack and pinion arrangement, in which the rotatable member 182 includes gear teeth 186 on an exterior surface that engage gear teeth 188 of the actuating member 184. As the actuating member 132 slides relative to the rotatable member 182, engagement between the gear teeth 186 and 188 drives rotation of the rotatable member 182, the radial arm 180 and the needle 112 about the axis 117, and moves the needle 112 between the retracted position 116 and the suture capture position 118.

[0050] Thus, during a suturing operation, the needle head 110B may be positioned by a surgeon at a desired location within bodily tissue 123 of a patient while a suture 120 is held by the suture holder 114, the needle 112 is in the retracted position 116 and the actuating member 132 is in its first position, as indicated in FIG. 6C. The actuating member 132 may then be moved relative to the housing 128 toward the second position, which drives the needle 112 through the opening 129 in the housing 128, through the bodily tissue 123 and to the suture capture position 118, as indicated in FIGS. 6D and 6E. The actuating member 132 may then be moved toward its first position to drive movement of the needle 112 back toward the retracted position 116 to hook the suture 120 with the suture catch 119 and pull the suture 120 through the bodily tissue 123, as indicated in FIGS. 6F and 6G. In some embodiments, the suture 120 is pulled through the opening 129 in the housing 128 when the needle 112 is in the suture capture position 116,as indicated in FIG. 6G. This secures the suture 120 to the needle head HOB during subsequent movement of the needle head 110B relative to the bodily tissue 123.

[0051] Although the embodiments of the present disclosure have been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the present disclosure.

Claims

WHAT IS CLAIMED IS:

1. A suturing device including a needle head comprising: a needle including a proximal end and a distal end, the distal end including a needle point and a suture catch adjacent to the needle point; a needle actuator connected to the needle and configured to move the needle between a retracted position and a suture capture position; a housing that covers the needle when the needle is in the retracted position, the housing including an opening through which the needle extends when the needle is in the suture capture position; and a suture holder attached to the housing and configured to hold a suture for capture by the suture catch when the needle is moved from the suture capture position toward the retracted position.

2. The suturing device according to claim 1, including: a support arm having a proximal end and a distal end, which is attached to the needle head; a handle attached to the proximal end of the support arm; and an actuating member connected to the needle actuator, the actuating member configured to move between first and second positions to drive the needle actuator and movement of the needle, wherein: when the actuating member is in the first position, the needle actuator positions the needle in the retracted position; and when the actuating member is in the second position, the needle actuator positions the needle in the retracted position.

3. The suturing device according to claim 2, wherein the needle actuator is configured to rotate the needle about an axis during movement of the needle between the retracted and suture capture positions.

4. The suturing device according to claim 3, wherein: the needle includes a first guide member extending between the proximal and distal ends of the needle; and the actuating member includes:a distal end having a pivotable connection to the proximal end of the needle, the pivotable connection defining the axis; and a second guide member attached to the distal end of the support arm, the first and second guide members are configured to cooperate to guide movement of the needle between the retracted and suture capture positions.

5. The suturing device according to claim 4, wherein: the first guide member comprises a slot; and the second guide member comprises a pin that is received within the slot, the pin being supported by the housing across the opening.

6. The suturing device according to claim 5, wherein: the actuating member slides relative to the support arm between the first and second positions; when the actuating member is in the first position, the axis is displaced a first distance from the second guide member; and when the actuating member is in the second position, the axis is displaced a second distance from the second guide member that is less than the first distance.

7. The suturing device according to claim 3, wherein: the needle is connected to a rotatable member that is configured to rotate about the axis; a distal end of the actuating member engages the rotatable member; and movement of the actuating member relative to the housing between the first and second positions drives rotation of the rotatable member and the needle about the axis and moves the needle between the retracted and suture capture positions.

8. The suturing device according to claim 7, wherein: the rotatable member includes an external surface having first gear teeth; a distal end of the actuating member includes second gear teeth; andmovement of the actuating member relative to the housing drives rotation of the rotatable member and the needle about the axis through engagement between the first and second gear teeth.

9. The suturing device according to claim 7, wherein the proximal end of the needle is connected to the rotatable member through an arm.

10. The suturing device according to claim 1, wherein the needle catch comprises a notch that is configured to hook a suture supported in the suture holder during movement of the needle from the suture capture position toward the retracted position.

11. A method of operating a suturing device, the suturing device comprising: a needle head comprising: a needle including a proximal end and a distal end, the distal end of the needle including a needle point and a suture catch adjacent to the needle point; a needle actuator connected to the needle and configured to move the needle between a retracted position and a suture capture position; a housing that covers the needle when the needle is in the retracted position, the housing including an opening; and a suture holder; the method comprising: supporting a suture using the suture holder; with the needle in the retracted position, feeding the needle head through tissue of a patient; moving the needle from the retracted position through the opening and the tissue to the suture capture position using the needle actuator; hooking the suture at the suture holder with the suture catch including moving the needle from the suture capture position toward the retracted position using the needle actuator; and pulling the suture through the tissue including moving the needle to the retracted position using the needle actuator.

12. The method according to claim 11, wherein: the suturing device includes: a support arm having a proximal end and a distal end, which is attached to the needle head; a handle attached to the proximal end of the support arm; and an actuating member configured to move between first and second positions to drive the needle actuator and movement of the needle between the retracted and suture capture positions, wherein: when the actuating member is in the first position, the needle actuator positions the needle in the retracted position; and when the actuating member is in the second position, the needle actuator positions the needle in the retracted position; moving the needle from the retracted position through the opening and the tissue to the suture capture position comprises moving the actuating member from the first position to the second position; hooking the suture at the suture holder with the suture catch comprises moving the actuating member from the second position toward the first position; and pulling the suture through the tissue includes moving the actuating member to the first position.

13. The method according to claim 12, wherein movement of the needle between the retracted position and the suture capture position comprises rotating the needle about an axis.

14. The method according to claim 13, wherein: the needle includes a first guide member extending between the proximal and distal ends of the needle; and the actuating member includes: a distal end having a pivotable connection to the proximal end of the needle, the pivotable connection defining the axis; and a second guide member attached to the distal end of the support arm,the first and second guide members are configured to cooperate to guide movement of the needle between the retracted and suture capture positions.

15. The method according to claim 14, wherein: the first guide member comprises a slot; and the second guide member comprises a pin that is received within the slot, the pin being supported by the housing across the opening.

16. The method according to claim 15, wherein: the actuating member slides relative to the support arm between the first and second positions; when the actuating member is in the first position, the axis is displaced a first distance from the second guide member; and when the actuating member is in the second position, the axis is displaced a second distance from the second guide member that is less than the first distance.

17. The method according to claim 13, wherein: the needle is connected to a rotatable member that is configured to rotate about the axis; a distal end of the actuating member engages the rotatable member; and movement of the actuating member relative to the housing between the first and second positions drives rotation of the rotatable member and the needle about the axis and moves the needle between the retracted and suture capture positions.

18. The method according to claim 17 wherein: the rotatable member includes an external surface having first gear teeth; a distal end of the actuating member includes second gear teeth; and movement of the actuating member relative to the housing drives rotation of the rotatable member and the needle about the axis through engagement between the first and second gear teeth.

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