Abstract: An anchor for securing suture to tissue, the anchor comprising: an elongated body having a distal end and a proximal end, the distal end having a distal slot extending proximally into the elongated body, and the proximal end having a proximal slot extending distally into the body; the distal slot comprising a wide section and a narrow section, wherein the wide section has a width such that the suture is slidably accommodated therein and the narrow section has a width such that the suture is bound therein, and further wherein the wide section is disposed distally of the narrow section.

Abstract: An endoscopic stitching device includes a tool assembly having a pair of juxtaposed jaws pivotally associated with one another, each jaw defining a needle receiving recess formed in a tissue contacting surface thereof; a drive assembly including a pair of concentric, individually rotatably and translatably supported barrels, each barrel defining a central lumen therethrough; and a pair of axially translatable needle engaging blades slidably supported, one each, in a respective jaw. The stitching device further includes a center rod slidably and rotatably disposed through the lumen of the barrels, a distal end of the center rod being operatively engaged with the pair of jaws.

Abstract: An apparatus and method for minimally invasive suturing is disclosed. A suturing device for minimally invasive suturing includes proximal section having a proximal end, a distal end, and a longitudinal axis therebetween; a suture head assembly extending from the distal end of the proximal section; a suturing needle having a pointed end and a blunt end, the suturing needle capable of rotating about an axis approximately perpendicular to a longitudinal axis of the proximal section, wherein the pointed end of the suturing needle is positioned within the suture head assembly prior to and after rotation of the suturing needle; and an actuator extending from the proximal end of the proximal section to actuate a drive mechanism having a needle driver for engaging and rotating the suturing needle.

Abstract: An arthroscopic meniscal tear repair device comprises a catch needle and a transfer needle. which are pierced into a torn meniscus and advanced past the tear. Suture is transferred by a suture needle from the transfer needle through the meniscus and into the catch needle. The catch needle has an internal mechanism that retains the suture. The suture needle is then retracted back to its home position inside the transfer needle, leaving the free end of the suture across the meniscus and in the catch needle. The device is then retracted out of the meniscus, leaving behind a stitch across the meniscal tear inside the meniscus. A pre-tied knot of suture is then slid down the device and cinched up using a knot pusher having a dilation tip, thus completing the repair.

Abstract: A suture grasper for retrieving a suture from an internal surgical site includes an inner shaft defining a tissue-penetrating tip, an intermediate shaft disposed about the inner shaft, and an outer shaft disposed about the intermediate shaft. The intermediate shaft defines a plurality of spring fingers movable between a spread position, wherein the spring fingers extend radially outwardly from the inner shaft, and a compressed position, wherein the spring fingers are approximated about the inner shaft. The outer shaft is selectively translatable relative to the inner shaft and the intermediate shaft for moving the spring fingers between the spread position and the compressed position.

Abstract: A device for placing sutures through thick and/or moving tissue such as the wall of a beating heart. The device includes a tissue welting tip having a trough for forming a welt in a tissue section, an alignment guide having an opening receiving a guide wire and pivotally mounted in the distal end adjacent to the trough, and an elongated sleeve slidably engagable with the guide wire. The device also includes one or more expandable tissue engaging member(s) on the sleeve expandable from a collapsed configuration having a diameter small enough to pass through the opening in the tip to an expanded configuration having a diameter large enough to engage a tissue section and urge it into the trough to form a welt in the tissue section and a retractable needle extendable through at least two portions of a tissue section while the tissue section is engaged with the trough.

Abstract: Methods of repairing knee meniscus tears are described which use suture passer devices and suture shuttles. These methods may be used with continuous suture passing, so that the suture passer device may remain on or in the tissue while passing a suture shuttle, and therefore a suture, back and forth from one side of the tissue to the other. These methods may be used minimally invasively for repairing meniscus tissue while avoiding further damage to the meniscus.

Abstract: A suture assembly configured to load a suture instrument with suture includes a cap attached to an end of the suture, a suture container configured to retain a portion of the suture, and a cap retainer having a wall and a suture channel formed in the wall. The suture channel is configured to receive a length of the suture, and the wall is configured to deny passage of the cap into the suture channel and align the cap with the length of the suture for loading into the suture instrument.

Abstract: This invention is a device and method for reducing blood flow into an aneurysm, especially a cerebral aneurysm, in order to promote therapeutic embolization of the aneurysm. The device comprises: at least one core member that is inserted into the aneurysm; and at least one longitudinal flexible member that is wound repeatedly around the core member within the aneurysm. The longitudinal flexible member is wound around the core member until the rotational accumulation of the flexible member reduces blood flow into the aneurysm and promotes therapeutic embolization of the aneurysm.

Abstract: A suture placement device is inserted into an endoscopic trocar port site. A pivot bar with a pair of receptor ports is moved from a folded to an extended position below the fascia. The trocar port is removed over the device as the pivot bar is pulled upward against the fascia. A pair of stylet guides are deployed from two sides of the device housing, and intercept the receptor ports, thereby creating a suture path through the first guide, through a channel in the pivot bar between the receptor ports, and through the second guide. A stylet is directed through the suture path to pull a suture through the path. The guides are refracted, the pivot bar is folded, the device is removed, and the suture is tied. A stylet guide may have a partially deployed position to accurately inject an anesthetic at a desired intra-muscular layer.

Abstract: A method of repairing soft tissue of a joint of a human extremity, such as a hand or foot. The method includes maintaining a metapodial bone intact; inserting a suture passing instrument into a space adjacent the metapodial and phalangeal bones; passing the suture through a volar ligament near a distal end of the metapodial bone and reattaching the volar ligament to the proximal phalanx. The method also includes making an incision on the dorsal aspect of the extremity to expose the dorsal aspect; inserting the distal portion of the suture passer instrument through the incision on the dorsal aspect of the extremity; inserting the distal portion of the suture passing instrument into a tendon sheath connected to a volar plate; and passing a portion of a suture through the volar plate.

Abstract: Methods and instruments for repairing soft tissues of a skeletal joint, such as, for example, of the foot or hand are presented. The method includes the steps of maintaining the metapodial bone intact; forming a bone tunnel through the proximal phalanx between volar and dorsal aspects of the proximal phalanx; passing a repair suture through the soft tissue to be repaired; passing the repair suture through the bone tunnel; and securing the suture. The method may be used for the repair of soft tissue, such as a volar ligament and/or a collateral ligament.

Abstract: An apparatus includes a carrier configured to be movably disposed within a channel defined by an elongate member. The carrier includes a proximal end portion and a distal end portion. The proximal end portion is configured to be coupled to an actuator. The distal end portion includes a protrusion and an engagement surface. The protrusion has a tip configured to bodily pierce tissue. The protrusion is configured to be received within a lumen defined by a connecting portion of an implant, such as, for example, a pelvic floor implant, such that the tip extends through the lumen defined by the connecting portion of the implant. The engagement surface is configured to engage a portion of the connecting portion of the implant to limit movement of the connecting portion of the implant relative to the protrusion.

Abstract: An apparatus for anulus fibrosus repair includes a shaft, a pair of curved suturing needles mounted in parallel on the shaft, and a rotational driving mechanism connected to the shaft, which is configured to rotate the shaft and the pair of needles about a rotation axis of the shaft. Each needle includes a substantially semi-annular body having a proximal end, a distal end, an inner periphery, and an outer periphery, and an arm extending radially inward from the proximal end, in which a concavity is formed in the body proximate to the distal end extending in a direction away from it. Also disclosed is a suturing technique associated with use of the repair apparatus.

Abstract: A device is disclosed that can pierce and hold tissue and then pass suture through tissue. The device can have a shuttle that can removably attach to a suture and jaws that can be rotatably opened and closed with respect to each other. A method for using the device to repeatedly pass the suture through the tissue without removing the suture or device from the target site is also disclosed.

Abstract: An endoscopic stitching machine, including a housing for mounting the actuators for the stitch-forming tools (needle, gripper and pressure pad), and a housing shaft to house one or more devices for the transmission of the movements generated by the actuators to the stitch-forming tools, whereby the housing shaft (3) and the transmission devices (9, 12, 13) are divided into two shaft parts (14, 15) and lower and upper transmission devices (9a, 12a, 13a and 9b, 12b, 13b), in a plane perpendicular to the longitudinal direction thereof, detachably connected to each other by means of a corresponding coupling piece (26), whereby the coupling pieces (26) may be introduced into and positively housed within corresponding recesses (32, 33) of the lower and upper transmission means (9a, 12a, 13a and 9b, 12b, 13b), parallel to the section plane and running in the longitudinal direction of the transmission devices (9, 12, 13).

Abstract: A surgical suturing device having an axis extending between a proximal end and a distal end is operable to move a suture through body tissue. An actuating rod extends between the handle assembly and the shaft. A needle assembly at the distal end of the actuating rod is movable with the actuating rod between an extended state and a retracted state. Bifurcated portions of the needle assembly define a suture slot, the bifurcated portions have a proximate relationship when the needle assembly is in the retracted state and having a separated relationship when the needle assembly is in the extended state. The needle assembly is biased to the retracted state and the bifurcated portions are biased to the separated relationship. A handle assembly is configured to releasably receive the needle assembly and is operable to move the needle assembly between a free suture state and a captured suture state.

Abstract: A suturing assembly is provided that is configured to pull a capsule attached to a suture through tissue. The suturing assembly includes a shaft aligned on a longitudinal axis of the suturing assembly, and a head coupled to the shaft. The head includes a proximal portion and a distal end spaced apart from the proximal portion by a throat. The proximal portion houses a needle that is movable through a needle exit port. The proximal portion of the head and the needle exit port are both aligned on the longitudinal axis. A proximal side of the distal end of the head defines a cavity adapted to receive the capsule and a distal side of the distal end of the head defines a slot adapted to allow the suture to pass through the distal end of the head and into the cavity.

Abstract: A suture applying device includes a shaft which carries a pair of needles near its distal end. The needles are joined by a length of suture, and the shaft is used to both introduce the needles into a lumen of a body structure and to draw the needles back through tissue on either side of the puncture site. After the needles have passed through the tissue, they are captured by a needle receiver and drawn outward through the tract, leaving a loop of suture behind to close the puncture site near the body lumen. The suture can then be tied or otherwise secured to close the puncture site.

Abstract: A suturer may include a base mechanism. The base mechanism may include a first arm and a second arm. The suturer may be configured to selectively pass a needle from an enclosed position within the first arm to an enclosed position within the second arm.

Abstract: A surgical suture apparatus for open and/or endoscopic surgery is configured to pass a double-ended surgical needle backwards and forwards between a first jaw element and a second jaw element, the jaw elements each including a holding device to hold a respective needle end of the surgical needle, wherein the first and/or second jaw element are biased to an open position with a first biasing force. The apparatus further includes an operating device to operate the first and second holding devices, wherein the operating device includes a first operating organ biased in the normal position by one or more second spring elements with a second biasing force, wherein the first biasing force is smaller than the second biasing force such that exerting an actuation force on the first operating organ first results in movement of the first and second jaw element towards each other, and subsequently in actuation of the operating device.

Abstract: Systems and methods are provided for percutaneously suturing tissue. An elongated deployment member having a guide member coaxially disposed over a shaft member may be used to carry a needle deployment member. The needle deployment member may be carried at a distal end of the elongated deployment member and include a plurality of needles releasably secured to the needle deployment member, wherein each needle is routed coaxially within the distal end of the needle deployment member. The needle deployment member may further include a needle pusher driven by a link coaxially disposed within the shaft member, wherein the needle pusher is configured to advance each needle through the distal end of the needle deployment member and coaxially over the proximal end of the needle deployment member to position the plurality of needles at a piercing angle in a proximal direction.

Abstract: An adjustable anchor system for securing tissue to bone, including an anchor having at least one passage extending from a proximal end toward a distal end. The passage defines a restriction such as a restricted opening. The anchor has at least one bone-engaging feature disposed between the proximal and distal ends. The system further includes a first material formed as a closed loop and capable of being placed through a portion of the tissue, and a second filament having a terminal end, a post limb and a sliding knot tied between the terminal end and the post limb to establish an elongated, adjustable-length loop which extends beyond the proximal end of the anchor and captures the closed loop of the first material. The knot of the second filament is restrained by the restricted opening when tension is applied as desired to the post limb to shorten the elongated loop to draw the tissue toward the anchor.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose with first and second noose limbs connected, preferably slidably, to the filament engagement feature. The first and second noose limbs emerge from the anchor as first and second free filament limbs that are capable of being passed through tissue to be repaired and then passable through the noose. The noose is capable of receiving the free filament limbs and strangulating them when tension is applied to at least one of the free filament limbs and the noose to enable incremental tensioning of the tissue after anchor fixation. Preferably, the snare assembly further includes a flexible sleeve joining at least some portion of the first and second free filament limbs to facilitate passing of the free filament limbs as a single unit.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose with first and second noose limbs connected, preferably slidably, to the filament engagement feature. The first and second noose limbs emerge from the anchor as first and second free filament limbs that are capable of being passed through tissue to be repaired and then passable through the noose. The noose is capable of receiving the free filament limbs and strangulating them when tension is applied to at least one of the free filament limbs and the noose to enable incremental tensioning of the tissue after anchor fixation. Preferably, the snare assembly further includes a flexible sleeve joining at least some portion of the first and second free filament limbs to facilitate passing of the free filament limbs as a single unit.

Abstract: An apparatus and method for minimally invasive suturing is disclosed. A suturing device for minimally invasive suturing includes proximal section having a proximal end, a distal end, and a longitudinal axis therebetween; a suture head assembly extending from the distal end of the proximal section; a suturing needle having a pointed end and a blunt end, the suturing needle capable of rotating about an axis approximately perpendicular to a longitudinal axis of the proximal section, wherein the pointed end of the suturing needle is positioned within the suture head assembly prior to and after rotation of the suturing needle; and an actuator extending from the proximal end of the proximal section to actuate a drive mechanism having a needle driver for engaging and rotating the suturing needle.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose on a first portion of at least a first limb and has a second portion connected to the filament engagement feature of the anchor. Preferably, at least one free filament limb, which in some embodiments is a length of the first filament and in other embodiments is a second filament, is capable of being passed through tissue to be repaired and has at least one end passable through the noose to enable incremental tensioning of the tissue after the anchor is fixated in bone. The noose strangulates the free filament limb when tension is applied to at least one of the free filament limb and the noose.

Abstract: A medical fastening device is provided. The fastening device may include a first arcuate needle adapted to rotate about a first axis in a first direction, entering through a first section of one of a tissue and a prosthetic material, and exiting through a second section of one of the tissue and the prosthetic material; a second arcuate needle adapted to rotate about a second axis in a second direction, entering through the second section of one of the tissue and the prosthetic material, and exiting through the first section of one of the tissue and the prosthetic material; and a drive mechanism operatively coupled to each of the first and second arcuate needles and configured to engage each of the first and second arcuate needles between a retracted position and an extended position.

Abstract: A surgical instrument has a suture passer/advancer and a suture retriever manipulated from a common handle. The retriever is preferably a loop that closes around the suture advanced through it by the advancer. The loop is retracted to draw it around the suture. The passer/advancer has a fork-like distal end to readily advance and let go of the suture after it is in the loop of the retriever. The advancer and retriever can be manipulated longitudinally and rotationally with respect to a tubular body through which they extend so that the suture retriever can be passed through a needle pierced through tissue to be sutured, and the suture may be advanced and guided into the retriever loop to be gripped. Retracting the instrument will cause one end of the suture to be pulled retrograde through the tissue.

Abstract: A suturing instrument for placing multiple sutures include an elongate body engaged to a handle. A suturing head extends from a distal end of the elongate body, and the suturing head is articulable relative to the elongate body. Both a first needle carrier and a second needle carrier are movable into and out of the suturing head. A first actuator allows controlled movement of the first needle carrier, and this first actuator extends from a proximal end of the handle. A second actuator allows controlled movement of the second needle carrier, and this second actuator also extends from the proximal end of the handle. The suturing head can be articulated within a range of about 0 degrees to about 30 degrees, as measured from a longitudinal axis running along the length of the elongate body, and this variable articulation angle of the head allows deployment of the first needle carrier and the second needle carrier at various orientations with respect to the longitudinal axis.

Abstract: Suture passer devices, including suture passers configured with an axially slideable jaw that includes a tissue-penetrating distal end region. Also described are suture passers including jaws housing tissue penetrating needles to pass suture that are substantially thin. Methods of using such devices to pass a suture through tissue are provided.

Abstract: A needle delivery device that has particular application for providing needles for minimally invasive spinal surgical procedures. The device includes an elongated pincher having opposing rails that is slidable within a channel defined in an extended base portion. Widened end portions of the rails hold the needle and push it out of an end of the device where it is released. The pincher is then retracted to a location where the end portions can pick up a next needle to be delivered.

Abstract: A medical device for the delivery of sutures and implants through tissue of a patient's body. The medical device includes a handle, an elongated shaft member, a needle carrier, and a slideable mechanism. A method of delivering a suture or an implant includes inserting and deploying a medical device including a handle, an elongated shaft member, a needle carrier, and a slideable mechanism into tissue of a patient's body.

Abstract: A suture passing instrument includes an operation handle, a cannulated needle member, a suture pusher, a suture shuttle and a guide tube. The needle member has a curved end portion. The needle member has an outer sidewall and an inner sidewall defining a bore extending through the needle member for receiving a suture. The suture pusher is movable within the needle member from a retracted position to an extended position. The suture shuttle has at least one bead and is loaded into the bore cannulated needle and movable along the bore by the suture pusher. The guide tube has a body telescopically receiving a retriever loop. The loop is movable between a retracted position and an extended position. A suture can be moved by the suture pusher and captured by the retriever loop.

Abstract: A ligature device for medical treatment has an operating device that has a ligature tool for medical treatment fitted onto a distal end portion thereof. The operating device is provided with a cutting member that is able to move freely backwards and forwards and is used to cut a ligature wire of the ligature tool for medical treatment. A distal end side of the cutting member has an inclined end portion that is inclined relative to the direction of forward and backward movement, and a blade portion is provided in this inclined end portion.

Abstract: Improved surgical instruments are provided including improved suture passers, improved drill guides for forming holes in bones adjacent a joint at locations referenced to the joint anatomy, and improved osteotomy guides.

Abstract: A device for closing an opening in tissue includes a shaft having a proximal end, a distal end, and a channel disposed between the proximal and distal ends. A pair of pins are disposed within the channel and cooperate with a slidable and axially movable foot. The foot extends distally from the channel with a flexible guidebody extending from a distal foot end of the foot.

Abstract: The instant disclosure is directed to methods and devices for passing suture bi-directionally using a hybrid approach. Embodiments of a method described herein include steps of advancing a suture at least partially through tissue; and retrieving the suture; wherein one of the steps of advancing and retrieving comprises manipulating the suture directly, and wherein the other step of advancing and retrieving comprises manipulating a suture trap to which the suture is coupled.

Abstract: A suture passer comprising: a shaft having an axis; a first jaw mounted to the shaft in alignment with the axis, the first jaw being configured to releasably support a length of suture thereon; a second jaw movably mounted to the shaft; and a needle movably mounted to the shaft, the needle having a hook and being configured to reciprocate in alignment with the axis so that the hook can selectively pass by the second jaw and engage suture releasably supported on the first jaw; wherein the first jaw comprises a spring for selectively binding the suture to the first jaw.

Abstract: A surgical needle for use in a circular needle applier comprises a distal leading end, a proximal trailing end, and an arced body between the leading and trailing ends. The body has a medial face and a lateral face. A first step on the body is adapted to be engaged by a circular needle applier. The first step is positioned distally from the leading end. A longitudinal flat extends proximally from the first step. The flat defines a generally D-shaped cross sectional shape in the body. A second step on the body is adapted to be engaged by a circular needle applier. The second step is positioned about 180 degrees from the first step. A length of suture is connected to the trailing end.

Abstract: A surgical suturing device comprises a needle having a leading end, a trailing end, and an arced body between the leading and trailing ends. A length of suture is connected to the needle. A needle driver is adapted to engage and rotate the needle in a circular path in a first rotational direction. A pawl is adapted to engage the trailing end of the needle to prevent the needle from rotating in a second rotational direction opposite of the first rotational direction.

Abstract: A surgical suturing system comprises a reusable shaft having a proximal end and a distal end, the distal end has a receiver and a rotary drive. A reusable actuator is connected to the proximal end of the shaft. A disposable cartridge is adapted to be attached to and detached from the receiver. The cartridge comprises an arced track, an arced needle positioned in the track having a leading end and a trailing end, a length of suture connected to the trailing end, a reciprocating needle driver operative to engage and move the needle in the arced circular track, and a transmission operatively connected to the needle driver having a rotary input adapted to couple to the rotary drive. The reusable shaft and actuator may be autoclavable.

Abstract: A surgical suturing device comprises an arced needle track, an arced needle positioned in the needle track, and a length of suture connected to needle. A reciprocating needle driver is operative to engage and move the needle in the needle track. A rotary input rotates about an axis. A link has a proximal end connected to the rotary input and a distal end connected to the needle driver. Rotation of the rotary input in a first angular direction translates the needle driver in a second angular direction opposite of the first angular direction.

Abstract: A surgical suturing device comprises a needle having a leading end, a trailing end, an arced body between the leading and trailing ends, and two steps located at antipodal positions on the body. A length of suture is connected to the needle. A needle driver reciprocates at least 180 degrees between a driven position and a returned position. The needle driver is adapted to engage the needle steps to rotate the needle in a circular path in first rotational direction. A pawl is positioned adjacent the driven position of the needle driver. The pawl is adapted to engage the needle steps to prevent the needle from rotating in a second rotational direction opposite of the first rotational direction.

Abstract: A suturing device for suturing a portion of biological tissue includes a needle attached to a suture, a needle holder that releasably holds the needle, and a needle driver adapted to be advanced and retracted substantially parallel to a longitudinal axis of the suturing device. A distal needle holder adapted to releasably hold the needle is positioned in a distal position relative to the portion of biological tissue and a distal end of the needle driver is positioned in a proximal position relative to the portion of biological tissue. The needle is positioned in either the proximal position or the distal position. The needle driver is moved longitudinally in a first direction along a path substantially parallel to the longitudinal axis such that the needle and suture pass through the portion of biological tissue, thereby forming a suture incision through which the suture passes. By repeating the above-described processes, a series of stitches is thereby formed.

Abstract: Suturing apparatuses configured to suture biological tissue, such as an anatomical valve. The suturing apparatuses can comprise an elongate member having a proximal end, a distal end, one or more arms, and one or more needles. A protective member may be used to inhibit contact between a distal end of a needle and surrounding tissue. Methods for suturing bodily tissue such as an anatomical valve may be performed with the suturing apparatuses. The suturing apparatuses may be used to suture adjacent valve leaflets or the base of a valve in order to treat or repair the valve.

Abstract: A surgical apparatus, including an instrument, a shaft part with a jaw opening at its distal end and a thread carrier guided by the shaft part displaceable from a retracted position, in which it exposes the jaw opening, and an advanced position, in which it crosses the jaw opening. A thread supported by the thread carrier can be guided through or around human or animal tissue to form a suture or ligature. The thread has a bulge at its end made of the material of the thread so that when the bulge is pushed through a passage opening of the jaw part it elastically deforms and is retained when the thread carrier is retracted.

Abstract: A suture passing instrument including an operation handle, a needle member, and a suture holder assembly. The operation handle has at least one actuator movable between a first position and a second position. The needle member extends from the operation handle. The needle member has a curved end portion and defines an eyelet extending therethrough. The suture holder assembly extends from the operation handle and has a movable suture carrier at a distal end configured to hold a suture. The movable suture carrier has a suture pusher telescopically and movably received in the movable suture carrier. The suture carrier is movable between a retracted position and an extended position. The suture pusher is movable beyond the suture carrier to carry the suture through the eyelet.

Abstract: Described herein are methods of repairing tissue using a suture passer configured to relasably couple to a suturing element to pass the suturing element (and therefore a suture) through the tissue so that that the suture may be loaded and/or unloaded while the suture passer is positioned within the tissue. Thus, the methods described herein may allow the suture passer to be loaded without requiring that the suture passer be removed from within the patient or in some variations from off of the target tissue. The same suture or multiple sutures may thus be loaded and/or unloaded onto the suture passer, allowing the formation of complex suture patterns without requiring the extra steps of withdrawing the suture passer from the patient (or target tissue). Knotless suture anchors are also described.

Abstract: A suture passing instrument includes an operation handle, a cannulated needle member, a suture pusher, and a guide tube. The handle has an actuator movable between first and second positions. The needle member extends from the operation handle. The needle member has a curved end portion. The needle member has an outer sidewall and an inner sidewall defining a bore extending through the needle member for receiving a suture. The suture pusher is movable within the needle member from a retracted position to an extended position. The guide tube has a body telescopically receiving a retriever loop. The loop is movable between a retracted position and an extended position. A suture can be moved by the suture pusher and captured by the retriever loop.