Abstract: A tissue fastening device for approximating tissue edges with successive placement of fasteners therebetween comprising a proximal portion having a handle and a trigger; a distal portion having an effector end responsive to depression of the trigger; an actuator assembly operably coupled with the trigger; approximation arms disposed in the effector end. The approximation arms are rotatably coupled to the actuator assembly; and a gear mechanism enenmeshingly engageable with the trigger. The gear mechanism is configured to rotate an arcuate needle disposed in the effector end. Method to fasten opposing tissue comprises (a) approximating two opposing tissue edges, the tissue edges comprising a dermal layer; (b) driving an H-fastener vertically through the dermal layer of each of the tissue edges using a tissue fastening device, and (c) advancing the device to an adjacent position between the tissue edges and repeating steps (a) and (b).