Abstract: A surgical system, method, and apparatus for suturing a first anatomical structure to a second anatomical structure of a subject includes an endoscope tube for being advanced through a lumen of the first anatomical structure to a surgical site near the second anatomical structure. A manipulator arm extends through the endoscope tube to the surgical site, and includes a first concentric tube manipulator with an end effector configured to grasp and manipulate a suture at the surgical site. A needle arm extends through the endoscope tube to the surgical site, and includes a second concentric tube manipulator with a needle tip configured to pierce the tissue of the first and second anatomical structures. The needle arm is also configured to grasp the suture and to retract and pull the suture through the pierced tissue so that the suture extends through and forms stitching that stitches together the first and second anatomical structures.