An instrument for applying a suture to a trocar wound includes an obturator coupled to a central shaft and a coaxially disposed skin pressure plate. The obturator and skin pressure plate are movable relative to each other, and function together to position the tissue and needles relative to each other. The skin pressure plate is provided with two spaced apart needle guides. A pair of hollow needles, held in the guides of the pressure plate are coupled to a needle mounting plate which is movable over the central shaft. One of the needles is provided with a suture control mechanism for moving a suture through the needle and the other needle is provided with a snare control mechanism for moving a snare through the needle.

A retaining collar for laparoscopic surgery includes a compressible and elastic body that has an inner periphery and an outer periphery where the inner periphery forms a conduit for receiving and securing a tubular device. The retaining collar also includes a rigid portion attached to the compressible and elastic body. The rigid portion has an inner periphery, an outer periphery and a cam lock where the inner periphery forms an aperture that aligns with the conduit and the cam lock receives and retains a suture.

A suture knot can be tied during a medical procedure by use of a suture retainer ring in connection with a suturing instrument. The retainer ring allows a user to orient a suture about the instrument, such that a knot in the suture is automatically advanced and tightened by withdrawing the instrument from a surgical site after placing the suture. The retainer ring can be an integral part of the suturing instrument, or it can be removably coupled to the suturing instrument to facilitate use of the retainer ring with other suturing instruments.

Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot near a distal end of a shaft is inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot carries suturing attachment cuffs, and needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cross-section of the shaft within the tissue tract can be minimized by laterally deflecting the needles as they leave the shaft, while tapered depressions within the foot can guide the advancing needles into engagement with the cuffs. The cuffs lockingly engage the needles and can be withdrawn proximally along the needle paths and through the tissue tract so as to form a loop of suture across the puncture. The articulating foot may be realigned with the shaft and withdrawn proximally through the tissue tract without dilating the tissue tract. The suture may be provided with a bight between first and second ends, the bight including one or more loops prearranged to define a pre-tied knot when one or more ends of the suture past therethrough.

A suture handling device for handling a plurality of suture elements is provided. The suture handling device comprises a body. It further comprises a plurality of passages defined on the body. Each passage has a mouth and an opposed end. The passages are arranged to diverge outwardly relative to one another in a direction away from their mouths, such that when the suture handling device is advanced over a plurality of spaced apart suture elements so that the suture elements enter the mouths and pass along the passages, the suture elements become spaced further apart. Advantageously, the suture handling device can be provided with an engaging formation for engaging the suture elements in the slots after they have been spaced further apart, thereby to retain the suture elements on the device.