Systems, devices, and methods for endoscopically retracting a target tissue. The device includes a first shaft and a second shaft slidably coupled thereto. An internal member extends in a transverse direction from the first shaft and is configured for advancement through a penetration in the target tissue to atraumatically engage a distal surface of the target tissue after being advanced therethrough. A pair of external members extend from the second shaft generally parallel to the transverse direction. The external members are spaced apart and are configured to atraumatically engage a proximal surface of the target tissue when the internal member is moved longitudinally relative to the external members. The internal member applies traction to the target tissue when retracted past the pair of external members, which apply counter-traction to the target tissue on opposing lateral sides of the internal member, to re-shape the target tissue and enable subsequent suture placement.

A minimally invasive surgical method of approximating tissue includes coupling an adjustable loop of suture around an inserter. The loop can be coupled to the inserter by applying tension to a tail of the suture to collapse the loop around the inserter, then the inserter and loop are passed through a first location in tissue. The loop is decoupled from the inserter, the inserter is retracted from the first location, and reinserted into a second location in the tissue, after which the loop is recoupled to the inserter while the loop is distal of the tissue. The decoupling, retraction, and reinsertion can occur without withdrawing the inserter from the patient's body. The inserter and loop are then withdrawn together from the tissue through this second location and outside of the patient's body. The tails and loop can form a luggage knot to be reduced around the tissue.

An assembly and method are provided for incorporation into suture anchor designs to facilitate the locking of a slidable working suture after it has been tensioned. The assembly can be utilized on multiple anchors in a pre-strung chain on a single working suture to create continuous, individually tensioned suture bridges between anchors in series, without knot tying. Further, the bridges are independently locked with selected tension for the particular application. An anchor body having at least one suture receiving passage therethrough is threaded with a working suture wherein the working suture flosses through the passage when tension is applied to the working suture. A locking cord extends through a second passage through the anchor body, the locking cord having a collapsible loop extending out the second passage and encircling a portion of the working suture, wherein collapsing the loop locks the working suture after tensioning.

Exemplary systems and methods encompass suture knot tools and suture knot tools pre-loaded with sutures for use in tendon repair and other surgical procedures. Related methods may include forming a nail knot between a suture and a tissue of a patient during a surgical procedure by drawing tissue into a port sleeve of an arthroscopic system, moving the port sleeve relative to a free end portion of the tissue and a nail knot cinch of a suture, to allow the nail knot cinch of the suture to contact the free end portion of the tissue; and tightening the nail knot cinch of the suture about the free end portion of the tissue, so as to form the nail knot with the suture and the tissue.

An improvement to devices and methods for suturing tissue in various applications, such as percutaneous closure of arterial and venous puncture sites and the like, providing a self-locking or self-securing suture that does not require manual knot-tying to hold in apposition the tissue of the vessel wall on opposite sides of the puncture.

Embodiments of a knot pusher and methods of use thereof are disclosed, that are usable for pushing a knot formed from a suture, two limbs of the suture extending from the knot. The knot pusher comprises a distal head defining top and bottom walls terminating in a distal knot pushing surface. The distal head includes at least two side grooves defined between the top and bottom walls that extend proximally from the knot pushing surface. Each of these side grooves is operable to receive one of the limbs of suture. The distal head additionally comprises a top wall suture receiving element for receiving one of the two limbs of the suture during advancement of the distal head to facilitate advancement of a sliding knot

A method and apparatus are disclosed for cutting a strand of suture. The apparatus comprises a solid outer member defining a lumen there-through. An inner member is received at least partially within the lumen, a portion of the inner member defining a curve. The inner member further defines a feature for retaining a strand of suture. At least one of the inner and outer members are moveable with respect to the other of the inner and outer members for cutting the strand of suture.

A suturing device includes a curved needle, a suture, an elongate body, an actuator and a curved needle holder. The suture connects with the curved needle. The actuator interacts with the elongate body and is operable between a first operating position and a second operating position. The curved needle holder extends away from a distal end portion or is provided as part of the distal end portion of the elongate body. The curved needle holder includes a distal end section having a distal-most tip. The curved needle holder includes an inner surface defining a needle passage for holding the needle and a distal opening. The curved needle has a curved needle radius and the curved needle passage has a curved needle passage radius that is different than the curved needle radius and the curved needle frictionally engages the inner surface when the needle is in a retracted position.

A suture assembly may include a needle having a cylindrical body with a sharp point on at least one end, a lumen extending transverse to a longitudinal axis of the cylindrical body, and a recess in communication with an opening to the lumen. A suture extends through the lumen and is secured within the recess of the needle by a sleeve extending over the needle.

A surgical knot assembly for tying a surgical knot is disclosed. The surgical knot assembly for tying a surgical knot includes an outer tube, an inner tube slidably interconnected within the outer tube and having a distal end protruding from the outer tube as a neck and a strand of suture material having a portion of a length configured as pre-tied knot and a loop. The loop is adapted to receive at least a strand of suture filaments therein, and fastening of the loop, the pre-tied knot and the suture filament to form a surgical knot. While the inner tube is retracted, the loop is closed to hold the at least one suture material and receive the at least one suture filament to form the surgical knot successfully.