SUTURE METHODS AND DEVICES

• US 20050267531A1
• Filed: 05/16/2005
• Published: 12/01/2005
• Est. Priority Date: 05/14/2004
• Status: Active Grant

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon Incorporated (Johnson & Johnson), Ethicon, LLC (Johnson & Johnson)
• Inventors: Leung, Jeffrey C., Kaplan, Andrew, Megaro, Matthew A., Batchelor, Stanton D., Ruff, Gregory L.
• Granted Patent: US 10,548,592 B2
• Time in Patent Office: Days
• US Class Current: 606/228
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/06 Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials puncturing needles A61B17/34; hypodermic needles A61M5/32 ; sewing needles D05B85/00
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/1146 of tendons
• CPC Class Codes: A61B 2017/00761 Removing layer of skin tissue, e.g. wrinkles, scars or cancerous tissue
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0462 One way system, i.e. also tensioning the suture
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end
• CPC Class Codes: A61B 2017/06171 helically or spirally coiled for needles A61B2017/06076
• CPC Class Codes: A61B 2017/06176 with protrusions, e.g. barbs

Abstract

A barbed suture including a body with barbs on the periphery, a pointed end, and an anchor at one end to resist movement of the suture in the direction of the pointed end is provided. One or more limbs on the anchor may be provided, which may be arcuate, of varying lengths, and of varying distribution about the periphery of the suture body. Other anchor designs are provided. Methods of placing single-directional and bi-directional barbed sutures to approximate the tissue on each side of a wound and to position and support tissue in the absence of a wound, as in cosmetic surgery, are provided, and may include terminal J-stitches or S-stitches. Methods of placement may be made with sharp, pointed ends, which may be needles, or insertion devices. Sinusoidal patterns of sutures that have amplitudes generally perpendicular to the resultant holding force of the suture are provided.

Claims

1. A barbed suture comprising:

an elongated body;

one pointed end;

a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end; and

one end having an anchor including at least one arcuate limb extending outside the periphery of the body to a greater degree than the barbs, the anchor preventing movement of the suture in the direction of movement of the pointed end.

2. The barbed suture of claim 1, wherein the anchor has a plurality of arcuate limbs that are substantially evenly spaced around the body of the suture.

3. The barbed suture of claim 1, wherein the anchor has a plurality of arcuate limbs that are unevenly spaced around the body of the suture.

4. The barbed suture of claim 3, wherein each of the plurality of arcuate limbs is a different length.

5. The barbed suture of claim 1, wherein the plurality of arcuate limbs are curved in a concave direction relative to the body of the suture.

6. The barbed suture of claim 1, wherein the plurality of arcuate limbs are curved in a convex direction relative to the body of the suture.

7. The barbed suture of claim 1, wherein segments are attached to the arcuate limbs of the anchor.

8. The barbed suture of claim 1, wherein the anchor collapses to fit within a insertion device, the insertion device including a tubular element in which the suture is disposed, having an inside diameter smaller than the extended reach of the anchor.

9. The barbed suture of claim 1, wherein there is one arcuate limb that forms a hook with the open end facing the suture body.

10. The barbed suture of claim 1, wherein the arcuate limb forms a loop, with the limb crossing itself and there being an opening at the crossing into which tissue may be embedded.

11. The barbed suture of claim 1, wherein the one pointed end is a needle.

12. A barbed suture comprising:

an elongated body;

one pointed end;

a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end; and

one end having an anchor including a bar perpendicular to body of the suture to form a T-configuration extending outside the periphery of the body to a greater degree than the barbs, and further including segments mounted to the bar, the anchor preventing movement of the suture in the direction of movement of the pointed end.

13. The barbed suture of claim 12, wherein the one pointed end is a needle.

14. A barbed suture comprising:

an elongated body;

one pointed end;

a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end; and

one end having an anchor configured to resemble a harpoon end and extending outside the periphery of the body to a greater degree than the barbs, the anchor preventing movement of the suture in the direction of movement of the pointed end.

15. The barbed suture of claim 14, wherein the one pointed end is a needle.

16. A barbed suture comprising:

an elongated body;

one pointed end;

a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end; and

one end having a loop through which the elongated body may pass to secure tissue as an anchor, the anchor preventing movement of the suture in the direction of movement of the pointed end.

17. The barbed suture of claim 16, wherein the one pointed end is a needle.

19. The barbed suture of claim 16, wherein the one pointed end is a needle.

18. A barbed suture comprising:

an elongated body;

one pointed end;

a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end; and

one end having an anchor configured to resemble an object selected from the group including an umbrella, a coneflower, and an “

M”

, the anchor preventing movement of the suture in the direction of movement of the pointed end.

20. A method of placing a barbed suture in bodily tissue, the suture including at least one pointed end and a central portion having barbs that allow movement of the suture in the direction of movement of the pointed end and resist movement of the suture away from the direction of movement of the pointed end, the method comprising:

inserting the pointed end of the suture in the tissue;

advancing the suture through the tissue such that the central portion is disposed along a first path; and

deviating from the first path proximate to the at least one pointed end of the suture along a second path,

wherein the second path forms an angle with the projected first path, had the suture remained on the first path, of at least approximately 30 degrees.

21. The method of claim 20, wherein the first path is substantially straight.

22. The method of claim 20, wherein the first path is substantially an alpha stitch.

23. The method of claim 20, wherein the first path substantially a purse-string stitch.

24. The method of claim 20, wherein the angle formed by the projected first path and the second path is at least approximately 60 degrees.

25. The method of claim 20, wherein the angle formed by the projected first path and the second path is at least approximately 90 degrees.

26. The method of claim 20, wherein the suture is a single-directional suture.

27. The barbed suture of claim 26, wherein the one pointed end is a needle.

28. The method of claim 20, wherein the suture is a bi-directional suture.

29. The barbed suture of claim 28, wherein the bi-directional suture has two pointed ends that are needles.

30. The method of claim 20, wherein the combined path of the first and second paths is selected from the group including a J-stitch and an inverted J-stitch.

31. The method of claim 20, wherein the second path is selected from the group including an S-stitch and an inverted S-stitch.

32. A method of placing a barbed suture in bodily tissue to approximate tissue on each side of a wound, the suture including at least one pointed end and a central portion having barbs that allow movement of the suture in the direction of movement of the pointed end and resist movement of the suture away from the direction of movement of the pointed end, the method comprising:

inserting the pointed end of the suture in the tissue;

advancing the suture through the tissue along a first path;

deviating from the first path to follow a second path generally disposed laterally away from the wound; and

deviating from the second path proximate to the at least one pointed end of the suture along a third path,

wherein the third path forms an angle with the projected second path, had the suture remained on the second path, of at least approximately 30 degrees.

33. The method of claim 32, wherein the first path is substantially straight.

34. The method of claim 32, wherein the first path is substantially curvilinear.

35. The method of claim 32, wherein the first path is substantially sinusoidal.

36. The method of claim 32, wherein the first path is substantially a corkscrew pattern.

37. The method of claim 32, wherein the angle formed by the projected second path and the third path is at least approximately 60 degrees.

38. The method of claim 32, wherein the angle formed by the projected second path and the third path is at least approximately 90 degrees.

39. The method of claim 32, wherein the suture is a single-directional suture.

40. The barbed suture of claim 39, wherein the one pointed end is a needle.

41. The method of claim 32, wherein the suture is a bi-directional suture.

42. The barbed suture of claim 41, wherein the bi-directional suture has two pointed ends that are needles.

43. The method of claim 32, wherein the combined path of the second and third paths is selected from the group including a J-stitch and an inverted J-stitch.

44. The method of claim 32, wherein the third path is selected from the group including an S-stitch and an inverted S-stitch.

45. A method of placing a single-directional barbed suture in bodily tissue to approximate a wound, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the method comprising:

inserting the pointed end of the suture into one face of the wound; and

advancing the suture through the tissue until the anchor achieves adequate holding strength in the tissue to resist further movement in the tissue,

wherein the anchor is embedded in the tissue.

46. The barbed suture of claim 45, wherein the one pointed end is a needle.

47. A method of placing a single-directional suture in tissue using an insertion device, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor when extended extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the insertion device including a tubular element in which the suture body is at least in part initially disposed and having leading and trailing ends, the method comprising:

(a) inserting the pointed end of the suture and the leading end of the insertion device into the tissue at an insertion point;

(b) pushing the pointed end of the suture and the leading end of the insertion device through the tissue until reaching an endpoint;

(c) gripping and pulling the insertion device at the trailing end to remove the insertion device; and

(d) manually grouping and advancing the tissue along the body of the suture as desired.

48. The method of claim 47, wherein the suture anchor, body, and pointed end are embedded in the tissue.

49. The method of claim 47, wherein the suture pointed end extends outside of the tissue at the endpoint.

50. The method of claim 47, wherein the pointed end of the suture and at least one barb initially extend outside of the insertion device leading end.

51. The method of claim 47, wherein the pointed end of the suture and at least one barb initially extend outside an opening in the side of the insertion device spaced from the leading end of the insertion device.

52. The barbed suture of claim 47, wherein the one pointed end is a needle.

53. A method of placing a single-directional suture in tissue using an insertion device, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor when extended extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the insertion device including a tubular element having leading and trailing ends, the method comprising:

(a) inserting the leading end of the insertion device at an insertion point and through the tissue until reaching an endpoint;

(b) inserting a leading end of the suture into the insertion device at least until the trailing end of the suture is within the insertion device;

(c) inserting a plunger into the trailing end of the insertion device to abut the trailing end of the suture;

(d) depressing the plunger to push the leading end of the suture out of the insertion device;

(e) gripping and pulling the insertion device at the trailing end to remove the insertion device, leaving the suture in place; and

(f) manually grouping and advancing the tissue along the body of the suture as desired.

54. The method of claim 53, wherein the leading end of the suture is the pointed end and the trailing end of the suture is the anchor.

55. The method of claim 54, wherein the one pointed end is a needle.

56. The method of claim 53, wherein the leading end of the suture is the anchor and the trailing end of the suture is the pointed end.

57. The method of claim 53, wherein after inserting the suture into the insertion device the pointed end of the suture and at least one barb extend outside of the insertion device leading end.

58. The method of claim 53, wherein after inserting the suture into the insertion device the pointed end of the suture and at least one barb extend outside an opening in the side of the insertion device spaced from the leading end of the insertion device.

59. A method of performing a surgical procedure using a barbed suture including an elongated body, first and second sharp pointed distal ends for penetrating tissue, and a plurality of barbs extending from the periphery of the body, the barbs on a first portion of the body between the first end of the suture and a first axial location on the body for permitting movement of the suture through the tissue in a direction of movement of the first end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the body between the second end of the suture and a second axial location on the body which is less than the distance from the second end to the first axial location permitting movement of the suture through the tissue in a direction of movement of the second end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the second end, and using an insertion device including a tubular element, the insertion device having leading and trailing ends, the method comprising:

(a) inserting the leading end of the insertion device at an insertion point in the tissue;

(b) advancing the leading end of the insertion device through tissue until reaching a selected point;

(c) inserting the first pointed end of the suture into the insertion device at least until one barb extends out of the insertion device;

(d) gripping and pulling the insertion device at the trailing end to remove the insertion device, leaving the full length of the suture in place in the tissue; and

(e) manually grouping and advancing the tissue along the body of the suture as desired.

60. The method of claim 59, wherein after inserting the suture into the insertion device the pointed end of the suture and at least one barb extend outside of the insertion device leading end.

61. The method of claim 59, wherein after inserting the suture into the insertion device the pointed end of the suture and at least one barb extend outside an opening in the side of the insertion device spaced from the leading end of the insertion device.

62. The barbed suture of claim 59, wherein the first and second sharp pointed distal ends are needles.

63. A method of performing a surgical procedure using a barbed suture including an elongated body, first and second sharp pointed distal ends for penetrating tissue, and a plurality of barbs extending from the periphery of the body, the barbs on a first portion of the body between the first end of the suture and a first axial location on the body for permitting movement of the suture through the tissue in a direction of movement of the first end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the body between the second end of the suture and a second axial location on the body which is less than the distance from the second end to the first axial location permitting movement of the suture through the tissue in a direction of movement of the second end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the second end, the method comprising:

(a) inserting the first end of the suture into tissue at an insertion point;

(b) advancing the suture in a generally curvilinear path until the second axial location is at the point of insertion of the first end of the suture and the first end of the suture exits the tissue at an exit point, leaving a length of the first portion of the suture in the tissue;

(c) inserting the second end of the suture at the insertion point of the first end of the suture into tissue;

(d) advancing the suture in a generally curvilinear path distally from the first portion of the suture, until the second end of the suture exits the tissue at an exit point, leaving a length of the second portion of the suture in the tissue; and

(e) manually grouping and advancing the tissue along the body of the suture as desired,

wherein the amplitude of each curvilinear path is generally perpendicular to the resultant holding force exerted by the suture on the tissue.

64. The method of claim 63, wherein the curvilinear path is generally sinusoidal.

65. The method of claim 63, wherein the path further comprises a generally straight path following the curvilinear path, disposed between the curvilinear path and each exit point.

66. The method of claim 63, wherein the first and second sharp pointed distal ends are needles.

67. The method of claim 66, wherein the needles are straight needles.

68. The method of claim 63, wherein the first and second pointed ends do not exit the tissue until their respective paths are complete.

69. The method of claim 63, wherein at least one path terminates in a pattern selected from the group including a J-stitch, an inverted J-stitch, an S-stitch, and an inverted S-stitch.

70. The method of claim 63, wherein:

(a) the surgical procedure is a browlift and the insertion point is on a person'"'"'s face approximately superior to the frontal hairline;

(b) the first end of the suture is pushed through subepidermal tissue, galea aponeurotica, or a combination thereof, underneath the scalp and the exit point of the first end of the suture is on the scalp;

(c) the second end of the suture is pushed through subepidermal tissue and the exit point of the second end of the suture is proximate to the brow; and

(d) the tissue is manually grouped and advanced along the second portion of the suture to provide the desired amount of lift.

71. The method of claim 70, wherein the insertion point is approximately superior to the frontal hairline.

72. The method of claim 70, wherein the insertion point is approximately at the midpoint between the brow and the frontal hairline.

73. The method of claim 70, wherein the first and second sharp pointed distal ends are needles.

74. The method of claim 63, wherein:

(a) the surgery procedure is a browlift and the insertion point is on a person'"'"'s face approximately superior to the frontal hairline;

(b) the first end of the suture is pushed through subepidermal tissue and the exit point of the first end of the suture is proximate to the brow;

(c) the second end of the suture is pushed through subepidermal tissue and the exit point of the second end of the suture is proximate to the brow and spaced from the exit point of the first end of the suture; and

(d) the tissue is manually grouped and advanced along the first and second portions of the suture to provide the desired amount of lift.

75. The method of claim 74, wherein the insertion point is approximately superior to the frontal hairline.

76. The method of claim 74, wherein the insertion point is approximately at the midpoint between the brow and the frontal hairline.

77. The method of claim 74, wherein the first and second sharp pointed distal ends are needles.

78. The method of claim 63, wherein:

(a) the surgery procedure is a facelift and the insertion point is approximately superior to the temporal hairline;

(b) the first end of the suture is pushed through subepidermal tissue, galea aponeurotica, or a combination thereof, to the exit point on the scalp;

(c) the second end of the suture is pushed through subepidermal tissue, the superficial muscular aponeurotic system, or combinations thereof, to the exit point proximate to the nasolabial fold; and

(d) tissue is manually grouped and advanced along the second portion of the suture to provide the desired amount of lift.

79. The method of claim 78, wherein the first and second sharp pointed distal ends are needles.

80. The method of claim 63, wherein:

(a) the surgery procedure is a facelift and the insertion point is approximately at the posterior mandibular angle;

(b) the first end of the suture is pushed posterially through subepidermal tissue, the superficial aponeurotic system, or combinations thereof along a path approximately parallel to the mandibular border, exiting distally;

(c) the second end of the suture is pushed anteriorly through subepidermal tissue, the superficial aponeurotic system, or combinations thereof along a path approximately parallel to the mandibular border, exiting distally;

(d) tissue is manually grouped and advanced along the second portion of the suture to provide the desired amount of lift.

81. The method of claim 80, wherein the first and second sharp pointed distal ends are needles.

82. The method of claim 63, wherein:

(a) the surgery procedure is a neck lift and the insertion point is approximately at the upper sternomastoid muscle;

(b) the first end of the suture is pushed posterially through subepidermal tissue, the superficial aponeurotic system, or combinations thereof along a path approximately parallel to the mandibular border, exiting distally;

(c) the second end of the suture is pushed anteriorly through subepidermal tissue, the superficial aponeurotic system, or combinations thereof along a path approximately parallel to the mandibular border, exiting distally;

(d) tissue is manually grouped and advanced along the second portion of the suture to provide the desired amount of lift.

83. The method of claim 82, wherein the first and second sharp pointed distal ends are needles.

84. The method of claim 63, wherein:

(a) the surgery procedure is a thigh lift and the insertion point is generally at the inguinal crease;

(b) the first end of the suture is pushed cranially through subepidermal tissue until the first end of the suture extends out of the tissue; and

(c) the second end of the suture is pushed caudally through subepidermal tissue until the second end of the suture extends out of the tissue on the thigh.

85. The method of claim 84, wherein the first and second sharp pointed distal ends are needles.

86. The method of claim 63, wherein:

(a) the surgery procedure is a breast lift and the insertion point is at the upper aspect of the breast curvature;

(b) the first end of the suture is pushed through subcutaneous tissue, dermal tissue, and pectoralis muscle until extending out of the tissue at an exit point on the upper portion of the breast; and

(c) the second end of the suture is pushed caudally through fibrous and fatty tissues until the second end of the suture extends out of the tissue at an exit point along the anterior aspect or the lower curvature of the breast.

wherein the first and second sharp pointed distal ends are needles.

87. The method of claim 86, wherein the first and second sharp pointed distal ends are needles.

88. A method of placing a first single-directional barbed suture and a second single-directional barbed suture in bodily tissue, the sutures each including an elongated body, one pointed end, and one trailing end, and a plurality of barbs extending from the periphery of the body, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the method comprising:

(a) inserting the first end of the first suture into tissue at an insertion point;

(b) advancing the suture in a generally curvilinear path until the pointed end of the first suture exits the tissue at an exit point, leaving a length of the body of the first suture in the tissue;

(c) inserting the pointed end of the second suture into tissue at the insertion point of the first suture;

(d) advancing the second suture in a generally curvilinear path until the pointed end of the second suture exits the tissue at an exit point, leaving a length of the body of the second suture in the tissue;

(e) tying the first and second suture together at the insertion point; and

(f) manually grouping and advancing the tissue along the body of each suture as desired,

wherein the amplitude of each curvilinear path is generally perpendicular to the resultant holding force exerted by each suture on the tissue.

89. The method of claim 88, wherein the pointed ends are needles.

90. The method of claim 88, wherein the needles are straight needles.

91. A method of placing a single-directional barbed suture in bodily tissue, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the method comprising:

(a) making an incision in the tissue to define a face of the tissue;

(b) inserting the pointed end of the suture in the face of the tissue;

(c) advancing the pointed end of the suture through the tissue to an exit point;

(d) placing the anchor in the incision; and

(e) advancing the pointed end of the suture through the tissue until the anchor achieves adequate holding strength in the tissue to resist further movement in the tissue,

wherein the anchor is embedded in the tissue.

92. The method of claim 91, wherein the pointed end is a needle.

93. The method of claim 91, wherein advancing the suture comprises advancing the suture in a generally curvilinear path and wherein the amplitude of each curvilinear path is generally perpendicular to the resultant holding force exerted by each suture on the tissue.

94. The method of claim 93, wherein the path is sinusoidal.

95. The method of claim 91, wherein the pointed end is a needle.

96. The method of claim 95, wherein the needle is a straight needle.

97. A method for joining two ends of severed internal tissue to allow tissue healing and regrowth together of the two ends of the internal tissue in vivo using a single-directional barbed suture, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the method comprising:

(a) inserting the pointed end of the suture into a first end of the internal tissue;

pushing the pointed end through the internal tissue along a curvilinear path,

proceeding away from the first end and farther into the tissue;

(b) gripping the pointed end of the suture and pulling the pointed end out of the internal tissue for drawing the anchor proximate to the first end of the tissue;

(c) pushing the pointed end along the curvilinear path then returning along the path to the first end, and exiting from the first end of the tissue;

(d) inserting the pointed end into an opposing, second end of tissue;

(e) pushing the pointed end along a curvilinear path, proceeding away from the second end and farther into the tissue, then returning to the second end, and exiting from the second end of the tissue; and

(f) inserting the pointed end into the first end of tissue, pushing the pointed end along a curvilinear path, proceeding away from the second end and farther into the tissue, then returning toward the first end and exiting the tissue.

98. The method of claim 97, wherein the pointed end is a needle.

99. A method of placing a single-directional barbed suture in a bodily tube to approximate first and second ends of the tube, the suture including an elongated body, one pointed end, one end terminating in an anchor, and a plurality of barbs extending from the periphery of the body, the anchor extending outside the periphery of the body to a greater degree than the barbs, the barbs permitting movement of the suture through the tissue in the direction of movement of the pointed end and preventing movement of the suture in a direction opposite the direction of movement of the pointed end, the anchor preventing movement of the suture in the direction of movement of the pointed end, the method comprising:

(a) inserting the pointed end of the suture through the wall and into the interior of the first end of the tube;

(b) inserting the pointed end of the suture from the interior of the tube through the wall of the second end of the tube;

(c) advancing the suture through the walls of the tube until the anchor contacts the outer surface of the wall of the first end of the tube for drawing together the two ends of the tube;

(d) inserting the pointed end of the suture through the wall of the first end of the tube at a point circumferentially spaced from the previous insertion point; and

(e) repeating steps (b) through (d) for advancing the suture around the tube.

100. The method of claim 99, wherein the one pointed end of the barbed suture is a needle.

101. The method of claim 99, wherein the suture pattern terminates in a path selected from the group including a J-stitch and an inverted J-stitch.

102. The method of claim 99, wherein the suture pattern terminates in a path selected from the group including an S-stitch and an inverted S-stitch.

103. A method of placing a bi-directional barbed suture in a bodily tube to approximate first and second ends of the tube, the barbed suture including an elongated body, first and second sharp pointed distal ends for penetrating tissue, and a plurality of barbs extending from the periphery of the body, the barbs on a first portion of the body between the first end of the suture and a first axial location on the body for permitting movement of the suture through the tissue in a direction of movement of the first end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the body between the second end of the suture and a second axial location on the body which is less than the distance from the second end to the first axial location permitting movement of the suture through the tissue in a direction of movement of the second end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the second end, the method comprising:

(a) inserting an end of the first portion of the suture through the wall and into the interior of the first end of the tube;

(b) inserting the end of the first portion of the suture from the interior of the tube through the wall of the second end of the tube;

(c) advancing the first portion of the suture through the walls of the tube until the opposed barbs on the second portion of the suture contact the outer surface of the wall of the first end of the tube for drawing the two ends of the tube together;

(d) inserting the end of the first portion of the suture through the wall and into the interior of the first end of the tube at a point circumferentially spaced in a first direction from the previous insertion point of the first end of the suture;

(e) inserting the end of the second portion of the suture through the wall and into the interior of the second end of the tube at a point circumferentially spaced from the exit point of the end of the first portion of the suture;

(f) inserting the end of the second portion of the suture from the interior of the tube through the wall of the first end of the tube at a point circumferentially spaced in a second direction from the initial insertion point of the second end of the suture; and

(g) repeating steps (a) through (f) for advancing each end of the barbed suture around the tube.

104. The method of claim 103, wherein the first and second sharp pointed distal ends of the suture are needles.

105. The method of claim 103, wherein the suture pattern at the ends of the suture terminates in a path selected from the group including a J-stitch and an inverted J-stitch.

106. The method of claim 103, wherein the suture pattern at the ends of the suture terminates in a path selected from the group including an S-stitch and an inverted S-stitch.

107. A method of placing a bi-directional barbed suture in a bodily tube to approximate first and second ends of the tube, the barbed suture including an elongated body, first and second sharp pointed distal ends for penetrating tissue, and a plurality of barbs extending from the periphery of the body, the barbs on a first portion of the body between the first end of the suture and a first axial location on the body for permitting movement of the suture through the tissue in a direction of movement of the first end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the body between the second end of the suture and a second axial location on the body which is less than the distance from the second end to the first axial location permitting movement of the suture through the tissue in a direction of movement of the second end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the second end, the method comprising:

(a) inserting an end of the first portion of the suture through the wall of the first end of the tube;

(b) inserting the end of the first portion of the suture from the interior of the tube through the wall of the second end of the tube;

(c) advancing the first portion of the suture through the walls of the tube until the opposed barbs on the second portion of the suture contact the outer surface of the wall of the first end of the tube for drawing the two ends of the tube together;

(d) inserting the end of the first portion of the suture through the wall and into the interior of the first end of the tube at a point circumferentially spaced in a first direction from the previous insertion point of the first portion of the suture;

(e) inserting the second portion of the suture through the wall of the first end of the tube at a point adjacent the initial insertion point of the first portion of the suture;

(f) inserting the end of the second portion of the suture from the interior of the tube through the wall of the second end of the tube at a point circumferentially spaced from the adjacent exit point of the end of the first portion of the suture;

(g) inserting the end of the second portion of the suture through the wall of the first end of the tube at a point circumferentially spaced in a second direction from the previous insertion point of the second portion of the suture; and

(h) repeating steps (b) through (g) for advancing each end of the barbed suture around the tube.

108. The method of claim 107, wherein the first and second sharp pointed distal ends of the suture are needles.

109. The method of claim 107, wherein the suture pattern at the ends of the suture terminates in a path selected from the group including a J-stitch and an inverted J-stitch.

110. The method of claim 107, wherein the suture pattern at the ends of the suture terminates in a path selected from the group including an S-stitch and an inverted S-stitch.

111. The method of claim 107, wherein the suture pattern at the ends of the suture terminates in crossed ends of the suture.