Surgical stab wound closure device and method

• US 5,503,634 A
• Filed: 09/27/1993
• Issued: 04/02/1996
• Est. Priority Date: 04/28/1993
• Status: Expired due to Fees

• Current Assignee: Christy, William J.
• Original Assignee: Christy, William J.
• Inventors: Christy, William J.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/127,775
• Time in Patent Office: 918 Days
• Field of Search: 606/139, 606/103, 606/144-148, 606/222-227, 112/169, 112/80.03, 223/102-104, 604/167, 604/246, 604/247, 604/256, 604/264, 604/280, 604/283, 604/164, 604/169
• US Class Current: 606/144
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/06123 Flat cylinders, e.g. including an inner reel
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/047 having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body J-shaped suture needles A61B2017/0608
• CPC Class Codes: A61B 2017/06019 by means of a suture-receiving lateral eyelet machined in the needle lateral opening for attaching suture to suture anchor A61B2017/0414
• CPC Class Codes: A61B 2017/06042 located close to needle tip
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/0608 J-shaped
• CPC Class Codes: A61B 2017/061 hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61F 2/06 Blood vessels

Abstract

A device and method are provided for the surgical suturing of narrow incisions that penetrate through a plurality of tissue layers. An elongated, "J"-shaped needle, through which suture material is threaded, is inserted into the wound, bringing the tip through one or more layers of tissue on one side of the wound and pulling suture material up through the wound. After repeating these steps on the other side of the wound, the suture material is knotted. A slidable locking member serves the dual purpose of covering the tip of the suture needle when not in use and also of maintaining pneumoperitoneum.

Claims

1. A surgical suturing apparatus for closing incisions penetrating a plurality of layers of tissue, the apparatus comprising:

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

covering means associated with the suture needle and relatively movable with respect to the suture needle between a first position wherein the covering means covers the suture gate and the pointed tip and a second position wherein the suture gate and the pointed tip are uncovered.

2. The surgical suturing apparatus recited in claim 1, the suture needle further comprising suture thread holding means affixed adjacent the second end of the tubular body.

3. The surgical suturing apparatus recited in claim 2, wherein the suture thread holding means comprises a spool around which suture material may be wound, the spool rotatably affixed to the second end of the tubular body.

4. The surgical suturing apparatus recited in claim 1, wherein the tubular body has at least one arcuate recess of a size and shape for the reception of the ball of a finger of an operator.

5. The surgical suturing apparatus recited in claim 1, further comprising suture material having a proximal end and a distal end, the proximal end retained at the second end of the tubular body, the suture material passing through:

the hole in the second end of the tubular body;

the inner space of the tubular body;

the hole in the first end of the tubular body; and

the bore of the suture needle;

the distal end of the suture material emerging from the suture gate.

6. The surgical suturing apparatus recited in claim 1, further comprising a suture lead having a proximal end and a distal end, the proximal end emerging from the bore in the second end of the tubular body, the suture lead passing through:

the hole in the second end of the tubular body;

the inner space of the tubular body;

the hole in the first end of the tubular body; and

the bore of the suture needle;

the distal end of the suture lead emerging from the suture gate, whereby a suture material having a first and a second end may be threaded through the apparatus by attaching the second end of the suture material to the proximal end of the suture lead and pulling the suture lead emerging from the suture gate until the second end of the suture material emerges from the suture gate.

7. The surgical suturing apparatus recited in claim 1, wherein:

the first and the second straight sections of the suture needle are biased to flare at an angle in the range of 10-40 degrees, a first perpendicular distance between the first straight section and the second straight section adjacent the curved middle section being smaller than a second perpendicular distance between the first straight section and the second straight section adjacent the pointed tip; and

when the covering means is in the first position, the first and the second straight sections are retained in a substantially parallel configuration, minimizing the projected surface area of the suture needle.

8. A surgical suturing apparatus for closing incisions penetrating a plurality of layers of tissue, the apparatus comprising:

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

suture locking means, the suture locking means comprising;

a locking member having a proximal end and a distal end and further having a first and a second bore, the first bore surrounding and slidably engaging the first straight section of the suture needle, the second bore surrounding and slidably engaging the second straight section of the suture needle, the locking member further having a length parallel to the first straight section of the suture needle substantially smaller than the length of the second straight section of the suture needle;

a tubular sheath having a proximal end and a distal end, the tubular sheath having a bore dimensioned to slidably surround the first straight section of the suture needle and dimensioned smaller than the first end of the tubular body; and

whereby the locking member is capable of assuming a plurality of positions, the plurality of positions comprising a first position wherein the locking member covers the suture gate and the pointed tip, and a second position wherein the distal end of the locking member is positioned adjacent the curved middle section of the suture needle.

9. The surgical suturing apparatus recited in claim 8, wherein the tubular sheath and the locking member further comprise indicia signifying the orientation of the pointed tip of the suture needle.

10. The surgical suturing apparatus recited in claim 8, the tubular sheath further comprising grasping means affixed to the proximal end of the tubular sheath.

11. The surgical suturing apparatus recited in claim 10, the grasping means comprising an annulus having a bore communicating with the bore of the tubular sheath.

12. The surgical suturing apparatus recited in claim 10, the grasping means comprising a first grasping member, which comprises an elongated member having a substantially straight middle portion having a first and a second end, the middle portion affixed in generally perpendicular fashion to the proximal end of the tubular sheath, and a first and a second substantially circular portion depending from the first and the second end of the middle portion, respectively, the circular portions being distal of the middle portion and further being dimensioned to enable human fingers to pass therethrough.

13. The surgical suturing apparatus recited in claim 12, the tubular body further comprising a second grasping member, which comprises an elongated member having a substantially straight middle portion having a first and a second end, the middle portion affixed to the distal end of the tubular body, and a first and a second substantially circular portion depending from the first and the second end of the middle portion, respectively, the circular portions being proximal of the middle portion and being dimensioned to enable human fingers to pass therethrough.

14. The surgical suturing apparatus recited in claim 8, wherein the suture locking means is biased to reside in the first position, wherein the pointed tip and suture gate are covered by the locking member.

15. The surgical suturing apparatus recited in claim 14, wherein the suture locking means is biased via spring means and the tubular body further comprises actuating means communicating with and operating upon the spring means.

16. The surgical suturing apparatus recited in claim 14, wherein the locking member has an outer surface that comprises protrusions extending away from a first plane encompassing to the first and the second bores.

17. The surgical suturing apparatus recited in claim 8, further having:

a first plane defined by the first and the second straight sections of the suture needle; and

wherein

the locking member has a substantially elliptical cross section in a second plane, the second plane parallel to the first straight section of the suture needle and perpendicular to the first plane, the elliptical cross section having a major axis parallel to the first straight section of the suture needle and a minor axis perpendicular to the first straight section of the suture needle.

18. The surgical suturing apparatus recited in claim 17, wherein the distal end of the locking member has a cross-sectional shape in the first plane substantially similar to the curved middle section of the suture needle.

19. The surgical suturing apparatus recited in claim 18, wherein the distal end of the locking member has a groove in the first plane, dimensioned to engage the curved middle section of the suture needle when the tubular sheath is in the second position.

20. The surgical suturing apparatus recited in claim 18, wherein the cross-sectional shape of the locking member in the first plane has two substantially parallel sides, substantially parallel to the first and the second straight sections of the suture needle.

21. The surgical suturing apparatus recited in claim 20, wherein the proximal end of the locking member has a shoulder sloping in the distal direction from the first straight section to the second straight section of the suture needle.

22. The surgical suturing apparatus recited in claim 8, wherein the second bore of the locking member further has a channel positioned to communicate with the suture gate when the tubular sheath is in the first position, the channel dimensioned to permit suture material to lie therein.

23. The surgical suturing apparatus recited in claim 8, wherein:

the first and the second straight sections of the suture needle are biased to flare to an angle in the range of 10-40 degrees, a first perpendicular distance between the first straight section and the second straight section adjacent the curved middle section being smaller than a second perpendicular distance between the first straight section and the second straight section adjacent the pointed tip; and

when the locking member is in the first position, the first and the second straight sections are retained in a substantially parallel configuration, minimizing the projected surface area of the suture needle.

24. A surgical suturing apparatus for closing incisions penetrating a plurality of layers of tissue, comprising:

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section;

covering means associated with the suture needle and relatively movable with respect to the suture needle between a first position wherein the covering means covers the suture gate and the pointed tip and a second position wherein the suture gate and the pointed tip are uncovered; and

a cylindrical cannula member having a proximal and a distal end and an inner space dimensioned to permit the suture needle to pass therethrough, the cannula member further having a proximal and a distal diaphragm covering, respectively, the proximal and distal ends of the cannula member, the proximal and the distal diaphragms having at least one slit dimensioned to permit the suture needle to pass therethrough and sealingly surround the suture needle to form a substantially airtight seal.

25. The surgical suturing apparatus recited in claim 24, wherein the proximal end of the cannula member further comprises means for sealingly engaging a proximal end of a trocar means.

26. A surgical suturing apparatus for closing incisions penetrating a plurality of layers of tissue, the apparatus comprising:

a tubular body having an inner space and a first and a second end;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section;

covering means associated with the suture needle and relatively movable with respect to the suture needle between a first position wherein the covering means covers the suture gate and the pointed tip and a second position wherein the suture gate and the pointed tip are uncovered; and

means for sealingly surrounding the suture needle, capable of relative movement with the suture needle from a first position wherein the suture needle tip protrudes from the surrounding means to a second position wherein the suture needle tip is enclosed within the surrounding means, thereby permitting insertion of the apparatus into an incision with the suture needle surrounded and protected when in the second position.

27. A surgical suturing apparatus for closing incisions penetrating a plurality of layers of tissue, the apparatus comprising:

a tubular body having an inner space and a first and a second end;

a generally "J"-shaped suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

covering means associated with the suture needle and relatively movable with respect to the suture needle between a first position wherein the covering means covers the suture gate and the pointed tip and a second position wherein the suture gate and the pointed tip are uncovered.

28. The surgical suturing apparatus recited in claim 27, further comprising means for maintaining gas pressure within a body cavity when the surgical suturing apparatus is being inserted into the body cavity and during a suturing operation.

29. A method of suturing a subcutaneous layer of tissue having a narrow incision therein, comprising the steps of:

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough; and

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section;

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate; and

suture locking means, movably covering the suture gate and restraining the suture material;

moving the suture locking means to cover the suture gate;

inserting the suture needle into the incision sufficiently deep that the pointed tip of the suture needle is beneath the subcutaneous layer of tissue;

moving the suture locking means to uncover the suture gate;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating only one layer of tissue;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

moving the suture locking means to cover the suture gate;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating only one layer of tissue;

grasping the suture material emerging from the suture gate;

pulling the suture material out of the incision to a length sufficient for tying a knot;

moving the suture locking means to cover the suture gate;

cutting the suture material;

removing the suture needle from the incision; and

tying a knot.

30. A method of suturing a subcutaneous layer of tissue of a body cavity having an incision therein while maintaining gas pressure within the body cavity, comprising the steps of:

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section;

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate; and

suture locking means, slidably engaging the second straight section of the suture needle, capable of assuming a plurality of positions, comprising a first position wherein the suture locking means covers the suture gate and the pointed tip and restrains the suture material, the locking member further dimensioned to plug an incision;

moving the suture locking means to cover the suture gate;

inserting the suture needle into the incision sufficiently deep that the pointed tip of the suture needle is beneath the subcutaneous layer of tissue;

plugging the incision with the suture locking means;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating only one layer of tissue, slidably maintaining the suture locking means within the incision;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue, continuing to slidably maintain the locking member within the incision;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating only one layer of tissue, slidably maintaining the locking member within the incision;

grasping the suture material emerging from the suture gate;

pulling the suture material out of the incision to a length sufficient for tying a knot;

cutting the suture material;

moving the suture locking means to cover the suture gate and the pointed tip of the suture needle;

removing the suture needle from the incision; and

tying a knot.

31. A method of suturing a subcutaneous layer of tissue of a body cavity having an incision therein while maintaining gas pressure within the body cavity, comprising the steps of:

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough; and

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate;

enclosing the suture needle within a tubular cannula means having a proximal end and a distal end, the proximal end having diaphragm means through which the suture needle may be inserted and substantially seal the proximal end of the cannula means, the cannula means having a length substantially less than the length of the suture needle;

inserting the cannula means into the incision;

pushing the suture needle into the incision sufficiently deep so that the second straight section of the suture needle is distal of the cannula means and so that the pointed tip of the suture needle is beneath the subcutaneous layer of tissue to be sutured;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating only one layer of tissue;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating only one layer of tissue;

grasping the suture material emerging from the suture gate;

pulling the suture material out of the incision to a length sufficient for tying a knot;

cutting the suture material;

removing the suture needle and the cannula means from the incision; and

tying a knot.

32. A method of suturing a subcutaneous layer of tissue of a body cavity having a trocar penetrating an incision therein while maintaining gas pressure within the body cavity, comprising the steps of:

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough; and

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate;

enclosing the suture needle within a tubular cannula means having a proximal end and a distal end, the proximal end having diaphragm means through which the suture needle may be inserted and substantially seal the proximal end of the cannula means, the cannula means having a length substantially less than the length of the suture needle;

sealingly inserting the cannula means into a trocar penetrating an incision in a body cavity, the trocar having a distal end, the distal end of the cannula means penetrating the incision further than the distal end of the trocar;

moving the suture needle distally so that the second straight section of the suture needle is distal of the cannula means and so that the pointed tip of the suture needle is beneath the subcutaneous layer of tissue to be sutured;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating only one layer of tissue;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating only one layer of tissue;

grasping the suture material emerging from the suture gate;

pulling the suture material out of the incision to a length sufficient for tying a knot;

cutting the suture material;

removing the suture needle, the cannula means, and the trocar from the incision; and

tying a knot.

33. A method of suturing a first and a second narrow incision in a subcutaneous layer of tissue comprising the steps of:

providing visualizing means;

inserting the visualizing means into a first incision;

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate;

utilizing upon a second incision a method of suturing a subcutaneous layer of tissue having a narrow incision therein, the method comprising the steps of;

inserting the suture needle into the incision sufficiently deep that the pointed tip of the suture needle is beneath the subcutaneous layer of tissue;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating only one layer of tissue;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating only one layer of tissue;

grasping the suture material emerging from the suture gate through the tissue layer;

pulling the suture material out of the incision to a length sufficient for tying a knot;

cutting the suture material; and

removing the suture needle from the incision;

removing the visualizing means from the first incision;

inserting the visualizing means into the second incision;

utilizing upon the first incision the method of suturing a subcutaneous layer of tissue;

tying a knot in the suture material within the first incision;

removing the visualizing means from the second incision; and

tying a knot in the suture material within the second incision.

34. A method of suturing a severed blood vessel adjacent a cannula and further adjacent a subcutaneous layer of tissue, the cannula penetrating the subcutaneous layer of tissue, the method comprising the steps of:

providing a surgical suturing apparatus, comprising;

a tubular body having an inner space and a first and a second end, the first and the second end each having a hole dimensioned to permit suture material to pass therethrough;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the suture needle having a bore dimensioned to permit suture material to pass therethrough, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate communicating with the suture needle bore, the suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

suture material having a proximal end and a distal end, the proximal end retained upon the tubular body, the distal end of the suture material emerging from the suture gate;

utilizing upon a first end of a severed blood vessel adjacent a subcutaneous layer of tissue a method for suturing an end of a severed blood vessel, the method comprising the steps of;

inserting the suture needle into a cannula having a distal end sufficiently deep that the pointed tip is beneath the distal end of the cannula;

moving the pointed tip of the suture needle beneath a first side of a severed blood vessel adjacent the cannula and also beneath a subcutaneous layer of tissue adjacent the severed blood vessel;

bringing the suture needle pointed tip surfaceward through the subcutaneous layer of tissue adjacent the first side of the severed blood vessel sufficiently far to pull the suture gate through the subcutaneous layer of tissue;

grasping the distal end of the suture material;

pulling the distal end of the suture material out of the incision to a length sufficient for tying a knot;

pushing the suture needle into the incision sufficiently deep that the pointed tip is beneath a second side of the severed blood vessel adjacent the cannula and also beneath the subcutaneous layer of tissue;

bringing the suture needle pointed tip surfaceward through the subcutaneous layer of tissue adjacent the second side of the severed blood vessel sufficiently far to pull the suture gate through the subcutaneous layer of tissue;

grasping the suture material emerging from the suture gate;

pulling the suture material emerging from the suture gate out of the incision to a length sufficient for tying a knot;

cutting the suture material; and

tying a knot;

utilizing upon a second end of the severed blood vessel the method for suturing an end of a severed blood vessel;

pushing the suture needle into the incision sufficiently deep that the pointed tip is beneath the distal end of the cannula; and

bringing the suture needle out of the cannula.

35. A method of suturing a subcutaneous layer of tissue having a narrow incision therein, the method comprising the steps of:

providing a surgical suturing apparatus comprising;

a tubular body having an inner space and a first and a second end;

a suture needle having a proximal end and a distal end, the proximal end attached to the first end of the tubular body, the distal end having a first straight section and a second straight section, the first and the second straight sections each adjacent a curved middle section forming a generally "U"-shaped distal end, the second straight section having a pointed tip, the second straight section further having a suture gate dimensioned to allow suture material to pass therethrough, the suture gate positioned along the second straight section adjacent the pointed tip, the second straight section shorter than the first straight section; and

means for sealingly surrounding the suture needle having a proximal end and a distal end, capable of relative movement with the suture needle from a first position wherein the suture needle tip protrudes from the distal end of the surrounding means to a second position wherein the suture needle tip is enclosed within the surrounding means, thereby permitting insertion of the apparatus into an incision with the suture needle surrounded and protected when in the second position;

inserting the suture needle and surrounding means in the second position into the incision sufficiently deep that the distal end of the surrounding means is beneath the subcutaneous layer of tissue;

moving the surrounding means into the first position to expose the suture needle;

bringing the suture needle pointed tip surfaceward through a first side of the incision sufficiently far to pull the suture gate through the first side of the incision, penetrating a layer of tissue;

threading suture material through the suture gate;

grasping a first end of the suture material;

pushing the suture needle into the incision sufficiently deep that the pointed tip is again beneath the subcutaneous layer of tissue;

rotating the suture needle so that the suture needle pointed tip is beneath a second side of the incision;

bringing the suture needle pointed tip surfaceward through the second side of the incision sufficiently far to pull the suture gate through the second side of the subcutaneous layer of tissue, penetrating a layer of tissue;

grasping the suture material emerging from the suture gate;

pulling the suture material out of the incision to a length sufficient for tying a knot;

cutting the suture material at a second end;

removing the suture needle and the surrounding means from the incision; and

tying a knot.

36. A method for suturing the periphery of a puncture wound comprising the steps of:

providing a tubular body having a distal end and an opposing, proximal end;

providing a needle having a generally "J" configuration, the needle having a proximal end attached to the tubular body and an intermediate curved portion curving toward a pointed tip, wherein the needle and the tubular body are movable relative to each other between a first position wherein the pointed tip of the needle protrudes outside the tubular body and a second position wherein the pointed tip of the needle is retained within the tubular body;

extending the needle through the wound while maintaining the proximal end of the tubular body outside the wound;

threading suture material through a bore in the needle adjacent the pointed tip while the wound is occluded; and

occluding the wound while manipulating the tubular body-needle combination to extend the pointed tip and bore of the needle around the periphery of the wound and to suture the periphery to thereby suture the wound.