AN APPLICATOR FOR TREATING A TISSUE

FIELD OF THE INVENTION

[1] The present invention relates to an applicator for suturing a tissue, and more particularly to an applicator and methods for manipulating and controlling the needle and fastenable- suture during minimally invasive suturing in laparoscopic procedures such as hernia procedures.

[2] The present invention further relates to an applicator for ligation of at least one bone, joint, and/or ligament, and more particularly to an applicator, kit and methods for manipulating and controlling the needle and a fastanble-suture during minimally invasive ligation of orthopedic procedures.

[3] The present invention also relates to a fastener applicator for suturing of at least one tissue and more particularly to a fastener applicator and methods for manipulating and controlling the suturing needle and the fastanble-suture during minimally invasive suturing in cardiac procedures.

BACKGROUND OF THE INVENTION

[4] Surgery is recommended for some types of hernias to prevent complications like obstruction of the bowel or strangulation of the tissue. Most abdominal hernias can be surgically repaired, but surgery has complications. Time needed for recovery after treatment is reduced if hernias are operated on laparoscopically however open surgery can be done sometimes without general anesthesia. Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue. If complications have occurred, the surgeon will check the viability of the herniated organ, and remove part of it if necessary.

[5] Muscle reinforcement techniques often involve synthetic materials such as a mesh prosthesis.

The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times staples are used to keep the mesh in place. These mesh repair methods are "tension free" repairs because, unlike some suture methods, muscle is not pulled together under tension. However, this widely used terminology is misleading, as there also exists many tension-free suture methods that do not use mesh.

[6] Evidence suggests that tension-free methods (with or without mesh) often have lower percentage of recurrences and the fastest recovery period compared to tension suture methods. However, among other possible complications, prosthetic mesh usage seems to have a higher incidence of chronic pain and, sometimes, infection.

[7] Various modes for treating hernia are known in the art. Several patent documents describe variety of suturing devices and procedures.

[8] U.S. Pat. App. No. 2014171978 disclosing surgical suturing device comprises a needle having a leading end, a trailing end, an arced body between the leading and trailing ends, and two steps located at antipodal positions on the body. A length of suture is connected to the needle. A needle driver reciprocates at least 180 degrees between a driven position and a returned position. The needle driver is adapted to engage the needle steps to rotate the needle in a circular path in first rotational direction. A pawl is positioned adjacent the driven position of the needle driver. The pawl is adapted to engage the needle steps to prevent the needle from rotating in a second rotational direction opposite of the first rotational direction.

[9] PCT App. No. 2013022959 discloses devices and methods for minimally invasive suturing.

One suturing device for minimally invasive suturing includes a proximal section a distal end, and an intermediate region there between. The device includes a suture head assembly having a needle with a pointed end and a second end. The needle is capable, of rotating about an axis approximately perpendicular to a longitudinal axis of the device, wherein the pointed end of the needle is positioned within the suture, head assembly prior to deployment of guides that are adapted and configured to guide, the needle around a circular path when advanced by a drive mechanism having a needle driver for engaging and rotating the needle.

[10] US Pat. App. No. 2012271285 discloses an articulating medical instrument comprising of: a substantially straight proximal segment; a substantially straight distal segment; an articulation mechanism having a straight configuration in which the proximal and distal segments form a substantially straight line and at least one articulated configuration in which the proximal and distal segments form an articulation angle of less than 180 degrees between the segments, the articulation mechanism being configured for increasing or decreasing the articulation angle; and one or more drive mechanisms configured for transferring force from the proximal segment to the distal segment, wherein the drive mechanism does not follow substantially straight lines between the proximal and distal segments passing through the apex of the articulation angle.

[11] US Pat. App. No. 2011024480 presents a surgical stapling instrument including a handle portion, a body portion, an articulating tool assembly and an articulation mechanism is disclosed. The body portion extends distally from the handle portion. The articulation mechanism includes an articulation link for articulating the tool assembly, an articulation knob for rotating an interface member, the articulation link having a slit at a proximal end operatively connected to the interface member, wherein rotational motion of the articulation knob is translated into axial motion of the first and second articulation links thereby articulating the articulating tool assembly.

[12] The devices described in the above-mentioned prior art presents articulation mechanism for suturing a tissue however, the orientation and size of the suture makes it difficult to visualize and cumbersome to use for minimal invasive procedures.

[13] It therefore remains a long felt and unmet need to provide novel means and methods for a suturing device that is easily manipulated; functions in an environment characterized by limited space, limited visualization, and limited mobility; mimics the preferred method of suturing used by surgeons; permits the surgeon to secure and tie knots quickly and with controlled tension.

SUMMARY OF THE INVENTION

[14] It is hence one object of the present invention to provide an applicator for suturing, ligating and thereby fastening tissues by means of one or a series of tied-sutures, said applicator characterized by a proximal portion comprising an actuating knob mounted to a handle, and a distal portion where a cartridge comprises a needle-assisted suture's discharging mechanism, and single or a plurality of fastenable-sutures, is located; at least one of said sutures is an elongated member having a male -head provided at its distal end, and a male-accepting female-head provided at its opposite proximal end, both said ends are interconnected by means of at least one cord, said distal portion further comprising an elongated shaft interconnected to a curved rotatable needle which is further interconnected to said sutures.

[15] It is also an object of the present invention wherein the tension of said fastening is configured to be adjusted. The adjustment is provided before fastening, while fastening or both.

[16] It is also an object of the present invention to provide the applicator as mentioned above, wherein said distal portion is positioned in parallel to a tissue to be fasten.

[17] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said suture comprises at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same.

[18] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said stature's male-head is connected to an anchor configured to be at least temporarily accommodated within said male-accepting female-head. [19] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said female-head comprises accepting-channel and a neighboring pushing-shaft accepting-channel; at least one of said accepting-channels comprises one or more flexible pawls configured by means of size and shape for allowing a cord, which comprises a tooth-like member, a continuous unidirectional forward linear motion.

[20] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said actuating knob is a rotating knob laterally articulated to the left of center, to the right of center, upwards, or downwards.

[21] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said distal portion additionally comprising a gear mechanism.

[22] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said distal portion additionally comprising an articulation strip configured for laterally articulation of said needle.

[23] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein said elongate shaft comprises at least one rotating joint which enables the shaft to reticulate in a range from about 0° to about 360° circular arc, or about 0° to about 180° circular arc or about 90°.

[24] It is also an object of the present invention to provide the applicator as mentioned in any of the above, provided useful for laparoscopic procedures selected from the group consisting of colostomy, colectomy, adrenalectomy, splenectomy, repair of paraesophageal hernia, inguinal hernia repair, ventral hernia repair, Nissen fundoplication, liver lobectomy, gastrectomy, small bowel resection, treatment of small bowel obstruction, distal pancreatectomy, nephrectomy, gastric bypass and any combination thereof.

[25] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein sidewall of the cartridge comprises an aperture enabling said needle to penetrate and grasp a suture.

[26] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the cartridge's shape is selected from the group consisting of tubular shape, rectangular shape, conical shape, cylindrical shape, roller shape, semicircular shape and a combination thereof.

[27] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle is provided by an angular motion and is maneuverable, by means of a knob-actuated gear mechanism, to grasp then release the suture from the cartridge. [28] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the suture is composed of a biocompatible material.

[29] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the suture is at least partially composed of a material selected form the group consisting of sterilizable medical grade plastic, sterilizable medical grade metal, including nickel titanium metal alloy (including commercially available Nitinol TM product), stainless steel, titanium, natural tissue and any combination thereof.

[30] It is also an object of the present invention to provide the applicator as mentioned in any of the above, comprising a suture-locking mechanism.

[31] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the cartridge is laterally articulated to a measure ranging from about 90° to about 360°.

[32] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle rotation is forming an arc-like path of rotation greater than 0° and less than about 180° and having a sharp leading edge.

[33] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle is held the a path of rotation by a combination of a gear system and a semi-rigid metal strip.

[34] It is another object of the present invention to provide a hernia repair kit comprising an applicator according to claim 1 and any of its dependent claims, and a flexible textile patch of mesh material; the patch is affixed to a portion of the abdominal cavity by a plurality of fastenable- sutures discharged from the fastener applicator.

[35] It is another object of the present invention to provide a method for ligating at least one tissue in laparoscopic procedures, comprising steps of: providing an applicator as defined above and below; introducing the distal portion of the applicator to a body cavity; activating an actuator knob coupled to the needle to cause rotational movement of the needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advancing the needle through the tissue; and discharging at least one fastenable-suture from the cartridge attached to the needle through the tissue forming at least one tied- suture.

[36] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of repeating steps (c) through (e) to cause a plurality of stitches to be placed through the tissue. [37] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of placing and affixing a flexible textile patch upon the abdominal region of a patient.

[38] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of positioning the cartridge against a tissue or/and organ.

[39] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of providing the fastenable-suture characterized by an elongated flexible cord, with at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end.

[40] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of providing the the actuating knob as a rotating knob which is laterally articulated to the left of center, to the right of center, upwards, or downwards.

[41] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of providing the distal portion comprising a gear system and an articulation strip capable of laterally articulating the needle to the left and right of center.

[42] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of guiding and fastening the fastenable-suture to form a tied- suture upon a target area in at least one additional act.

[43] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein method additionally comprising step of selecting laparoscopic procedures from the group consisting of laparoscopic colostomy, colectomy, adrenalectomy, splenectomy, repair of paraesophageal hernia, inguinal hernia repair, ventral hernia repair, Nissen fundoplication, liver lobectomy, gastrectomy, small bowel resection, treatment of small bowel obstruction, distal pancreatectomy, nephrectomy, gastric bypass and any combination thereof.

[44] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the providing the cartridge comprising at least one aperture in a sidewall of the cartridge allowing needle to penetrate and grasp at least one fastenable-suture. [45] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the providing cartridge having a shape selected from the group consisting of; tubular, conical, cylinderical, roller, semicircular and a combination thereof.

[46] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of operating the needle in an angular motion by the gear system to grasp and release the fastenable- suture from the cartridge .

[47] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the needle follows a curved path of less than about 180° during rotation of the cartridge.

[48] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the providing fastenable- suture composed of a biocompatible material.

[49] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the providing fastenable- suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy((including commercially available Nitinol TM product), natural tissue and any combination thereof.

[50] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of laterally articulating the cartridge to the left of center or the right of center in a 360° circular arc.

[51] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the providing the needle having a sharp leading edge, forming an arc-like path of rotation greater than 0° and less than about 180°.

[52] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of holding and stabilizing the needle in a path of rotation by a combination of the gear system and a semi-rigid metal strip.

[53] It is hence another object of the present invention to provide an applicator useful in orthopedic procedures, comprising: a distal portion and a proximal portion; the distal portion comprising: a cartridge comprising a plurality of fastenable- sutures for for ligation of at least one bone, joint, soft tissue and/or ligament; andan elongate shaft interconnected to the cartridge comprising a curved needle configured to rotate about an axis approximately; the proximal portion comprising: an actuating knob attached to a handle; wherein the fastenable- suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female-head at the proximal end; the cartridge is configured for loading and/or discharging at least one the fastenable- suture such that when activating the actuating knob at least one the fastenable-suture is discharged from the cartridge by the curved needle forming at least one tied-suture.

[54] It is also an object of the present invention to provide the applicator as mentioned above, wherein the fastenable-suture is with at least one member selected from the group consisting of a tooth, loop, barb, hook and clasp protruding from same.

[55] It is also an object of the present invention to provide the applicator as mentioned above, wherein the male-head of the fastenable-suture is in connection with an anchor ; the anchor configured to be temporarily accommodated by a distal end of a fastenable-suture; the female-head comprising a suture accepting-channel and a neighboring pushing-shaft accepting-channel ; at least one of the two accepting-channels comprising one or more flexible pawls for both allowing, by means of the tooth , a continuous linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the fastenable-suture a reversible reciprocal motion.

[56] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein additionally comprising a drill guide assembly configured for drilling at least one hole within the bone.

[57] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the drill guide assembly comprises a drill bit connected to a telescopic wire.

[58] It is also an object of the present invention to provide the applicator as mentioned above, wherein additionally comprising a fixation element for stabilizing the needle and the drill in a predefined position.

[59] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the actuating knob is a rotating knob laterally articulated to the left of center, to the right of center, upwards, or downwards.

[60] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating the needle to the left and right of center.

[61] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the elongate shaft comprises at least one rotating joint which further enables the shaft to reticulate in about 360°. [62] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the orthopedic procedures are selected from the group consisting of joint replacement,

knee arthroscopy, chondroplasty, replacement and meniscectomy, hip replacement, shoulder arthroscopy and decompression, rotator cuff repair, arthroscopic surgery, spine surgery, ankle replacement, anterior cruciate ligament (ACL) reconstruction, Carpal tunnel release, repair of femoral neck fracture, repair of trochanteric fracture, debridement of skin/muscle/bone/fracture, hip replacement, repair of rotator cuff tendon, repair fracture of radius (bone) na, laminectomy, repair of ankle fracture (bimalleolar type), shoulder arthroscopy and debridement, Lumbar spinal fusion, repair fracture of the distal part of radius, incise finger tendon sheath, repair of ankle fracture (fibula), repair of femoral shaft fracture, repair of trochanteric fracture and any combination thereof.

[63] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the cartridge further comprises an aperture in a sidewall of the cartridge allowing the needle to penetrate and grasp at least one fastenable-suture.

[64] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the cartridge is with a shape selected from the group consisting of; tubular, conical, cylindrical, roller, semicircular and a combination thereof.

[65] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle has an angular motion and is operable by the gear system to grasp, release and fasten the fastenable-suture from the cartridge.

[66] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the fastenable-suture is composed of a biocompatible material.

[67] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the fastenable-suture is composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof.

[68] It is also an object of the present invention to provide the applicator as mentioned in any of the above, further comprising a locking means for locking the fastenable-suture in a predefined position.

[69] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the cartridge is laterally articulated to the left of center or the right of center in a 360° circular arc. [70] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable-suture.

[71] It is also an object of the present invention to provide the applicator as mentioned in any of the above, wherein the needle is held in a path of rotation by a combination of the gear system and a rigid metal strip.

[72] It is another object of the present invention to provide a kit for ligation of at least one bone, joint, soft tissue and/or ligament, comprising: a drill guide assembly; and an applicator useful in orthopedic procedures, comprising: a distal portion and a proximal portion; the distal portion comprising: a cartridge comprising a plurality of fastenable-sutures for ligation of at least one bone, joint, and/or ligament; and an elongate shaft/ barrel interconnected to the cartridge comprising a curved needle configured to rotate about an axis approximately; the proximal portion comprising: an actuating knob attached to a handle; wherein the fastenable- suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female-head at the proximal end; the cartridge is configured for loading and/or discharging at least one the fastenable-suture such that when activating the actuating knob at least one the fastenable-suture is discharged from the cartridge by the curved needle forming at least one tied-suture.

[73] It is also an object of the present invention to provide the kit as mentioned above, wherein the drill guide assembly comprises a drill bit connected to a telescopic wire.

[74] It is also an object of the present invention to provide the kit as mentioned in any of the above, wherein the drill guide assembly is configured to form a hole having predefined diameter within the bone for fastenable-suture insertion.

[75] It is also an object of the present invention to provide the kit as mentioned in any of the above, wherein additionally comprising a fixation element housing the drill guide assembly and/or applicator for stabilizing and affixing the drill and the needle in a predefined position.

[76] It is another object of the present invention to provide a method for ligating at least one bone, joint, soft tissue and/or ligament, comprising steps of: providing an applicator as defined above; introducing the distal portion of the applicator to at least one bone, joint, and/or ligament; activating an actuator knob coupled to the needle to cause rotational movement of the needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advance the needle through the bone, joint, soft tissue and/or ligament; anddischarging at least one fastenable-suture from the cartridge attached to the needle through the bone, joint, and/or ligament, forming at least one fastenable- suture stitch.

[77] It is also an object of the present invention to provide the method as mentioned above, wherein the method additionally comprising steps of repeating steps (c) through (d) to cause a plurality of the fastenable- suture stitches to be placed through the bone, joint, and/or ligament.

[78] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of positioning the cartridge against or parallel to the bone, joint, soft tissue and/or ligament.

[79] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the method additionally comprising steps of deploying the needle to drive the suture into the bone, joint, soft tissue and/or ligament and retracting the same.

[80] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising steps of providing a drill guide assembly for forming a path for fastenable- suture insertion.

[81] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising steps of providing the fastenable- suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male- head at the distal end and an accepting female-head at the proximal end.

[82] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising steps of actuating the knob for rotating the knob to the left of center, to the right of center, upward, or downwards.

[83] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating the needle to the left and right of center.

[84] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising steps of guiding and fastening the fastenable-suture to form a tied- suture upon a target area in at least one additional act.

[85] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the step of providing the cartridge comprising at least one aperture in a sidewall of the cartridge allowing needle to penetrate and grasp at least one fastenable-suture.

[86] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the step of providing cartridge having a shape selected from the group consisting of: tubular, conical, cylindrical, roller, semicircular and a combination thereof. [87] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of operating the needle in an angular motion by the gear system to grasp, release and fasten the fastenable-suture from the cartridge.

[88] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising steps of activating the needle to follow a curved path of less than about 180° during rotation of the cartridge.

[89] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the step of providing fastenable-suture composed of a biocompatible material.

[90] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the step of providing fastenable-suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof.

[91] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of laterally articulating the cartridge to the left of center or the right of center in a 360° circular arc.

[92] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein the step of providing needle covering an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable-suture.

[93] It is also an object of the present invention to provide the method as mentioned in any of the above, wherein additionally comprising step of holding and stabilizing the needle in a path of rotation by a combination of the gear system and a rigid metal strip.

[94] It is also an object of the present invention to disclose an applicator useful in orthopedic procedures, comprising: a distal portion and a proximal portion; said distal portion comprising: a cartridge comprising a plurality of fastenable- sutures for for ligation of at least one bone, joint, soft tissue and/or ligament; and an elongate shaft interconnected to said cartridge comprising a curved needle configured to rotate about an axis approximately;

[95] said proximal portion comprising: an actuating knob attached to a handle; wherein said fastenable-suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female -head at the proximal end; said cartridge is configured for loading and/or discharging at least one said fastenable-suture such that when activating said actuating knob at least one said fastenable-suture is discharged from said cartridge by said curved needle forming at least one tied-suture. [96] It is another object of the present invention to disclose the applicator as defined above, wherein said fastenable- suture is with at least one member selected from the group consisting of a tooth, loop, barb, hook and clasp protruding from same.

[97] It is another object of the present invention to disclose the applicator as defined above, wherein said male-head of said fastenable- suture is in connection with an anchor ; said anchor configured to be temporarily accommodated by a distal end of a fastenable-suture; said female-head comprising a suture accepting-channel and a neighboring pushing-shaft accepting-channel ; at least one of said two accepting-channels comprising one or more flexible pawls for both allowing, by means of said tooth , a continuous linear forward motion of said male-head and said cord within said accepting-channel in only one direction, while preventing motion of said male-head and cord in a backward direction and allowing only said fastenable-suture a reversible reciprocal motion.

[98] It is another object of the present invention to disclose the applicator as defined above, wherein it additionally comprising a drill guide assembly configured for drilling at least one hole within said bone.

[99] It is another object of the present invention to disclose the applicator as defined above, wherein said drill guide assembly comprises a drill bit connected to a telescopic wire.

[100] It is another object of the present invention to disclose the applicator as defined above, wherein it additionally comprising a fixation element for stabilizing said needle and said drill in a predefined position.

[101] It is another object of the present invention to disclose the applicator as defined above, wherein said actuating knob is a rotating knob laterally articulated to the left of center, to the right of center, upwards, or downwards.

[102] It is another object of the present invention to disclose the applicator as defined above, wherein said distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating said needle to the left and right of center.

[103] It is another object of the present invention to disclose the applicator as defined above, wherein said elongate shaft comprises at least one rotating joint which further enables the shaft to reticulate in about 360°.

[104] It is another object of the present invention to disclose the applicator as defined above, wherein said orthopedic procedures are selected from the group consisting of joint replacement, knee arthroscopy, chondroplasty, replacement and meniscectomy, hip replacement, shoulder arthroscopy and decompression, rotator cuff repair, arthroscopic surgery, spine surgery, ankle replacement, anterior cruciate ligament (ACL) reconstruction, Carpal tunnel release, repair of femoral neck fracture, repair of trochanteric fracture, debridement of skin/muscle/ bone/fracture, hip replacement, repair of rotator cuff tendon, repair fracture of radius (bone) na, laminectomy, repair of ankle fracture (bimalleolar type), shoulder arthroscopy and debridement, Lumbar spinal fusion, repair fracture of the distal part of radius, incise finger tendon sheath, repair of ankle fracture (fibula), repair of femoral shaft fracture, repair of trochanteric fracture and any combination thereof.

[105] It is another object of the present invention to disclose the applicator as defined above, wherein said cartridge further comprises an aperture in a sidewall of said cartridge allowing said needle to penetrate and grasp at least one fastenable-suture.

[106] It is another object of the present invention to disclose the applicator as defined above, wherein said cartridge is with a shape selected from the group consisting of; tubular, conical, cylindrical, roller, semicircular and a combination thereof.

[107] It is another object of the present invention to disclose the applicator as defined above, wherein said needle has an angular motion and is operable by said gear system to grasp, release and fasten said fastenable-suture from said cartridge.

[108] It is another object of the present invention to disclose the applicator as defined above, wherein said fastenable-suture is composed of a biocompatible material.

[109] It is another object of the present invention to disclose the applicator as defined above, wherein said fastenable-suture is composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof.

[110] It is another object of the present invention to disclose the applicator as defined above, wherein further comprising a locking means for locking said fastenable-suture in a predefined position.

[I l l] It is another object of the present invention to disclose the applicator as defined above, wherein said cartridge is laterally articulated to the left of center or the right of center in a 360° circular arc.

[112] It is another object of the present invention to disclose the applicator as defined above, wherein said needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[113] It is another object of the present invention to disclose the applicator as defined above, wherein said needle is held in a path of rotation by a combination of said gear system and a rigid metal strip. [114] It is another object of the present invention to a kit for ligation of at least one bone, joint, soft tissue and/or ligament, comprising: a drill guide assembly; and an applicator useful in orthopedic procedures, comprising: a distal portion and a proximal portion; said distal portion comprising: a cartridge comprising a plurality of fastenable- sutures for ligation of at least one bone, joint, and/or ligament; and an elongate shaft/ barrel interconnected to said cartridge comprising a curved needle configured to rotate about an axis approximately;

[115] said proximal portion comprising: an actuating knob attached to a handle; wherein said fastenable-suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female -head at the proximal end; said cartridge is configured for loading and/or discharging at least one said fastenable-suture such that when activating said actuating knob at least one said fastenable-suture is discharged from said cartridge by said curved needle forming at least one tied-suture.

[116] It is another object of the present invention to disclose the kit as defined above, wherein said drill guide assembly comprises a drill bit connected to a telescopic wire.

[117] It is another object of the present invention to disclose the kit as defined above, wherein said drill guide assembly is configured to form a hole having predefined diameter within said bone additionally comprising a fixation element housing said drill guide assembly and/or applicator for stabilizing and affixing said drill and said needle in a predefined position.

[118] It is another object of the present invention to disclose a method for ligating at least one bone, joint, soft tissue and/or ligament, comprising steps of: providing an applicator as defined above; introducing the distal portion of said applicator to at least one bone, joint, and/or ligament; activating an actuator knob coupled to the needle to cause rotational movement of the needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advance the needle through said bone, joint, soft tissue and/or ligament; discharging at least one fastenable-suture from said cartridge attached to the needle through said bone, joint, and/or ligament, forming at least one fastenable-suture stitch.

[119] It is another object of the present invention to disclose the method as defined above, wherein said method additionally comprising steps of repeating steps (c) through (d) to cause a plurality of said fastenable-suture stitches to be placed through said bone, joint, and/or ligament.

[120] It is another object of the present invention to disclose the method as defined above, wherein said method additionally comprising steps of positioning the cartridge against or parallel to said bone, joint, soft tissue and/or ligament. [121] It is another object of the present invention to disclose the method as defined above, wherein said method additionally comprising steps of deploying the needle to drive said suture into said bone, joint, soft tissue and/or ligament and retracting the same.

[122] It is another object of the present invention to disclose the method as defined above, wherein additionally comprising steps of providing a drill guide assembly for forming a path for fastenable- suture insertion.

[123] It is another object of the present invention to disclose the method as defined above, wherein additionally comprising steps of providing said fastenable- suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end.

[124] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of actuating the knob for rotating said knob to the left of center, to the right of center, upward, or downwards.

[125] It is another object of the present invention to disclose the method as defined above, wherein said distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating said needle to the left and right of center.

[126] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of guiding and fastening said fastenable-suture to form a tied- suture upon a target area in at least one additional act.

[127] It is another object of the present invention to disclose the method as defined above, wherein said step of providing said cartridge comprising at least one aperture in a sidewall of said cartridge allowing needle to penetrate and grasp at least one fastenable-suture .

[128] It is another object of the present invention to disclose the method as defined above, wherein said step of providing cartridge having a shape selected from the group consisting of: tubular, conical, cylindrical, roller, semicircular and a combination thereof.

[129] It is another object of the present invention to disclose a fastener applicator useful in cardiac procedures, comprising: a distal portion and a proximal portion; said distal portion comprising: a cartridge comprising a plurality of fastenable-sutures for suturing of at least one tissue; and an elongate shaft interconnected to said cartridge comprising a curved suturing needle configured to rotate about an axis approximately; said proximal portion comprising: an actuating knob attached to a handle; wherein said fastenable-suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female-head at the proximal end; said cartridge is configured for loading and/or discharging at least one said fastenable-suture such that when activating said actuating knob at least one said fastenable- suture is discharged from said cartridge by said curved suturing needle forming at least one tied-suture.

[130] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable- suture is with at least one tooth, loop, barb, hook or/and clasp protruding from same.

[131] It is another object of the present invention to disclose the fastener as defined above, wherein said male-head of said fastenable-suture is in connection with an anchor ; said anchor configured to be temporarily accommodated by a distal end of a fastenable-suture; said female-head comprising a suture accepting-channel and a neighboring pushing-shaft accepting-channel ; at least one of said two accepting-channels comprising one or more flexible pawls for both allowing, by means of said tooth , a continuous linear forward motion of said male-head and said cord within said accepting-channel in only one direction, while preventing motion of said male-head and cord in a backward direction and allowing only said fastenable-suture a reversible reciprocal motion.

[132] It is another object of the present invention to disclose the fastener as defined above, wherein said actuating knob is a rotating knob which is laterally articulated to the left of center, to the right of center, up, and/or down.

[133] It is another object of the present invention to disclose the fastener as defined above, wherein said distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating said needle to the left and right of center.

[134] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is guided and fastened to form a tied-suture upon a target area in at least one additional act.

[135] It is another object of the present invention to disclose the fastener as defined above, wherein said elongate shaft comprises at least one rotating joint which further enables the shaft to reticulate in about 360°.

[136] It is another object of the present invention to disclose the fastener as defined above, wherein said cardiac procedures are selected from the group consisting of cardiac catheterization and coronary angiography, cardiac surgeries, angioplasty and Stenting, carotid angiography and intervention, aortic endovascular aneurysm repair, transcatheter aortic-valve implantation, peripheral intervention, coronary artery bypass grafting, transmyocardial laser revascularization, heart valve repair or replacement, arrhythmia treatment, aneurysm repair, heart transplant, surgery to place ventricular assist devices or total artificial hearts, open-heart surgery, off-pump heart surgery , minimally invasive heart surgery and any combination thereof.

[137] It is another object of the present invention to disclose the fastener as defined above, wherein said cartridge further comprises an aperture in a sidewall of said cartridge allowing said needle to penetrate and grasp at least one fastenable-suture.

[138] It is another object of the present invention to disclose the fastener as defined above, wherein said cartridge is with a shape selected from the group consisting of; tubular, conical, cylindrical , roller, semicircular and a combination thereof.

[139] It is another object of the present invention to disclose the fastener as defined above, wherein said needle has an angular motion and is operable by said gear system to grasp, release and fasten said fastenable-suture from said cartridge.

[140] It is another object of the present invention to disclose the fastener as defined above, wherein said needle follows a curved path of less than about 180° during rotation of said cartridge.

[141] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is composed of a biocompatible material.

[142] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof.

[143] It is another object of the present invention to disclose the fastener as defined above, wherein it further comprising a locking means for locking said fastenable-suture in a predefined position.

[144] It is another object of the present invention to disclose the fastener as defined above, wherein said cartridge is laterally articulated to the left of center or the right of center in a 360° circular arc.

[145] It is another object of the present invention to disclose the fastener as defined above, wherein said suturing needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[146] It is another object of the present invention to disclose the fastener as defined above, wherein said suturing needle is held in a path of rotation by a combination of said gear system and a rigid metal strip.

[147] It is another object of the present invention to disclose a fastener applicator for ligation of a first tissue to a second tissue, comprising: a distal portion and a proximal portion; said distal portion comprising griping means configured as scissors-like clamps; at least one clamp is mounted to a curved suturing needle; said proximal portion comprising an elongate shaft connected to said griping means ; said elongate shaft comprises a plurality of fastenable- sutures; wherein said fastenable-suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female-head at the proximal end; said scissors- like clamps is configured for loading and/or discharging at least one said fastenable-suture such that when activating said clamps at least one said fastenable-suture is discharged from said elongate shaft by said curved suturing needle forming at least one tied-suture.

[148] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable- sutures are organized in a vertical or horizontal manner within said shaft.

[149] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is guided and fastened to form a tied-suture upon a target area in at least one additional act.

[150] It is another object of the present invention to disclose the fastener as defined above, wherein said shaft is manipulated relative to the longitudinal axis of said applicator.

[151] It is another object of the present invention to disclose the fastener as defined above, wherein said needle has an angular motion and is operable by said scissors-like clamps to grasp, release and fasten said fastenable-suture around said first and second tissue.

[152] It is another object of the present invention to disclose the fastener as defined above, wherein said needle follows a curved path of less than about 180°.

[153] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is composed of a biocompatible material.

[154] It is another object of the present invention to disclose the fastener as defined above, wherein said fastenable-suture is composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof.

[155] It is another object of the present invention to disclose the fastener as defined above, wherein said suturing needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[156] It is another object of the present invention to disclose the fastener as defined above, wherein said scissors-like clamps are two curved opposed pincer-like elements.

[157] It is another object of the present invention to disclose a method for suturing at least one tissue, comprising steps of: providing a fastener applicator as defined above; introducing the distal portion of said fastener applicator to at least one tissue; activating an actuator knob coupled to the suturing needle to cause rotational movement of the suturing needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advance the suturing needle through said tissue; discharging at least one fastenable-suture from said cartridge attached to the suturing needle through said tissue, forming at least one fastenable-suture stitch.

[158] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of repeating steps (c) through (d) to cause a plurality of said fastenable-suture stitches to be placed through said tissue.

[159] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of positioning the cartridge against or parallel to said tissue.

[160] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of deploying the suturing needle to drive said suture into said tissue and retracting the same.

[161] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of providing said fastenable-suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end.

[162] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of actuating the knob for rotating said knob to the left of center, to the right of center, up, and/or down.

[163] It is another object of the present invention to disclose the method as defined above, wherein said distal portion additionally comprising a gear system and an articulation strip capable of laterally articulating said needle to the left and right of center.

[164] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of guiding and fastening said fastenable-suture to form a tied- suture upon a target area in at least one additional act.

[165] It is another object of the present invention to disclose the method as defined above, wherein wherein said step of providing said cartridge comprising at least one aperture in a sidewall of said cartridge allowing needle to penetrate and grasp at least one fastenable-suture .

[166] It is another object of the present invention to disclose the method as defined above, wherein wherein said step of providing cartridge having a shape selected from the group consisting of: tubular, conical, cylindrical, roller, semicircular and a combination thereof. [167] It is another object of the present invention to disclose the method as defined above, wherein wherein additionally comprising step of operating said needle in an angular motion by said gear system to grasp, release and fasten said fastenable-suture from said cartridge .

[168] It is another object of the present invention to disclose the method as defined above, wherein wherein additionally comprising steps of activating said needle to follow a curved path of less than about 180° during rotation of said cartridge.

[169] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a biocompatible material.

[170] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[171] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising step of laterally articulating said cartridge to the left of center or the right of center in a 360° circular arc.

[172] It is another object of the present invention to disclose the method as defined above, wherein said step of providing suturing needle covering an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[173] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising step of holding and stabilizing said suturing needle in a path of rotation by a combination of said gear system and a rigid metal strip.

[174] It is another object of the present invention to disclose a method of ligating a first tissue to a second tissue,comprising steps of: providing a fastener applicator as defined above; introducing the distal portion of said fastener applicator to said first and second tissue; activating griping means coupled to the suturing needle to cause rotational movement of the shaft comprising plurality of fastenable- sutures ;and discharging at least one fastenable-suture from said shaft encircling said first and second tissue, forming at least one tied -suture.

[175] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of repeating steps (c) through (d) to cause a plurality of said fastenable-suture stitches to be placed around said first and second tissue.

[176] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of deploying the suturing needle to drive said suture around said first and second tissue and retracting the same. [177] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of providing said fastenable- suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end.

[178] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of manipulating said shaft relative to the longitudinal axis of said applicator.

[179] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of guiding and fastening said fastenable-suture to form a tied- suture around said first and second tissue in at least one additional act.

[180] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of detaching said griping means from said first and second tissue.

[181] It is another object of the present invention to disclose the method as defined above, wherein said step of activating said griping means comprising step of activating said needle to follow a curved path of less than about 180°.

[182] It is another object of the present invention to disclose the method as defined above, wherein said step of providing comprising suturing needle covering an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[183] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a biocompatible material.

[184] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[185] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising step of operating said needle in an angular motion by said gear system to grasp, release and fasten said fastenable-suture from said cartridge .

[186] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising steps of activating said needle to follow a curved path of less than about 180° during rotation of said cartridge.

[187] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a biocompatible material. [188] It is another object of the present invention to disclose the method as defined above, wherein said step of providing fastenable-suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[189] It is another object of the present invention to disclose the method as defined above, wherein additionally comprising step of laterally articulating said cartridge to the left of center or the right of center in a 360° circular arc.

[190] It is another object of the present invention to disclose the method as defined above, wherein said step of providing needle covering an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging said fastenable-suture.

[191] It is another object of the present invention to disclose the method as defined above, wherein it additionally comprising step of holding and stabilizing said needle in a path of rotation by a combination of said gear system and a rigid metal strip. An end-type (tail-type) inter- connectable fastenable-suture characterized by one of the followings: male connecting means, female connecting means and male & female connecting means.

[192] It is another object of the present invention to disclose a middle-type (body-type) inter- connectable fastenable-suture characterized by one of the followings: male connecting means, female connecting means and male & female connecting means.

[193] It is another object of the present invention to disclosea train of at least two reversibly or temporarily connected segments, each segment is selected from a group consisting of (a) at least one end-type (tail-type) inter-connectable fastenable-suture, and (b) middle-type (body- type) inter-connectable fastenable-suture.

[194] It is another object of the present invention to disclose a suture's cartridge, comprising a train of at least two reversibly or temporarily connected segments, each segment is selected from a group consisting of (a) at least one end-type (tail-type) inter-connectable fastenable-suture, and (b) middle-type (body-type) inter-connectable fastenable-suture.

[195] It is another object of the present invention to disclose suture's cartridge as defined above, wherein said cartridge comprises a train of at least two reversibly or temporarily connected segments, wherein said train is configured as a spiral wound or snake-like segments arrangements.

BRIEF DESCRIPTION OF THE DRAWINGS [196] In the following description of the preferred embodiments, reference is made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration specific embodiments in which the invention may be practiced. It is understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present invention. The present invention may be practiced according to the claims without some or all of these specific details. For the purpose of clarity, technical material that is known in the technical fields related to the invention has not been described in detail so that the present invention is not unnecessarily obscured.

In the accompanying drawing:

[197] FIG. 1 presents a perspective view of the applicator distal portion of the present invention;

[198] FIG. 2 presents a cross section view of the needle and the gear system, of the present invention;

[199] FIGs. 3A-3D present a cross section view of the needle rotation movement, according to an embodiment of the present invention;

[200] FIG. 4 presents a graph of the distance of the needles axis vs. the rotation angle of the needle, according to an embodiment of the present invention;

[201] FIG. 5 presents a cross section view of the tubular cartridge comprising a plurality of fastenable sutures, according to an embodiment of the present invention;

[202] FIG. 6 presents a view of the tubular cartridge comprising a plurality of fastenable sutures, according to an embodiment of the present invention;

[203] FIG.7 is a schematic drawing of the applicator useful in laparoscopic procedures, according to an embodiment of the present invention;

[204] FIG.8 is a schematic drawing of the of fastenable- suture comprising a curved needle, according to an embodiment of the present invention;

[205] FIG. 9 presents a view of the of fastenable- suture deployment mechanism, according to an embodiment of the present invention;

[206] FIG. 10 is a schematic drawing of the fastenable- suture deployment mechanism, according to an embodiment of the present invention.

[207] FIG. 11 is schematic drawing of the drill guide assembly, according to an embodiment of the present invention;

[208] FIGs. 12-13 illustrates a cross sectional view of the drill guide assembly in predefined position, according to an embodiment of the present invention;

[209] FIG. 14 is schematic drawing of the fastnable-sutures placed within a bone, according to an embodiment of the present invention. [210] FIG. 15 presents a perspective view of the fastener applicator distal portion according to an embodiment of the present invention;

[211] FIGS. 16-18 are schematic drawings of the fastener applicator configuration and fastenable- suture deployment for ligation of a first tissue to a second tissue according to an embodiment of the present invention;

[212] FIG. 19 is schematic drawing of a fastenable- suture, according to an embodiment of the present invention;

[213] FIG. 20 is schematic drawing of a train of end-type inter-connectable fastenable-sutures, according to an embodiment of the present invention;

[214] FIG. 21 is schematic drawing of a spiral-wound roll of inter-connectable fastenable-sutures, according to an embodiment of the present invention;

[215] FIGS. 222a & 22b are schematic drawings of a cartridge of a spiral- wound roll of inter- connectable fastenable-sutures, according to an embodiment of the present invention and FIG. 22c is a schematic drawing of a cartridge of a snake-like roll of inter-connectable fastenable-sutures, according to an embodiment of the present invention;

[216] FIG. 23 is schematic drawing of snake-like sequence of inter-connectable fastenable-sutures, an assembly utilizable in a cassette, according to an embodiment of the present invention;

[217] FIGS. 24A and 24B are schematic drawing of middle-type inter-connectable fastenable- sutures (i.e., the fastener„-to-fastner„.; inter-connecting member is not located at the end portion of the fastener, but somewhere in its middle portion(s)), according to an embodiment of the present invention; and

[218] FIGs. 25A and 25B are schematic drawing of a train of middle-type inter-connectable fastenable-sutures, according to an embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[219] The present invention have been defined specifically to provide fastener applicator, means and method useful in laparoscopic procedures such as laparoscopic colostomy, colectomy, adrenalectomy, splenectomy, repair of paraesophageal hernia, inguinal hernia repair, ventral hernia repair, Nissen fundoplication, liver lobectomy, gastrectomy, small bowel resection, treatment of small bowel obstruction, distal pancreatectomy, nephrectomy and/or gastric bypass.

[220] In another embodiment of the present invention, the applicator is configured for trocar site closure in laparoscopic surgery. The applicator provides a simple, quick, safe, reliable, and inexpensive method to effectively achieve a full thickness closure of trocar site defects. Hernias have been reported to occur at trocar sites and small anterior wall defect has been casually identified during laparoscopic surgery. Closure is accomplished with an absorbable suture, which is applied in a pursestring manner using 15 gauge spinal cord needle. This procedure is also suitable for the laparoscopic repair of uncomplicated small hernias or fascial defects of the anterior abdominal wall. This technique allows a secure closure of umbilical or fascial defects of the anterior abdominal wall. It is a useful method for large trocar sites closure and is recommended for small uncomplicated hernias or fascial defects of the anterior abdominal wall. The present invention provides an applicator useful in laparoscopic procedures, comprising a distal portion and a proximal portion. The distal portion comprising a cartridge comprising a plurality of fastenable-sutures for suturing and ligation of at least one tissue and an elongate shaft configured as a barrel interconnected to the cartridge. The elongate shaft comprising a curved needle configured to rotate about an axis approximately.

[221] The proximal portion comprising an actuating knob mounted to a handle.

[222] The cartridge is configured for loading, deploying and/or discharging at least one fastenable- suture such that when activating the actuating knob at least one fastenable- suture is discharged.

[223] In another embodiment of the present invention, the applicator is further useful for minimal invasive procedures.

[224] In another embodiment of the present invention, the fastenable-suture enables the precise adjustment of the required diameter during implantation. The fastenable suture's circumference can be adjusted every 2 mm until the inner diameter of the circumference matches the outer diameter of the encircled organ such as the stomach tissue.

[225] In another embodiment of the present invention, the applicator is configured for placing continuous stitches.

[226] The term " Fastenable-Suture" refers herein to a suture useful for suturing and ligation of at least one tissue and characterized by an elongated flexible cord, with one or more teeth, loop, barb, hook or/and clasp protruding from same.

[227] The fastenable-suture includes a male-head at the distal end and an accepting female-head at the proximal end. The male-head is in connection with an anchor, where the anchor is configured to be temporarily accommodated by a distal end of a guiding- shaft. The female- head includes a suture accepting-channel and a neighboring guiding-shaft accepting-channel. At least one of the two accepting-channels comprise one or more flexible pawls for both allowing, by means of the teeth, a continuous and linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the guiding- shaft a reversible reciprocal motion.

[228] The fastenable- suture may be a strand or fiber used to sew or suture parts of the living body; it can also refer to a ligature, such as a filament or thread, used to unite, connect, bind or tie tissues and/or hollow structured organs.

[229] In another embodiment of the present invention, the fastenable-Suture may be further adapted together with a bioadhesive material such as natural polymeric materials that act as adhesives and may be composed of biocompatible materials. The bioadhesive material may consist of a variety of substances.

[230] As used herein the term "about X" or "approximately X" or "substantially X" usually refers to a range 25% less than to 25% more than of X (X +- 25%), at times X +- 20%, X +- 15% and preferably X +- 10%.

[231] Reference is now made to Figure 1 presenting a perspective view of the applicator distal portion 1 comprising a tubular or semicircular cartridge 3 connected to an elongate shaft 2. The cartridge comprises a plurality of fastenable- sutures 4 for suturing at least one tissue. The fastenable- sutures are characterized by an elongated flexible cord, with at least one at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same , having a male-head at the distal end and an accepting female-head at the proximal end.

[232] The elongate shaft 2 may be a spherical or tubular portion which can further rotate about an axis approximately perpendicular to a longitudinal axis of the elongated shaft. The elongate shaft comprises at least one rotating joint 5 which further enables the shaft to reticulate in to a measure ranging from about 0° to about 360° circular arc, or about 0° to about 180° circular arc or about 90°. The rotating joint may be configured as a foldable arm which further can be manipulated and/ or maneuvered relative to the longitudinal axis of the fastener applicator. The rotating joint is configured for reversible deployment and withdrawal by means of reversible folding, collapsing, retracting and/or telescopic motion.

[233] Reference is now made to Figure 2 presenting a cross section view of the needle and a gear system 10 located within the elongate shaft. The needle 11 follows a curved path during rotation of the cartridge. The gear system comprises an articulation strip and at least one gear wheel. The gear system movement is transferred via a semi-rigid metal strip (2D) connected to the manipulation system held by the user. [234] The gear system 13, 12, 14 is further actuated by the knob which is further configured to engage, move, maneuver and/or manipulate the needle relative to the cartridge. The curved needle 11 is driven in a curved path, circulate path, or arc-like path about an axis approximately perpendicular to the longitudinal axis of the fastener applicator. Preferably, the needle may have a radius of curvature of about 3 mm to about 40 mm. The needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable suture. The needle comprises a sharp pointed end.

[235] In another embodiment of the present invention, the needle may be a disposable needle.

[236] In another embodiment of the present invention, the needle rides in a track formed as a C- brace shape. The needle is selectively operable to grasp and release at least one fastenable- suture.

[237] Reference is now made to Figures 3A-D presenting cross section view of the curved needle rotation movement. As illustrated in Fig. 3B, the needle starts to rotate around its axis while protruding from the surface of the elongate shaft. Figures 3B, 3C and 3D further illustrate the needle angular motion whilst the angle a is increasing until the needle perform a 180° turn. The angular motion is with an angle a in a range of about -45°<a <45°.

[238] Reference is now made to Figure 4 which presents an exponential decay graph of the distance of the needle axis vs. the rotation angle of the needle. As illustrated, the ratio of the distance is decreasing as the the rotation angle of the needle perform a 180° turn. Thereby, each time the rotation angle is increased, the distance is decreased.

[239] Reference is now made to Figure 5 presenting a cross section view of the tubular cartridge 20 comprising a plurality of fastenable-sutures 21 for suturing at least one tissue characterized by an elongated flexible cord, with at least one at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same, having a male-head at the distal end and an accepting female-head at the proximal end. The male-head of the fastenable- suture is in connection with an anchor. The anchor configured to be temporarily accommodated by a distal end of a pushing-shaft. The female-head comprising a suture accepting-channel and a neighboring pushing-shaft accepting-channel; at least one of the two accepting-channels comprising one or more flexible pawls for both allowing, by means of the teeth, a continuous linear forward motion of the male-head and the cord within the accepting- channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the pushing-shaft a reversible reciprocal motion.

[240] The fastenable-suture 21 may be composed of a biocompatible material or/and of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy((including commercially available Nitinol TM product), natural tissue and any combination thereof .

[241] Reference is now made to Figure 6 presenting a view of the tubular cartridge 30 comprising a plurality of fastenable- sutures 31 for suturing and ligating at least one tissue. The cartridge 30 may further comprise at least one aperture, a notch or an orifice in the sidewall of the housing 32 of the cartridge 30.

[242] The cartridge may laterally be articulated to the left of center or the right of center to a measure ranging from about 90° to about 360° circular arc.

[243] The cartridge comprises plurality of template or mold having a cavity configured to fit and adjusted to the structure and size of the fastenable-suture. This further allows the penetration of the needle via the cartridge aperture for loading at least one fastenable-suture via its proximal end and forming at least one tied-suture.

[244] In another embodiment, the fastenable- sutures 31 may be attached to the cartridge 30 by adhesive material, mechanically attached, laser technics, welding technics, adhesion technics, injection technics and the like.

[245] In another embodiment, the cartridge may comprise fastenable- sutures having a length which can be range from about 10 mm to about 100 mm.

[246] Reference is now made to Figure 7 presenting a view of the applicator 40 useful in laparoscopic procedures comprising a distal portion 40a and a proximal portion 40b. The distal portion 40a comprising: a tubular cartridge 41 comprising a plurality of fastenable- sutures for suturing at least one tissue. The fastenable-suture is characterized by an elongated flexible cord, with at least one at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same, having a male-head at the distal end and an accepting female-head at the proximal end; an elongate shaft interconnected to the cartridge comprising a curved needle configured to rotate about an axis approximately.

[247] The distal portion further comprises an elongate shaft 42 interconnected to the cartridge 41 comprising a curved needle configured to rotate about an axis approximately.

[248] The proximal portion 40b further comprising an actuating knob 43 mounted to a handle 44.

[249] In another embodiment, the applicator includes an actuator mechanism which comprises an elongated shaft having barrel-like shape and a handle at the proximal portion. In another embodiment of the present invention, the handle is with an open and close configuration. The handle 44 is configured as a grip assembly which is squeezed in order to actuate the fastener applicator. [250] In another embodiment, the applicator ,portions or parts of the fastener applicator, such as the cartridge, the elongated shaft or/and the handle, are composed of a sterilizable medical grade plastic material, in which case, the applicator or parts of the applicator may discarded and disposed after a single use.

[251] In another embodiment, the applicator is composed of a sterilizable medical grade metallic material such as stainless steel to enable reuse subsequent to sterilization following a prior use.

[252] In another embodiment, the applicator is composed of a sterilizable medical grade metallic material such as titanium to enable reuse subsequent to sterilization following a prior use. The use of titanium is beneficial for certain procedures including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) because they are X-Ray radiolucent and do not interfere with MRI and CT scans.

[253] The applicator is configured in different manner with respect to length and angle of the fastenable suture. The size and position of the needle and the cartridge may also be varied for use in open surgery to perform procedures such as closing of the fascia, skin closure, soft tissue attachment, anastomosis, fixation of mesh, patches, grafts and other artificial materials.

[254] The present invention further provides a hernia repair kit comprising an applicator and a flexible textile patch of mesh material. The patch is affixed to a portion of the abdominal cavity by a plurality of fastenable-sutures discharged from the fastener applicator.

[255] In another embodiment of the present invention, fixation of mesh may include flexible mesh patches which can be woven or knitted or made of other suitable fabric material of the type that can be used in hernia repair. Preferably, the patches are made of polymeric material that is biocompatible, such as polypropylene or polytetrafluoroethylene (PTFE).

[256] Reference is now made to Figure 8 presenting a view of the fastenable- suture comprising a curved needle deployment mechanism 50. The fastenable- suture comprising a curved needle 52 which further promotes greater support per release of at least one fastenable-suture. The distal portion of the applicator is with a flat faced to improve adherence against a target region in an organ or/and at least one tissue.

[257] Reference is now made to Figure 9 which illustrates the distal side of the applicator 60 comprising a cartridge 61 during mid deployment of at least one fastenable-suture 62.

[258] Reference in now made to Figure 10 which illustrates the applicator 70 comprising a plurality of fastenable-sutures 71 positioned against the peritoneum 72 for deployment. The elongate shaft comprises at least one rotating joint which further enables the shaft to reticulate in about 360° circular arc. As illustrated in Fig. 10, the rotating joint is configured as a foldable arm which further can be manipulated and/ or maneuvered relative to the longitudinal axis of the fastener applicator. The rotating joint is configured for reversible deployment and withdrawal of fastenable- sutures by means of reversible folding, collapsing, retracting and/or telescopic motion.

[259] In another embodiment of the present invention, the applicator is with an improved visibility offered by the shape and configuration of the suture enables precise device placement over the incision, and uniform advancement of the applicator after every stitch to provide a uniform and symmetric suture, thereby minimizing the risk of tearing tissue and bleeding due to a stitch being positioned too close to the edge of the incised tissue.

[260] In another embodiment of the present invention method for ligating at least one tissue in laparoscopic procedures is provided. The method comprising the steps of: providing a fastener applicator; introducing the distal portion of the applicator into a body cavity; activating an actuator knob coupled to the needle to cause rotational movement of the needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable- suture and advance the needle through the tissue; and discharging at least one fastenable-suture from the cartridge attached to the needle through the tissue forming at least one tied-suture.

[261] The method additionally comprising steps of repeating steps (c) through (e) to cause a plurality of stitches to be placed through the tissue.

[262] The method additionally comprising steps positioning the cartridge against a tissue or/and organ.

[263] The method additionally comprising steps of providing the fastenable-suture characterized by an elongated flexible cord, with at least one at least one member selected from a group consisting of tooth, loop, barb, hook and clasp protruding from the same, having a male-head at the distal end and an accepting female-head at the proximal end.

[264] The method additionally comprising steps of placing and affixing a flexible textile patch upon the abdominal region of a patient.

[265] The method additionally comprising step of operating the needle in an angular motion by the gear system to grasp and release the fastenable-suture from the cartridge.

[266] The method additionally comprising step of laterally articulating the cartridge to the left of center or the right of center to a measure ranging from about 90° to about 360° circular arc.

[267] The method additionally comprising step of holding and stabilizing the needle in a path of rotation by a combination of the gear system and a semi-rigid metal strip. [268] The present invention further have been defined specifically to provide applicator, means and method useful in orthopedic procedures such as repair of achilles tendon ruptures, joint replacement, knee arthroscopy, chondroplasty, replacement and meniscectomy, hip replacement, shoulder arthroscopy and decompression, rotator cuff repair, arthroscopic surgery, ankle replacement, anterior cruciate ligament (ACL) reconstruction, carpal tunnel release, repair of femoral neck fracture, repair of trochanteric fracture, debridement of skin/muscle/bone/fracture, hip replacement, repair of rotator cuff tendon, repair fracture of radius (bone) na, laminectomy, repair of ankle fracture (bimalleolar type), shoulder arthroscopy and debridement, repair fracture of the distal part of radius, incise finger tendon sheath, repair of ankle fracture (fibula), repair of femoral shaft fracture, repair of trochanteric fracture, bone flap fixation and the like.

[269] The present invention provides an applicator useful in minimally invasive surgical procedure such as Arthroscopy (i.e. arthroscopic surgery) and Brostrom procedures.

[270] The applicator is further useful for attaching at least one suture, ligation, fixation binding, immobilization and minimally invasive surgical procedure on bones, joints, soft tissues and/or ligaments. Furthermore, the applicator is configured for securing sections of a fractured bone and/or securing body tissue to bone.

[271] In another embodiment of the present invention, the applicator may further be used for meniscus repair such as meniscus tear, a damage to one of the rubbery discs that cushion the knee joint. The applicator can be inserted through small incisions allowing the surgeon to repair the meniscus using sutures or anchors.

[272] The present invention provides an applicator to stabilize and hold anatomical structures, more particularly a broken bone or bones, in place until healing is confirmed.

[273] The present invention provides an applicator useful in orthopedic procedures, comprising a distal portion and a proximal portion. The distal portion comprising a cartridge comprising a plurality of fastenable- sutures for ligation of at least one bone, joint, soft tissue and/or ligament and an elongate shaft interconnected to the cartridge. The elongate shaft comprising a curved needle configured to rotate about an axis approximately.

[274] The proximal portion comprising an actuating knob attached to a handle.

[275] The cartridge is configured for loading, deploying and/or discharging at least one fastenable- suture such that when activating the actuating knob at least one fastenable- suture is discharged.

[276] In another embodiment of the present invention, the fastenable-suture enables the precise adjustment of the required diameter during implantation. The fastenable suture's circumference can be adjusted every 2mm until the inner diameter of the circumference matches the outer diameter of the bone.

[277] In another embodiment of the present invention, the applicator is configured for placing plurality and/or continuous stitches.

[278] In another embodiment of the present invention, the applicator comprising at least one fastenable- suture is configured for tissue reinforcement. Bandages and/or casts may further be employed.

[279] The term "Fastenable-Suture" refers herein to a suture useful for ligation of at least one bone, joint, soft tissue and/or ligament, and characterized by an elongated flexible cord, with one or more teeth, hook, barb or/and clasp protruding from same. The fastenable- suture includes a male-head at the distal end and an accepting female -head at the proximal end. The male-head is in connection with an anchor, where the anchor is configured to be temporarily accommodated by a distal end of a guiding-shaft. The female -head includes a suture accepting-channel and a neighboring guiding-shaft accepting-channel. At least one of the two accepting-channels comprise one or more flexible pawls for both allowing, by means of the teeth or barbs, a continuous and linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the guiding-shaft a reversible reciprocal motion.

[280] The fastenable- suture may be a strand or fiber used to sew or suture parts of the living body; it can also refer to a ligature, such as a filament or thread, used to unite, connect or bind bones, joints, soft tissue and/or ligaments.

[281] The fastenable- suture may have variety of strip-like length ranging from about 20mm to about 60mm.

[282] The fastenable- suture has improved retention strength and it's easy to cut and handle.

[283] In another embodiment of the present invention, the fastenable-Suture may be further adapted together with a bioadhesive material such as natural polymeric materials that act as adhesives and may be composed of biocompatible materials. The bioadhesive material may consist of a variety of substances.

[284] Reference is still made again to Figure 1 presenting a perspective view of the applicator distal portion 1 comprising a tubular or semicircular cartridge 3 connected to an elongate shaft 2. The cartridge comprises a plurality of fastenable-sutures 4 for ligation of bones, joints, soft tissue and/or ligaments. The fastenable-sutures are characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male-head at the distal end and an accepting female-head at the proximal end.

[285] The elongate shaft 2 may be a cylindrical, spherical or tubular portion which can further rotate about an axis approximately perpendicular to a longitudinal axis of the elongated shaft. The elongate shaft comprises at least one rotating joint 5 which further enables the shaft to reticulate in about 360 ° circular arcs. The rotating joint may be configured as a foldable arm which further can be manipulated and/ or maneuvered relative to the longitudinal axis of the applicator. The rotating joint is configured for reversible deployment and withdrawal by means of reversible folding, collapsing, retracting and/or telescopic motion.

[286] The rotating joint may be a pivot joint, trochoid joint and/or rotary joint configured for protraction, retraction, flexion, extension, adduction and/or abduction. The rotation movement has a several degrees of freedom selected from the group consisting of: moving upwards or/and downwards, moving left and right, moving forward and backward, tilting forward and backward (i.e. pitching), swiveling left and right (i.e. yawing), pivoting side to side (i.e. rolling) and a combination thereof.

[287] The fastenable-sutures may extend across the fracture of the bone and may extend through the bone and/or through the second bone plate.

[288] In another embodiment of the present invention the applicator may comprise a plurality of distal edges that can fasten the tie lock in a secured and robust manner.

[289] Reference is now made again to Figure 2 presenting a cross section view of the needle and a gear system 10 located within the elongate shaft. The needle 11 follows a curved path during rotation of the cartridge. The gear system comprises an articulation strip and at least one gear wheel. The gear system movement is transferred via a semi-rigid metal strip (2D) connected to the manipulation system held by the user.

[290] It is in the scope of the invention wherein the needle or portions thereof is assembled in a telescopic manner, e.g., where needle is configured as a sequence of interconnected shafts comprising at least one first non-hollow shaft is insertable within an open bore of at least one second shaft. Such a telescopic needle arrangement provides the needle with a rotation of more than 180 degrees.

[291] The gear system 13, 12, 14 is further actuated by the knob which is further configured to engage, move, maneuver and/or manipulate the needle relative to the cartridge. The curved needle 11 is driven in a curved path about an axis approximately perpendicular to the longitudinal axis of the applicator. Preferably, the needle may have a radius of curvature of about 3 mm to about 40 mm. The needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable suture. The needle comprises a sharp pointed end.

[292] In another embodiment of the present invention, the needle may be a disposable needle.

[293] In another embodiment of the present invention, the needle rides in a track formed as a C- brace shape. The needle is selectively operable to grasp, release and fasten at least one fas tenable-suture.

[294] Reference is now made again to Figures 3A-D presenting cross section view of the curved needle rotation movement. As illustrated in Fig. 3B, the needle starts to rotate around its axis while protruding from the surface of the elongate shaft. Figures 3B, 3C and 3D further illustrate the needle angular motion whilst the angle a is increasing until the needle perform a 180° turn. The angular motion is with an angle a in a range of about -45°<a <45°.

[295] Reference is now made again to Figure 4 which presents an exponential decay graph of the distance of the needle axis vs. the rotation angle of the needle. As illustrated, the ratio of the distance is decreasing as the the rotation angle of the needle perform a 180° turn. Thereby, each time the rotation angle is increased, the distance is decreased.

[296] Reference is now made again to Figure 5 presenting a cross section view of the tubular cartridge 20 comprising a plurality of fastenable- sutures 21 for ligation of at least one bone, joint, and/or ligament, characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end. The male-head of the fastenable-suture is in connection with an anchor. The anchor configured to be temporarily accommodated by a distal end of a pushing-shaft. The female-head comprising a suture accepting-channel and a neighboring pushing-shaft accepting-channel; at least one of the two accepting-channels comprising one or more flexible pawls for both allowing, by means of the teeth, a continuous linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the pushing-shaft a reversible reciprocal motion.

[297] The fastenable-suture 21 may be composed of a biocompatible material , absorbable material or/and of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[298] In another embodiment of the present invention, the natural tissue may be a living tissue from an animal or human body such as bone, muscle and other tissues useful for medical transplants. The natural tissue provide longer-lasting suture with a faster recovery rate. [299] Reference is now made again to Figure 6 presenting a view of the tubular cartridge 30 comprising a plurality of fastenable-sutures 31 for and ligating at least one bone, joint, and/or ligament. The cartridge 30 may further comprise at least one aperture, a notch or an orifice in the sidewall of the housing 32 of the cartridge 30.

[300] The cartridge may laterally articulated to the left of center or the right of center in about 360° circular arc.

[301] The cartridge comprises plurality of template or mold having a cavity configured to fit and adjusted to the structure and size of the fastenable-suture. This further allows the penetration of the needle via the cartridge aperture for loading at least one fastenable-suture via its proximal end and forming at least one tied-suture.

[302] In another embodiment, the fastenable-sutures 31 may be attached to the cartridge 30 by adhesive material, mechanically attached, laser technics, welding technics, adhesion technics, injection technics and the like.

[303] In another embodiment, the cartridge may comprise fastenable-sutures having a length which can be range from about 10 mm to about 100 mm.

[304] Reference is now made again to Figure 7 presenting a view of the applicator 40 useful in orthopedic procedures comprising a distal portion 40a and a proximal portion 40b. The distal portion 40a comprising: a tubular cartridge 41 comprising a plurality of fastenable-sutures for ligation of at least one bone, joint, soft tissue and/or ligament. The fastenable-suture is characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end; an elongate shaft interconnected to the cartridge comprising a curved needle configured to rotate about an axis approximately.

[305] The distal portion further comprises an elongate shaft 42 interconnected to the cartridge 41 comprising a curved needle configured to rotate about an axis approximately.

[306] The proximal portion 40b further comprising an actuating knob 43 attached to a handle 44.

[307] In another embodiment, the applicator includes an actuator mechanism which comprises an elongated shaft having barrel-like shape and a handle at the proximal portion. In another embodiment of the present invention, the handle is with an open and close configuration. The handle 44 is configured as a grip assembly which is squeezed in order to actuate the applicator.

[308] In another embodiment, the applicator ,portions or parts of the applicator, such as the cartridge, the elongated shaft or/and the handle, are composed of a sterilizable medical grade plastic material, in which case, the applicator or parts of the applicator may discarded and disposed after a single use.

[309] In another embodiment, the applicator is composed of a sterilizable medical grade metallic material such as stainless steel to enable reuse subsequent to sterilization following a prior use.

[310] In another embodiment, the applicator is composed of a sterilizable medical grade metallic material such as titanium to enable reuse subsequent to sterilization following a prior use. The use of titanium is beneficial for certain procedures including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) because they are X-Ray radiolucent and do not interfere with MRI and CT scans.

[311] The applicator is configured in different manner with respect to length and angle of the fastenable suture.

[312] In another embodiment of the present invention, the size and position of the fastenable- suture , the needle and the cartridge may also be varied for use in open surgery to perform procedures such as closing of the fascia, skin and wound closure, soft tissue attachment, anastomosis, fixation of mesh, grafts and other artificial materials.

[313] Reference is now made again to Figure 8 presenting a view of the fastenable- suture comprising a curved needle deployment mechanism 50. The fastenable- suture comprising a curved needle 52 which further promotes greater support per release of at least one fastenable-suture. The distal portion of the applicator is with a flat faced to improve adherence against a target region in a bone, joint, and/or ligament.

[314] Reference is now made again to Figure 9 which illustrates the distal side of the applicator 60 comprising a cartridge 61 during mid deployment of at least one fastenable-suture 62.

[315] The eployment of at least one fastenable-suture may further be performed with a mesh overlapping the desired region.

[316] Reference in now made again to Figure 10 which illustrates the applicator 70 comprising a plurality of fastenable- sutures 71 positioned against the peritoneum 72 for deployment.

[317] In another embodiment of the present invention, the applicator is with an improved visibility offered by the shape and configuration of the suture enables precise device placement over the incision, and uniform advancement of the applicator after every stitch to provide a uniform and symmetric suture, thereby minimizing the risk of tearing tissue and bleeding due to a stitch being positioned to close to the edge of the incised tissue.

[318] Reference in now made to Figure 11 which illustrates a drill guide assembly comprising a distal portion 80a and a proximal portion 80b. The distal portion 80a has a curved shape comprising a sharp blade bit connected to a telescopic cable or wire. The drill assembly is configured to form at least one hole and a path for a fastenable- suture which may extend diametrically through the generally cylindrical bone.

[319] The elongate wire is composed of a flexible or semi-flexible material allowing the wire to be bend, twist or/and turn.

[320] The sharp blade bit may be a replaceable element having different size, length, tip and structure. The drill bit is selected from the group consisting of twist drill bits, step drill bits, unibit and a combination thereof.

[321] The drill bits are rotatable by providing torque and axial force to create the hole within the bone.

[322] The drill bit is a composed of medical grades material selected from the group consisting of of stainless steel, titanium, cobalt chrome (CoCr), nitinol (NiTi), exotic alloys, aluminum, brass and polymers; including PEEK, polyethylene (UHMWPE), Radel and a combination thereof.

[323] The proximal portion comprises an actuating switch for activating, controlling and rotating the drill bits.

[324] The drill guide assembly is a telescopic assembly allowing the user to position the drill bit in a desired location.

[325] The drill assembly is with an angular motion for internal fixation of bone fractions.

[326] In another embodiment the present invention is useful for both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

[327] Reference in now made to Figures 12-13 which illustrate a kit 90 for ligation of at least one bone, joint, and/or ligament, comprising: a drill guide assembly 92; and an applicator 91 useful in orthopedic procedures, comprising: a distal portion and a proximal portion; the distal portion comprising:a cartridge comprising a plurality of fastenable-sutures for for ligation of at least one bone, joint, and/or ligament and, an elongate shaft/ barrel interconnected to the cartridge comprising a curved needle configured to rotate about an axis approximately. The proximal portion comprising an actuating knob attached to a handle.

[328] The kit may further comprise an inflatable element for housing and stabilizing the applicator and the drill assembly in a predefined position and region.

[329] In another embodiment the present invention the kit and procedure may be performed under screening and imaging system and procedures selected from the group consisting of MRI, X- ray and CT. [330] As illustrated in Figure 12, a hole is drilled through the bone fragment 96 to form the first section of the passage for a fastenable-suture.

[331] As illustrates in Figure 13, the distal portion of the drill comprising a drill bit which can be manipulate in a predefined angle to drill a hole and preparing the bone for a fastenable-suture deployment.

[332] Reference in now made to Figure 14 which illustrates the bone fixation 100 by using the fastnable-suture forming at least one tied-suture 110. The fastnable-suture is threaded through the formed hole and/or path within the bone forming a secured closer of a loop or ring-like pattern.

[333] The method comprising the steps of providing an applicator as defined above; introducing the distal portion of the applicator to at least one bone, joint, and/or ligament; activating an actuator knob coupled to the needle to cause rotational movement of the needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advance the needle through the bone, joint, and/or ligament ;and discharging at least one fastenable-suture from the cartridge attached to the needle through the bone, joint, and/or ligament, forming at least one stitch.

[334] In another embodiment of the present invention the method additionally comprising steps of repeating steps (c) through (d) to cause a plurality of stitches to be placed through the bone, joint, and/or ligament.

[335] In another embodiment of the present invention the method additionally comprising steps positioning the cartridge against or parallel to the bone, joint, and/or ligament.

[336] In another embodiment of the present invention the method additionally comprising steps of providing a drill guide assembly for forming a path for fastenable-suture insertion.

[337] In another embodiment of the present invention the method additionally comprising steps of deploying the needle to drive the suture into the bone, joint, soft tissue and/or ligament and retracting the same.

[338] In another embodiment of the present invention the method additionally comprising steps of providing the fastenable-suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male-head at the distal end and an accepting female- head at the proximal end.

[339] In another embodiment of the present invention the method additionally comprising steps of guiding and fastening the fastenable-suture to form a tied-suture upon a target area in at least one additional act. [340] In another embodiment of the present invention the step of providing the cartridge comprising at least one aperture in a sidewall of the cartridge allowing needle to penetrate and grasp at least one fastenable-suture .

[341] The present invention have been further defined specifically to provide fastener applicator, means and method useful in cardiac and cardiovascular procedures such as

[342] cardiac catheterization and coronary angiography, cardiac surgeries, angioplasty and stenting, carotid angiography and intervention, aortic endovascular aneurysm repair, transcatheter aortic- valve implantation, peripheral intervention, coronary artery bypass grafting, transmyocardial laser revascularization, arrhythmia treatment, aneurysm repair, heart transplant, surgery to place ventricular assist devices or total artificial hearts, open-heart surgery, off-Pump heart surgery, repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG and any minimally invasive heart surgery.

[343] The fastener applicator of the present invention is configured to facilitate standard tissue securing.

[344] The fastener applicator is further useful for attaching at least one suture, suturing, ligation, fixation binding, immobilization and minimally invasive surgical procedure on tissues, organs, vessels, veins, mitral valve and/or artery.

[345] The present invention provides a fastener applicator useful in cardiac procedures, comprising a distal portion and a proximal portion. The distal portion comprising a cartridge comprising a plurality of fastenable-sutures for suturing of at least one tissue and an elongate shaft interconnected to the cartridge. The elongate shaft comprising a curved suturing needle configured to rotate about an axis approximately.

[346] The proximal portion comprising an actuating knob attached to a handle.

[347] The cartridge is configured for loading, deploying and/or discharging at least one fastenable- suture such that when activating the actuating knob at least one fastenable-suture is discharged.

[348] In another embodiment of the present invention, the fastenable-suture enables the precise adjustment of the required diameter during implantation. The fastenable suture's circumference can be adjusted every e.g., about 0.5 to about 8 mm, e.g., about 2mm, until the inner diameter of the circumference matches the outer diameter of the organ, vessel, vein or any desired tissue.

[349] In another embodiment of the present invention, the fastener applicator is configured for placing plurality and/or continuous stitches. [350] In another embodiment of the present invention, fine-tuning is further enabled by the fastener applicator during or after fastenable-suture placement in order to optimize the mitral valve repair.

[351] In another embodiment of the present invention, the fastener applicator comprising at least one fastenable-suture is configured for tissue reinforcement.

[352] In another embodiment of the present invention, the fastener applicator may further comprise an expandable member or balloon such that when expanded within the patient's ascending aorta separates the heart and coronary blood vessels from the rest of the patient's arterial system, configured to deploy a plurality of suture connected to the tissue within the heart.

[353] In another embodiment of the present invention, the fastener applicator may further comprise an automated suturing mechanism and/or anchoring system.

[354] The term "Tissue" refers herein to arteries, veins, vessels, ducts and/or any natural tissue of a human or animals. The term "tissue " further refers herein to any visceral organ that is a hollow tube or pouch, such as the stomach, urinary bladder, urethra, intestine, male reproductive system, female reproductive system such as uterus, fallopian tube, ovary, cervix, or that includes anatomical cavity, such as the heart or the lung.

[355] In another embodiment of the present invention the fastener applicator may be used

[356] for endoscopic clip placement within the gastrointestinal tract for the purpose of endoscopic marking, hemostasis for mucosal/submucosal defects in the upper GI tract, bleeding ulcers, arteries and polyps in the GI tract, appendectomy , sterilization procedures, cholecystectomy, Uterine Prolapse and other pelvic floor procedures, GI repair ,endoluminal gastroplication for gastro-oesophageal reflux disease, bariatric surgery such as adjustable gastric band surgery and any known GI procedures.

[357] The term " Fastenable-Suture" refers herein to a fastenable-suture useful for suturing and/or ligation and/or restriction tissue and/or block circular/tuvular organs of at least one tissue and characterized by an elongated flexible cord, with one or more teeth, hook, barb or/and clasp protruding from same. The fastenable-suture includes a male-head at the distal end and an accepting female-head at the proximal end. The male -head is in connection with an anchor, where the anchor is configured to be temporarily accommodated by a distal end of a guiding- shaft. The female -head includes a suture accepting-channel and a neighboring guiding- shaft accepting-channel. At least one of the two accepting-channels comprise one or more flexible pawls for both allowing, by means of the teeth, hooks or barbs, a continuous and linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the guiding-shaft a reversible reciprocal motion.

[358] The fastenable-suture is configured to hold tissues together or to secure prosthetics to a native tissue including but not limited to, heart valve prosthetics, annuloplasty rings, vascular grafts, and orthopedic implants.

[359] The fastenable-suture may be a strand or fiber used to sew or suture parts of the living body; it can also refer to a ligature, such as a filament or thread, used to unite, connect or bind tissues.

[360] The fastenable-suture may have variety of strip-like length ranging from about 20 mm to about 60mm.

[361] The fastenable-suture has improved retention strength and it's easy to cut and handle.

[362] In another embodiment of the present invention the fastenable-suture may further comprise plurality of slots along its length.

[363] Reference is now made yet again to Figure 1 presenting a perspective view of the fastener applicator distal portion 1 comprising a tubular or semicircular cartridge 3 connected to an elongate shaft 2. The cartridge comprises a plurality of fastenable-sutures 4 for suturing a tissue. The fastenable-sutures are characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male-head at the distal end and an accepting female-head at the proximal end.

[364] The elongate shaft 2 may be a cylindrical, spherical or tubular portion which can further rotate about an axis approximately perpendicular to a longitudinal axis of the elongated shaft. The elongate shaft comprises at least one rotating joint 5 which further enables the shaft to reticulate in about 360 ° circular arcs. The rotating joint may be configured as a foldable arm which further can be manipulated and/ or maneuvered relative to the longitudinal axis of the fastener applicator. The rotating joint is configured for reversible deployment and withdrawal by means of reversible folding, collapsing, retracting and/or telescopic motion.

[365] The rotating joint may be a pivot joint, trochoid joint and/or rotary joint configured for protraction, retraction, flexion, extension, adduction and/or abduction. The rotation movement has a several degrees of freedom selected from the group consisting of: moving up and down, moving left and right, moving forward and backward, tilting forward and backward (i.e. pitching), swiveling left and right (i.e. yawing), pivoting side to side (i.e. rolling) and a combination thereof.

[366] The fastenable-sutures may extend across the vessels and/or veins and may extend through the organ and/or through the second organ vessels and/or veins. [367] The fastener applicator can be inserted through small incisions in the chest. This allows the surgeon to do complex and highly precise surgery.

[368] Reference is now made yet again to Figure 2 presenting a cross section view of the suturing needle and a gear system 10 located within the elongate shaft. The needle 11 follows a curved path during rotation of the cartridge. The gear system comprises an articulation strip and at least one gear wheel. The gear system movement is transferred via a semi-rigid metal strip (2D) connected to the manipulation system held by the user.

[369] The gear system 13, 12, 14 is further actuated by the knob which is further configured to engage, move, maneuver and/or manipulate the needle relative to the cartridge. The curved needle 11 is driven in a curved path about an axis approximately perpendicular to the longitudinal axis of the fastener applicator. Preferably, the needle may have a radius of curvature of about 3 mm to about 40 mm. The suturing needle covers an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable suture. The needle comprises a sharp pointed end.

[370] In another embodiment of the present invention, the needle may be a disposable needle.

[371] In another embodiment of the present invention, the suturing needle rides in a track formed as a C-brace shape. The needle is selectively operable to grasp, release and fasten at least one fastenable-suture.

[372] Reference is now made yet again to Figures 3A-D presenting cross section view of the curved needle rotation movement. As illustrated in Fig. 3B, the needle starts to rotate around its axis while protruding from the surface of the elongate shaft. Figures 3B, 17C and 3D further illustrate the needle angular motion whilst the angle a is increasing until the needle perform a 180° turn. The angular motion is with an angle a in a range of about -45°<a <45°.

[373] Reference is now made yet again to Figure 4 which presents an exponential decay graph of the distance of the needle axis vs. the rotation angle of the needle. As illustrated, the ratio of the distance is decreasing as the the rotation angle of the needle perform a 180° turn. Thereby, each time the rotation angle is increased, the distance is decreased.

[374] Reference is now made yet again to Figure 5 presenting a cross section view of the tubular cartridge 20 comprising a plurality of fastenable- sutures 21 for suturing and/or ligation of at least one tissue characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male-head at the distal end and an accepting female-head at the proximal end. The male-head of the fastenable-suture is in connection with an anchor. The anchor configured to be temporarily accommodated by a distal end of a pushing-shaft. The female- head comprising a suture accepting-channel and a neighboring pushing-shaft accepting- channel, at least one of the two accepting-channels comprising one or more flexible pawls for both allowing, by means of the teeth, a continuous linear forward motion of the male-head and the cord within the accepting-channel in only one direction, while preventing motion of the male-head and cord in a backward direction and allowing only the pushing-shaft a reversible reciprocal motion.

[375] The fastenable-suture 21 may be composed of a biocompatible material , absorbable material or/and of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[376] In another embodiment of the present invention, the natural tissue may be a living tissue from an animal or human body such as vessels, veins, muscle and other tissues useful for medical transplants. The natural tissue provide longer-lasting suture with a faster recovery rate.

[377] Reference is now made yet again to Figure 6 presenting a view of the tubular cartridge 30 comprising a plurality of fastenable-sutures 31 for suturing and/or ligating at least one tissue. The cartridge 30 may further comprise at least one aperture, a notch or an orifice in the sidewall of the housing 32 of the cartridge 30.

[378] The cartridge may laterally be articulated to the left of center or the right of center in about 360° circular arc.

[379] The cartridge comprises plurality of template or mold having a cavity configured to fit and adjusted to the structure and size of the fastenable-suture. This further allows the penetration of the needle via the cartridge aperture for loading at least one fastenable-suture via its proximal end and forming at least one tied-suture.

[380] In another embodiment, the fastenable-sutures 31 may be attached to the cartridge 30 by adhesive material, mechanically attached, laser technics, welding technics, adhesion technics, injection technics and the like.

[381] In another embodiment, the cartridge may comprise fastenable-sutures having a length which can be range from about 10 mm to about 100 mm.

[382] Reference is now made yet again to Figure 7 presenting a view of the fastener applicator 40 useful in cardiac procedures comprising a distal portion 40a and a proximal portion 40b. The distal portion 40a comprising: a tubular cartridge 41 comprising a plurality of fastenable- sutures for suturing and/or ligation of at least one tissue. The fastenable-suture is characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male -head at the distal end and an accepting female-head at the proximal end; an elongate shaft interconnected to the cartridge comprising a curved suturing needle configured to rotate about an axis approximately.

[383] The distal portion further comprises an elongate shaft 42 interconnected to the cartridge 41 comprising a curved suturing needle configured to rotate about an axis approximately.

[384] The proximal portion 40b further comprising an actuating knob 43 attached to a handle 44.

[385] In another embodiment, the fastener applicator includes an actuator mechanism which comprises an elongated shaft having barrel-like shape and a handle at the proximal portion. In another embodiment of the present invention, the handle is with an open and close configuration. Handle 44 is configured as a grip assembly which is squeezed in order to actuate the fastener applicator.

[386] In another embodiment, the fastener applicator ,portions or parts of the fastener applicator, such as the cartridge, the elongated shaft or/and the handle, are composed of a sterilizable medical grade plastic material, in which case, the fastener applicator or parts of the fastener applicator may discarded and disposed after a single use.

[387] In another embodiment, the fastener applicator is composed of a sterilizable medical grade metallic material such as stainless steel to enable reuse subsequent to sterilization following a prior use.

[388] In another embodiment, the fastener applicator is composed of a sterilizable medical grade metallic material such as titanium to enable reuse subsequent to sterilization following a prior use. The use of titanium is beneficial for certain procedures including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) because they are X-Ray radiolucent and do not interfere with MRI and CT scans.

[389] The fastener applicator is configured in different manner with respect to length and angle of the fastenable suture.

[390] In another embodiment of the present invention, the size and position of the fastenable- suture, the needle and the cartridge may also be varied for use in open surgery to perform procedures such as closing of the fascia, skin and wound closure, soft tissue attachment, anastomosis, fixation of mesh, grafts and other artificial materials.

[391] Reference is now made yet again to Figure 8 presenting a view of the fastenable- suture comprising a curved needle deployment mechanism 50. The fastenable- suture comprising a curved needle 52 which further promotes greater support per release of at least one fastenable-suture. The distal portion of the fastener applicator is with a flat faced to improve adherence against a target region in a tissue or/and organ. [392] Reference is now made yet again to Figure 9 which illustrates the distal side of the fastener applicator 60 comprising a cartridge 61 during mid deployment of at least one fastenable- suture 62.

[393] The eployment of at least one fastenable-suture may further be performed with a mesh overlapping the desired region.

[394] Reference in now made yet again to Figure 10 which illustrates the fastener applicator 70 comprising a plurality of fastenable- sutures 71 positioned against the peritoneum 72 for deployment.

[395] In another embodiment of the present invention, the fastener applicator is with an improved visibility offered by the shape and configuration of the suture enables precise device placement over the incision, and uniform advancement of the fastener applicator after every stitch to provide a uniform and symmetric suture, thereby minimizing the risk of tearing tissue and bleeding due to a stitch being positioned too close to the edge of the incised tissue.

[396] Reference in now made to Figures 15-15C which illustrate the fastener applicator configuration 81 for deploying and ligation of at least one fastenable-suture 83 to at least one vessel 82, vein and/or artery.

[397] Figure 11A presents a fastener applicator for ligation of a first tissue to a second tissue, comprising: a distal portion and a proximal portion. The distal portion comprising griping means configured as scissors-like clamps whilst at least one clamp is mounted to a curved suturing needle. The proximal portion comprising an elongate shaft connected to the griping means. The elongate shaft comprises a plurality of fastenable-sutures arranged in a vertical or horizontal manner.

[398] The fastenable-suture is characterized by an elongated flexible cord, having a male-head at the distal end and an accepting female -head at the proximal end. The scissors-like clamps is configured for loading and/or discharging at least one fastenable-suture such that when activating the clamps at least one fastenable-suture is discharged from the elongate shaft by the curved suturing needle forming at least one tied-suture around first and second tissue.

[399] As illustrate the fastener applicator comprises scissors-like clamps having a curved shape for guiding, embracing and ligating at least two blood vessels.

[400] As illustrated the scissors-like clamps are two curved, opposed pincer-like elements.

[401] Reference in now made to Figures 16A-16C which illustrate the fastener applicator when discharging at least one fastenable-suture. The fastenable-sutures may be deployed and discharged from the applicator in a vertical or horizontal manner. The scissors-like clamps is further configured to grip, secure and tie knots quickly with a controlled tension. The scissors-like clamps have a close and open configuration.

[402] Reference in now made to Figures 17A-17F which illustrate the fastener applicator forming a closure of a tied-suture loop encircling the vessels or through the tissue.

[403] As illustrated in Fig. 17A the fastener applicator is retracted for releasing the tied-suture surrounding the vessels 131.

[404] Reference in now made to Figures 18a-18b which illustrate a fastener applicator position when the tied fastenable- suture is drawn and secured at a given tension, whereupon the applicator is detached and removed.

[405] In another embodiment the present invention is useful for both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

[406] In another embodiment of the present invention method of ligating a first tissue to a second tissue, is provided. The method comprising steps of: providing a fastener applicatorthe; introducing the distal portion of the fastener applicator to the first and second tissue; activating griping means coupled to the suturing needle to cause rotational movement of the shaft comprising plurality of fastenable- sutures; and discharging at least one fastenable-suture from the shaft encircling the first and second tissue, forming at least one tied -suture.

[407] In another embodiment of the present invention a method for suturing at least one tissue is provided.

[408] The method comprising the steps of: providing a fastener applicator; introducing the distal portion of the fastener applicator to at least one tissue; activating an actuator knob coupled to the suturing needle to cause rotational movement of the suturing needle about an axis approximately perpendicular to a longitudinal axis of the cartridge comprising at least one fastenable-suture and advance the suturing needle through the tissue ;and discharging at least one fastenable-suture from the cartridge attached to the suturing needle through the tissue, forming at least one stitch.

[409] In another embodiment of the present invention the method additionally comprising steps of repeating steps (c) through (d) to cause a plurality of stitches to be placed through the tissue.

[410] In another embodiment of the present invention the method additionally comprising steps positioning the cartridge against or parallel to the tissue.

[411] In another embodiment of the present invention the method additionally comprising steps of deploying the suturing needle to drive the suture into the tissue and retracting the same. [412] In another embodiment of the present invention the method additionally comprising steps of providing the fastenable- suture characterized by an elongated flexible cord, with at least one teeth protruding from same, having a male-head at the distal end and an accepting female- head at the proximal end.

[413] In another embodiment of the present invention the method additionally comprising steps of guiding and fastening the fastenable-suture to form a tied-suture upon a target area in at least one additional act.

[414] In another embodiment of the present invention the step of providing the cartridge comprising at least one aperture in a sidewall of the cartridge allowing needle to penetrate and grasp at least one fastenable-suture .

[415] In another embodiment of the present invention the step of providing cartridge having a shape selected from the group consisting of; tubular, conical, cylindrical, roller, semicircular and a combination thereof.

[416] In another embodiment of the present invention the method additionally comprising step of operating the needle in an angular motion by the gear system to grasp, release and fasten the fastenable-suture from the cartridge.

[417] In another embodiment of the present invention the method additionally comprising step of activating the needle to follow a curved path of less than about 180° during rotation of the cartridge.

[418] In another embodiment of the present invention the step of providing fastenable-suture composed of a biocompatible material.

[419] In another embodiment of the present invention the step of providing fastenable-suture composed of a material selected form the group consisting of sterilizable medical grade plastic material, sterilizable medical grade metallic material such as stainless steel, titanium and a combination thereof, metal alloy, natural tissue and any combination thereof .

[420] In another embodiment of the present invention the method additionally comprising step of laterally articulating the cartridge to the left of center or the right of center in a 360° circular arc.

[421] In another embodiment of the present invention the step of providing suturing needle covering an arc greater than about 0° and less than about 180° having a sharp leading edge for engaging the fastenable-suture.

[422] In another embodiment of the present invention the method additionally comprising step of holding and stabilizing the suturing needle in a path of rotation by a combination of the gear system and a rigid metal strip. [423] Reference in now made to FIG. 19 which illustrates in a non-limiting manner schematic drawings of an end-type, or tail-type inter-connectable fastenable- suture (390), according to an embodiment of the present invention. This fastener is an elongated member, comprising a female side (here lower portion of the fastener, 392) and a male side (here high portion of the fastener, 394). In this example, a female male-accepting connecting member 391 is located at the female portion of the fastener 392, and male connecting member 393 is located at the male portion of the fastener 394. Other options and possible, e.g., female connector in male saide etc.

[424] In one embodiment of the technology, the tension of the fastening of the fastener is configured to be adjusted. The adjustment is provided before fastening, while fastening or both.

[425] Reference in now made to FIG. 20 which schematically illustrates a train of tail-type inter- connectable fastenable-sutures (390), according to an embodiment of the present invention. Here fastener 390„ is reversibly and/or temporarily head-to-tail connected with fastener 390 _n+ i, by means male and female interconnecting members, respectively.

[426] Reference in now made to FIG. 21 which schematically illustrates a spiral-wound roll of inter-connectable fastenable-sutures, e.g., 390 type fasteners, according to an embodiment of the present invention.

[427] Reference in now made to FIGS. 22A & 22B which schematically illustrates two views of a cartridge of a spiral-wound roll of inter-connectable fastenable-sutures, e.g., 390 type fasteners, according to an embodiment of the present invention.

[428] Reference in now made to FIG. 22c which schematically illustrates a cartridge of a snakelike roll of inter-connectable fastenable-sutures, according to an embodiment of the present invention. Here fastener 390 _n is reversibly and/or temporarily head-to-tail connected with fastener 390 _n+ i, by means male and female interconnecting members, respectively.

[429] Reference in now made to FIGS. 23 which schematically illustrates a snake-like sequence of inter-connectable fastenable-sutures, an assembly utilizable in a cassette, according to an embodiment of the present invention. Here again, fastener 390 _n is reversibly and/or temporarily head-to-tail connected with fastener 390 _n+ i, by means male and female interconnecting members, respectively

[430] Reference in now made to FIGS. 24A & 24B which schematically illustrates two views of a middle-type (body-type) inter-connectable fastenable-suture 450 (i.e., the fastener„-to- fastner„ ₊ ; inter-connecting member is not located at the end portion of the fastener, but somewhere in its middle portion(s), 451), according to an embodiment of the present invention.

Reference in now made to FIGS. 25A & 25B which schematically illustrates two views of a train of middle-type inter-connectable fastenable-sutures, according to an embodiment of the present invention. Here fastener 450„ is reversibly and/or temporarily body-to-body connected with fastener 450 _n+ i, by means male and female interconnecting members, respectively. It is acknowledged in this respect that any inter-connecting combination e.g., body-to-body, body-to-tail, and body-to-head, head-to-tail connection is utilizable.