Endoscopic suturing device with circular needle

1. An endoscopic suturing system comprising:

(a) a distal assembly comprising:

(i) a first housing comprising an arcuate needle guide and an endoscope fastener, wherein the endoscope fastener attaches the first housing to an endoscope;

(ii) an arcuate needle comprising a notch and a suture attachment, wherein the arcuate needle has a center axis, and wherein the arcuate needle is disposed within the arcuate needle guide; and

(b) a proximal assembly comprising:

(i) a second housing;

(ii) an actuator connected to the second housing; and

(c) a cable having a pawl, wherein the pawl extends from a cable surface and is biased away from the cable surface;

wherein the notch and the pawl engage when the cable translates in a first rotational direction about the center axis, and wherein the notch and the pawl disengage when the cable translates opposite the first rotational direction.

2. The system of claim 1 , wherein the pawl comprises a spring, a flexure, a dual spring gate, a cushion, a piston, a rod, a pin, a tooth, or any combination thereof.

3. The system of claim 1 , wherein the notch is ramped in a direction opposite the first direction.

4. The system of claim 1 , wherein the endoscope fastener comprises a press-fit fastener, a clamp, an adhesive, a tape, a strap, a set screw, a hook and loop fastener, a magnet, or any combination thereof.

5. The system of claim 1 , wherein the endoscope has a proximal outer diameter of about 5 mm to about 156 mm.

6. The system of claim 1 , further comprising a cable sheath surrounding at least a portion of the cable.

7. The system of claim 6 , further comprising a cable fastener that removably couples at least a portion of the cable to the endoscope.

8. The system of claim 7 , wherein the cable fastener comprises a press-fit fastener, a tie, a string, a band, a hook and loop fastener, a tape, a strap, a magnet, a cinch, a press fit, a set screw, an adhesive, or any combination thereof.

9. The system of claim 1 , wherein an angle between a center axis of the arcuate needle guide and a proximal axis of the endoscope is about 5 degrees to about 85 degrees.

10. The system of claim 9 , wherein the angle between the center axis of the arcuate needle guide and a proximal axis of the endoscope is adjustable within about 5 degrees to about 85 degrees.

11. The system of claim 1 , wherein the arcuate needle comprises two or more notches.

12. The system of claim 1 , wherein at least one of the first housing, the second housing, the arcuate needle, and the actuator are composed of plastic, metal, fiberglass, carbon fiber, wood, or any combination thereof.

13. The system of claim 1 , wherein the first housing further comprises a cable pulley that guides the cable.

14. The system of claim 1 , wherein the arcuate needle further comprises a suture attachment fastener.

15. The system of claim 1 , wherein the second housing removably couples to the endoscope.