for example a sharpened distal tip may be formed as an integral part of the helical needle e g by sharpening the distal end of the hypotube or as separate element e g an inner needle with a sharp tip that can extend from within the helical needle as depicted in fig6 and or a detachable sharp tip positioned at the distal end of the hypotube that forms of the helical needed as depicted in fig2 a 2d in one embodiment of the invention after or as the helical needle is rotated into the heart wall 82 the distal end of the helical needle 26 is advanced back out of the heart wall 82 so that the surgeon or other user can grasp the distal portion 34 of the suture 30 in order to form the full purse string for example when the helical needle 26 has been rotated about 360 degrees in screw like fashion in the heart wall 82 the distal end of the helical needle 26 such as the detachable distal tip 28 of fig2 a 2d can be advanced back out of the heart wall 82 at a position at or adjacent the position where the helical needle 26 first entered the heart wall 82 such as in the embodiment depicted in fig7 advancing the distal end of the helical needle 26 out of the heart wall 82 may be achieved by various methods depending on the particular application for example simply angling the entire instrument 20 can cause the distal end of the helical needle 26 to be directed in a generally proximal direction and back out of the heart wall 82.