A method of suturing a tissue opening can comprise placing a tissue-facing surface of a first pad (374), a second pad (372) and a third pad (370) over respective tissue areas adjacent to the tissue opening. The second pad (372) can be positioned on a first side of the first pad (374) and the third pad (370) can be positioned on a second side of the first pad. The first and second pads can be coupled to a suture (310), the suture forming a stitch (316, 320) over the upper surface of each of the respective pads. The suture can be stitched through an area of tissue between the first pad and the second pad, between the second pad and the third pad, and between the third pad and the first pad. A first distal portion (312) and a second distal portion (324) of the suture can be coupled to the third pad (370) for forming the purse-string suture.
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