A method of attaching a knotting element to a suturing device including the steps of providing an adapter for insertion into a body, the adapter having a proximal end and an open distal end. Providing a knot tying element for tying suture together. Releasably attaching the distal end of the adapter to the knot tying element by inserting a proximal end of the knot tying element into the open distal end of the adapter and thereafter rotating the knot tying device with respect to the adapter.