provide increased frictional engagement between the tissue and the instrument a preferred embodiment includes two spacer limbs 115 116 alternate embodiments are operable with one spacer limb or with more than two spacer limbs the spacer limbs 115 116 can be coupled to the instrument in a number of ways preferably as illustrated in fig3 the spacer limbs 115 116 are slidably coupled to the limbs 120 and 121 such that the distance between spacer limbs 115 116 and the plane defined by limbs 120 and 121 is selectively variable more specifically as illustrated in the embodiment of fig3 and 4 the spacer limbs 115 and 116 are slidably coupled to the handle 135 each spacer limb 115 116 is integrally formed with an elongate member 140 141 respectively oriented generally perpendicular to the spacer limb 115 116 this elongate member 140 141 resides in a tube 150 151 coupled to the handle 135 tubes 150 151 terminate in proximal ends 153 154 and at distal ends 156 157 preferably the elongate members 140 141 are sized to slide in a longitudinal direction within the respective tube 150 151 flanges 160 161 are integrally coupled to the proximal ends of the elongate member 140 141 and are disposed generally perpendicular to the elongate member the flanges 160 161 limit the movement of the elongate member in the distal direction by abutting the.