referring to fig1 , grasper 100 includes top jaw member 102 and bottom jaw member 104 connected by joint member 106 . jaw members 102 , 104 open to receive a portion of tissue 105 , e . g ., a portion of rotator cuff tissue in a shoulder . joint member 106 allows jaw members 102 , 104 to engage and grasp the tissue located therebetween ( e . g . by articulating jaws 102 , 104 from an open position to a closed position , or simply by providing mechanical resistance as tissue is received between the jaw members ). as shown , the jaw members 102 , 104 are flat , paddle type jaws . jaw members 102 , 104 each include a pair of anchor target slots 108 . as described in further detail below , anchor target slots 108 can be used to easily and reliably provide desired positioning of suture anchors used to secure tissue 105 to bone 110 . paddle 100 may be constructed of any suitable material , e . g . biocompatible material including metal ( e . g . stainless steel ), plastic , polymers , and or other materials . fig2 shows a top down view of grasper 100 positioned to grasp tissue 105 . anchor target slots 108 are formed as aligned pair of , e . g ., semicircular apertures in the sides ( e . g . in the outer / perimeter edge 101 ) of the upper and lower jaw member paddles ( note that as used herein the term aperture indicates any open region through which a suture anchor may pass , and need not completely surround the anchor ). the position of target anchor slots are chosen to correspond to a desired position for a pair of suture anchors 112 . for example , as shown , target anchor slots 108 are placed such they are located a desired distance l from the edge of tissue 105 when the grasper has fully engaged the tissue . accordingly , anchors 112 inserted at the target anchor locations will be placed at the correct distance medial the edge of tissue 105 . further anchor targets 108 are positioned distance w apart from each other on either side of jaw members 102 , 104 accordingly , anchors 122 inserted at the target anchor locations will be placed at the correct distance relative to each other . of course , it is to be understood that other configurations may be used to provide any desired anchor placement . fig3 a - 3i illustrate the use of grasper 100 to secure rotator cuff tissue 105 to adjacent humerous head bone 110 . referring to fig3 a , grasper 100 receives tissue 105 between jaw members 102 , 104 such that bottom jaw member 104 is adjacent to bone 110 . the grasper is advanced as far as possible in the medial direction , filling the area between jaw members 102 , 104 with tissue to provide the desired tissue “ bite .” a portion of tissue 105 is thereby grasped between jaw members 102 , 104 . fig3 b shows a top down view of grasper 100 corresponding to the perspective view shown in fig3 a . referring to fig3 c , suture anchors 112 are positioned over anchor target slots 108 . suture anchors 112 each include a rigid ( e . g . metal or rigid plastic ) punch through portion 114 with a threaded tip 116 . a flexible suture portion 118 extends from the end 119 of punch through portion 114 opposite threaded tip 116 . suture portions 118 may be made from any suitable suture material , including weldable ( e . g . heat - or ultrasound - weldable ) material . the ends 119 of punch through portions 114 are engaged by anchor drivers 120 ( e . g . manual screw anchor driver , motorized anchor driver , etc .). fig3 d shows a top down view of grasper 100 corresponding to the perspective view shown in fig3 c . referring to fig3 e , drivers 120 have been used to drive anchors 112 through tissue 105 and into bone 110 , such that the rigid punch through portions 116 have penetrated ( e . g . bored , treaded , augured , etc ) into bone 110 . flexible suture portions 112 extend from the ends 119 of punch through portions 119 out through tissue 105 . in the interest of clarity , anchor drivers 120 are not shown , but remain engaged with ends 119 . in some embodiments , the driving of anchors 112 may be preceded by pre - drilling step when a drill is used to provide a guide hole into the tissue and bone . fig3 f shows a top down view of grasper 100 corresponding to the perspective view shown in fig3 e . arrows indicate the rotation of anchor 112 by driver 120 to auger through tissue 105 and thread into bone 110 . referring to fig3 g , grasper 100 has been removed , and anchor drivers 120 withdrawn from the treatment area . punch through portions 114 of anchors 112 are securely anchored at the desired position ( both relative to tissue 105 and each to each other ) in bone 110 . flexible suture portions 118 extend from ends 119 of punch through portions 114 , passing out through tissue 105 . referring to fig3 h , suture welder 122 engages flexible suture portions 118 extending from tissue 105 . welder 122 captures suture portions 118 in between welder jaws 124 . suture portions 118 are tensioned to secure tissue 105 to bone 110 ( e . g . with a mattress style stitch or other suitable stitch known in the art ). welder 122 brings areas of flexible suture portions 118 into proximity with each other and applies energy ( e . g . heat energy from a heating element , ultrasound energy from a ultrasound transducer , etc .) to fuse the areas together , thereby forming a knotless suture stitch connecting anchors 112 to each other to secure tissue 105 to bone 110 . for example , tensioner 123 may apply tension in opposing directions to suture portions 118 ( as indicated by dark arrows ). it is to be understood that any other suitable technique for attaching anchors 112 may be used , including , for example , performing a conventional knotted stitch with flexible suture portions 118 . in various embodiments , welder 122 may be any suitable welder , e . g . of the types available from axya medical , inc . of beverly , mass ., including those described in , u . s . pat . no . 7 , 090 , 111 , issued aug . 16 , 2006 , u . s . pat . no . 6 , 923 , 824 , issued aug . 2 , 2005 , u . s . pat . no . 6 , 669 , 705 , issued dec . 30 , 2003 , u . s . pat . no . 6 , 666 , 877 , issued dec . 23 , 2003 , u . s . pat . no . 6 , 409 , 743 , issued jun . 25 , 2002 , u . s . pat . no . 6 , 358 , 271 , issued mar . 19 , 2002 , u . s . pat . no . 6 , 286 , 746 , issued sep . 11 , 2001 , u . s . pat . no . 6 , 217 , 591 , issued apr . 17 , 2001 , u . s . pat . no . 6 , 174 , 324 , issued jan . 16 , 2001 , u . s . pat . no . 6 , 106 , 545 , issued aug . 22 , 2000 , u . s . pat . no . 6 , 056 , 751 , issued may 2 , 2000 , u . s . pat . no . 5 , 964 , 765 , issued oct . 12 , 1999 , and u . s . pat . no . 5 , 893 , 880 , issued apr . 13 , 1999 the contents of each of which are incorporated by reference herein in their entirety . fig3 i shows welder 122 retracted from the area after the formation of knotless stitch 126 . note that by employing grasper 120 , proper placement of anchors 112 was easily accomplished . the above steps may be repeated to deliver additional anchors . note that while the above examples show a grasper 100 featuring paddle type jaw members 102 , 014 each having a pair of anchor target slots 108 , any suitable jaw shape featuring and number of anchor target slots may be used . for a given embodiment , placement of the anchor target slots is determined by the desired positioning of the anchors to be implanted . referring to fig4 , in some embodiments grasper 100 is incorporated in endoscopic system 400 . endoscopic system 400 includes handle 402 with a controller 404 . stem 406 connects controller 404 to grasper 100 , allowing an operator to articulate grasper 100 ( e . g . to advance , retract , rotate , etc . grasper 100 , or to articulate jaws 102 , 104 to engage tissue 105 ). grasper 100 and stem 406 are contained in a surgical cannula 408 or other tube which can be inserted into the patient through a small incision . in various embodiments , endoscopic system 400 may include any of the various features or devices familiar in the art of endoscopic surgery . as illustrated in fig5 , in one embodiment , one suture anchor 112 includes an elongated rigid punch through portion 114 which extends along a longitudinal axis between end 119 and threaded tip end 116 . end 119 includes a drive head ( e . g . as shown a hexagonal drive head ) for engagement with driver 120 . end 116 includes a threaded portion 140 for auguring , boring , etc . through bone and tissue . anchor 112 includes flexible suture portion 118 extending from end 119 , and secured to punch through portion 114 . suture portion 118 may be made of a material amenable to bonding through the application of heat or energy thereto such as , for example , nylon ( polyamide ), polypropylene , dacron ® ( polyester ), polyglycolic acid ( pga ), polyglyconate , and polydioxanone . in some embodiments , rigid punch through portion 114 may also be made of such material . in such cases portion 114 may be bonded to portion 118 by the application by the application of heat or other energy ( e . g . ultrasound energy ). other suitable methods of bonding can be used if for example , portion 114 is made of another material , such as stainless steel , titanium , or some other durable , non - degradable , biocompatible material . the suture anchor 112 or parts thereof can be made of a bioresorbable material which will be resorbed after residing in a patient . fig6 a and 6b show an embodiment of suture welder 122 for creating fused stitch . the suture welder 122 includes a jaw assembly 618 having a first jaw 620 for receiving a first suture segment 622 in recess 640 , and a second jaw 624 for receiving a second suture segment 626 in recess 640 so that the second suture segment is adjacent the first suture segment . the suture welder 122 also includes a heater element 612 positioned between the suture segments 622 , 626 . the heater element 612 is adapted to melt at least adjacent surfaces of the overlapping first and second suture segments 622 , 626 . once melted , the suture segments 622 , 626 can be pressed together by the jaws 620 , 624 and allowed to cool to form a fused layer 28 to secure the suture segments 622 , 626 together . the suture welder 122 beneficially provides a fused stitch 14 an elongated material , such as a surgical suture 616 , wherein the stitch has at least comparable strength to knotted stitches or loops closed by other means . the fused stitch gains its comparable strength from the properties of the fused layer of the stitch , as detailed more fully in u . s . pat . no . 5 , 893 , 880 , which is assigned to the assignee of the present disclosure and incorporated herein by reference . in particular , the fused stitch is formed through a welding process in which portions of the suture segments are locally heated through the application of heat thereto until opposing portions melt . the melted portions are then pressed together in an overlapped joint and become fused . the joint includes a fused layer between and joining the first and second suture segments . the fused layer is fused material from the first and second suture segments and preferably is relatively thin and has a relatively large shear area compared to the suture segments . in some embodiments , the suture welder 122 facilitates the creation of such a fused portion by maximizing contact between the suture segments during welding . the fused stitch produced by the suture welder 122 comprises one or more pieces of an elongated material , such as a surgical suture , or other material which is amenable to bonding through the application of heat thereto . suitable materials for the elongated material include polymers , especially thermoplastic materials such as , for example , nylon ( polyamide ), polypropylene , dacron ®. ( polyester ), polyglycolic acid ( pga ), polyglyconate , and polydioxanone . the elongated material can be made of a single strand of a substantially monofilamentous material , or it can comprise multiple strands forming a single suture . the multi - strands can be twisted , braided or otherwise interlinked to increase the density , and thus the strength , of the composite strand . as noted above , in some embodiments , welder 122 may produce fused stitch 126 from suture portions 118 by applying other types of energy including ultrasound energy , radio frequency energy , chemical energy , optical energy , etc . the techniques and devices disclosed herein may be used to fixate any suitable tissue to bone , including , but not limited to , muscle tissue , tendons , and ligaments . the techniques and devices disclosed above may be used in treating human patients , veterinary patients , etc . in the event that any technical definitions presented in this application conflict with any documents incorporated by reference , the definition found in the present application should be understood to hold . while particular examples have been provided above , it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the claims .
an instrument is disclosed including : a top jaw member extending between a proximal end and a distal end and including a first top anchor target slot and a second top anchor target slot ; a bottom jaw member extending between a proximal end and a distal end and including a first bottom anchor target slot and a second bottom anchor target slot ; and a joint member connected to the proximal ends of the top jaw member and the bottom jaw member .