Abstract:
A material comprising a matrix or a buttress is impregnated with an adhesive initiator and is used with a surgical stapling device and an adhesive. The tissue and material are stapled together, and a knife in the surgical stapling device cuts the tissue and the material. The adhesive is applied across the cut and sets up or polymerizes to seals the cut when the adhesive contacts the adhesive initiator. The surgical stapling device can place the staples in a linear, arcuate, or circular array, and can anastomose luminal tissue. The methods of use can include stapling luminal tissue end to end, stapling two portions of material onto ether side of tissue, and stapling two portions of tissue onto a portion of material. Additionally, a portion of adhesive filed material can be stapled onto one side of portion of tissue and the adhesive initiator impregnated material can be stapled onto the other. Cutting the material and tissue provides a path for the adhesive across the cut, and catalyzes the adhesive from contact with the adhesive initiator.

Description:
FIELD OF THE INVENTION 
   The present invention relates, in general, to tissue fastening devices, and more particularly, to tissue fastening devices using a combination of staples and adhesives. 
   BACKGROUND OF THE INVENTION 
   Adhesives and sealants have been contemplated to supplement or replace staple based transaction devices for many years. The primary challenges in accomplishing this are control of getting the adhesive into the correct location at the correct time as well as preventing it from adhering the stapler itself to the treatment site. Adhesives have proven themselves as great short term bonding/sealing mechanisms. Staples on the other have proven themselves a very good long term tissue apposition mechanisms. Therefore the best of both worlds would be to use staples to fasten and adhesives in combination with adhesive initiators to seal the juncture of tissue or tissue cuts. 
   The primary challenge in the creation of a hybrid adhesive/staple deploying system is the positioning of the adhesive into only the areas of desired adhesion and controlling where the adhesive bonds to the area. 
   Closure Medical is conducting an FDA clinical trial using a cyanoacrylate adhesive as an internal vascular tissue sealant and internal surgical adhesive. Some adhesives such as the cyanoacrylates, stick well to tissue, but like metallic fasteners, the fastener itself can become a local barrier to tissue regrowth through the fastener. For internal body use of surgical adhesives, the adhesive is used sparingly, not on top of the wound as in external use, but actually in the cut areas of the wound. By minimizing the glue areas across the wound, the surgeon is assured of maximum areas of tissue regrowth and minimal areas of the adhesive barrier. As the tissue regrows together and heals, the adhesive areas within the wound are encapsulated with healed tissue. Thus, internal adhesives are ideal for short term needs to hold cut tissue together so that healing can occur, and can remain as a long term fastener to provide additional strength to the healed tissue. Additionally, the adhesives can be biocompatible, bioabsorbable, and/or flexible, inside the body. 
   Tissue fastening can be either short term or long term duration. Short term duration fasteners can include a bandage, tape, removable staples, removable suture, adhesives, or absorbable stitches that are meant to provide temporary support until natural healing can occur. 
   Longer duration fasteners must remain in or on the body, possibly for the life of the patient. Longer duration fasteners include biocompatible implantables such as suture, staples, clips, tacks, clamps, pins, and the like. These long duration fasteners could be inserted subcutaneously in a surgical procedure and, after the patient has healed, cannot be removed without additional surgery. Longer term fasteners can provide short term and long term reinforcement for high force loads that can be 200-400% of normal forces. These high force loads could be caused by violent vomiting, coughing, and, in some cases, chronic overeating. For chronic overeaters that have undergone bariatric surgery to create a small stomach pouch, it is highly likely that a patient will “overload” the new pouch by attempting to eat the same large portions of food imbibed before the surgery. 
   Adhesives have been used topically as a short term fastener for wound repair. Closure Medical has developed a 2-octyl cyanoacrylate compound with a long carbon chain (eight carbons) that is biocompatible, has good bonding strength, and has received FDA approval for topical use. For short duration topical wound closure, the edges of the wound are brought together and at least one layer of the adhesive is applied along the surface of the wound line to form a barrier that holds the wound edges together. The cyanoacrylate adhesive also acts as a microbial barrier, keeping bacteria out and is eventually removed. Cyanoacrylate adhesives are described in United States Application 20040190975 by Goodman et al. which is herein incorporated by reference in its entirety. 
   Closure Medical is conducting an FDA clinical trial using a cyanoacrylate adhesive as an internal vascular tissue sealant and internal surgical adhesive. Some adhesives such as the cyanoacrylates, stick well to tissue, but like metallic fasteners, the fastener itself can become a local barrier to tissue regrowth through the fastener. For internal body use of surgical adhesives, the adhesive is used sparingly, not on top of the wound as in external use, but actually in the cut areas of the wound. By minimizing the glue areas across the wound, the surgeon is assured of maximum areas of tissue regrowth and minimal areas of the adhesive barrier. As the tissue regrows together and heals, the adhesive areas within the wound are encapsulated with healed tissue. Thus, internal adhesives are ideal for short term needs to hold cut tissue together so that healing can occur, and can remain as a long term fastener to provide additional strength to the healed tissue. Additionally, the adhesives can be biocompatible, bioabsorbable, and/or flexible, inside the body. 
   Adhesives used to hold buttress materials to linear and circular surgical devices are known, such as that taught in U.S. Pat. No. 6,592,597 to Grant et al. entitled “Foam Buttress For Stapling Apparatus” as well as U.S. 2005/0228446 by D. Mooradian et al. entitled “Circular Stapler Buttress Combination”, both of which are incorporated by reference herein in their entirety. 
   Consequently, a significant need exists for a surgical device that can staple and cut tissue, can simply and easily place an adhesive initiator at desired sites to attract and set an adhesive about a junction or cut line in the tissue, can prevent unwanted adhesive migration away from the desired adhesion areas, and can ensure a seal across the cut line or tissue junction. 
   BRIEF SUMMARY OF THE INVENTION 
   The invention overcomes the above-noted and other deficiencies of the prior art by providing a surgical stapling instrument for clamping and stapling tissue. The surgical stapling instrument has a handle, and a first and a second opposed tissue clamping members connected to the handle. At least one of the first and second opposed tissue clamping members are movable between an open position for receiving tissue and a closed position for stapling tissue therebetween. The first clamping member includes a plurality of staples disposed therein in an array, and the second clamping member comprises an anvil for forming the staples. Also provided is a first portion of biocompatible material containing an adhesive initiator. The first portion of biocompatible material is releasably attached to one of the first and second opposed tissue clamping members. A second portion of biocompatible material contains a fluid adhesive and is releasably attached to the other of the first and second opposed tissue clamping members. A knife is operably movable between the first and a second opposed tissue clamping members. Wherein when the tissue is clamped and stapled, the knife cuts the tissue and the first and second portions of material and the adhesive is released. The cut provides a passage for migration of the adhesive from the second portion of material to the adhesive initiator to initiate hardening of the adhesive across the cut. 
   In another aspect of the invention, a method for securing a first and a second portion of tissue together with a plurality of staples and an adhesive is disclosed. The method includes a first step of placing a portion of material containing an adhesive initiator between a first portion and a second portion of tissue. The second step comprises, clamping the material and the first and second portion of tissue between a first and a second clamping member of a surgical device with at least an edge of the material exposed. The third step includes stapling the two portions of tissue together with the portion of material therebetween with the plurality of staples in an array. The last step includes applying an adhesive about the exposed material and the two portions of tissue to initiate the adhesive and secure the two portions of tissue together. 
   In yet another aspect of the invention, a method for sealing a first portion and a second portion of tissue together with a plurality of staples and an adhesive is disclosed. The first step comprises clamping the first portion and the second portion of tissue between a first portion of buttress and between a second portion of buttress with a surgical stapling device. The first portion of buttress contains an adhesive initiator. The second step is stapling the first portion and the second portion of tissue between the first portion of buttress and the second portion of buttress by applying a plurality of fasteners in an array. The third step is cutting the tissue and the buttress about the array of staples with a knife of the surgical device. And the last step is sealing the cut tissue and buttress together by applying an adhesive across the cut and initiating the adhesive by contacting the adhesive with the adhesive initiator in the first portion of buttress. 
   These and other objects and advantages of the present invention shall be made apparent from the accompanying drawings and the description thereof. 

   
     BRIEF DESCRIPTION OF THE FIGURES 
     The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention. 
       FIG. 1  is an isometric view of an end effector of a surgical stapling device with a first portion of a buttress material containing an adhesive attached thereto on a one jaw and a second portion of a buttress material containing an adhesive initiator on the another jaw. 
       FIG. 2  is a cross sectional view of the end effector of  FIG. 1  clamped on tissue. 
       FIG. 3  is a cross sectional view of the cut and stapled tissue and buttress material of  FIG. 2  showing the adhesive migrating across the cut tissue to contact the adhesive initiator in the second portion of a buttress material to initiate setting of the adhesive. 
       FIG. 4  is an isometric view of another surgical stapling device after stapling a first and a second portion of buttress material containing an adhesive initiator onto the tissue and with an adhesive applicator applying adhesive to the tissue and to the buttress with the adhesive initiator to initiate setting of the adhesive. 
       FIG. 5  is an isometric view of two portions of tissue stapled together and sandwiching a portion of buttress therebetween, and showing a polymerized adhesive applied to the cut tissue and polymerized by contact with the adhesive initiator. 
       FIG. 6  is an isometric view of a circular stapler with a first portion of a buttress material containing an adhesive attached thereto on a fixed jaw and a second portion of a buttress material containing an adhesive initiator on a movable jaw in an open position. 
       FIG. 7  is a cross sectional side view of the circular stapler of  FIG. 6  showing a first step in creating an end-to-end anastomosis between two portions of severed intestinal tissue by placing the instrument in tissue. 
       FIG. 8  is a cross sectional side view of the circular stapler of  FIG. 7  showing a second step in creating an end-to-end anastomosis between two portions of severed intestinal tissue by creating purse strings in the tissue and drawing the tissue inward with the purse strings. 
       FIG. 9  is a cross sectional side view of the circular stapler of  FIG. 8  showing a third step in creating an end-to-end anastomosis between two portions of severed intestinal tissue by closing the instrument to clamp tissue between the jaws. 
       FIG. 10  is a cross sectional side view of the circular stapler of  FIG. 9  showing a fourth step in creating an end-to-end anastomosis between two portions of severed intestinal tissue by firing the instrument to staple and cut both the tissue and the buttress, and to release the adhesive. 
       FIG. 11  is a cross sectional side view of the circular stapler of  FIG. 10  showing a fifth step in creating an end-to-end anastomosis between two portions of severed intestinal tissue by returning the knife and applying the adhesive across the cut tissue and the buttress, wherein the adhesive initiator in the first portion of buttress is initiating setting or polymerization of the adhesive. 
       FIG. 12  is an isometric view of an alternate method of creating an end-to-end anastomosis between two portions of severed intestinal tissue by placing the instrument in tissue, and placing a single layer of a matrix between the two portions of tissue drawn inward by purse strings. 
       FIG. 13  is an isometric view of another alternate method of creating an end-to-end anastomosis between two portions of severed intestinal tissue by placing the instrument in tissue, and placing a single layer of a buttress disk between the two portions of tissue drawn inward by purse strings. 
       FIG. 14  is an isometric view of sealing an end-to end anastomosis between two portions of stapled and cut intestinal tissue with a portion of material containing an adhesive initiator therebetween and by placing adhesive onto the tissue and the portion of material containing the adhesive initiator to initiate polymerization of the adhesive and sealing of the anastomosis. 
   

   DETAILED DESCRIPTION OF THE INVENTION 
   The following description of certain examples of the invention should not be used to limit the scope of the present invention. Other examples, features, aspects, embodiments, and advantages of the invention will become apparent to those skilled in the art from the following description, which is by way of illustration, one of the best modes contemplated for carrying out the invention. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive. 
   Surgical stapling devices are well known in the art for clamping onto tissue and placing a plurality of fasteners in an array into the tissue. Knives can also be included in the surgical stapling device and are used to sever or cut tissue within the array of staples. Such stapling devices can be circular, linear, arcuate, or any other shape and are commonly used to resects or transect tissue, can perform an anastomosis on luminal structures such as intestines, can resects lung tissue, or be used in any one of a number of other surgeries. Using an adhesive initiator impregnated material (such as a buttress or matrix) in combination with a stapling device and an adhesive offers advantages as will be described below. 
   In  FIG. 1 , an end effector  30  of a surgical stapling device  25  such as an endocutter is shown prior to clamping on lung tissue  90  and placing a plurality of surgical fasteners such as staples therein. The surgical stapling device  25  can have an end effector  30  at a distal end of shaft  55  comprising a pair of moveably opposed tissue clamping members at least one of which is moveable. The tissue clamp members may comprise a fixed first clamping member  35  and a movable second clamping member  45  movable from an open position to a closed position to clamp and staple tissue  90  therebetween. A handle  32  (not shown) can extend proximally from the shaft  55  and could be operably attached to the end effector  30  to clamp and unclamp the first clamping member  35  and second clamp member  45  onto tissue, and to staple and cut the clamped tissue when fired. The surgical stapling device  25  can include buttressing or matrix materials to buttress and strengthen the staple line formed in tissue which can comprise a first portion of material  36  releasably attached to the first clamping member  35  and a second portion of material  46  releasably attached to the second clamping member  45 . The first and second portions of material  36 ,  46  could be biocompatible, and the first portion of material  36  may contain an adhesive initiator  38  that can initiate setting or polymerization of an adhesive on contact. The second portion  46  of material can contain a biocompatible polymer adhesive  48  that reacts or polymerizes from contact with the adhesive initiator  38 . 
   The first clamping member  35  can have a removable staple cartridge  56  containing a plurality of surgical fasteners or staples  57  therein covered by the first portion of material  36 . The second clamping member  45  may contain a plurality of opposing staple pockets  47  for the formation of the staples  57  therein and releasably covered by the second portion of material  46  containing an adhesive  47 . When the second clamping member  35  is clamped on tissue, the staple pockets  47  align with the array of staples  57  in the cartridge  56 , and when the surgical device  25  is fired, the staples  57  are driven upwards through the tissue and the materials to form the staples  57  in the staple pockets  47 . 
     FIG. 2  is a cross sectional view of the end effector  30  clamped on lung tissue  90 . The staples  57  are positioned in the removable cartridge  56  in an array of six parallel longitudinal rows in alignment with the pockets  47 . For this example, the rows of staples  57  are staggered. A knife  58  is located between the innermost rows of staples  57  and when the surgical device is fired, the knife  58  travels longitudinally along the first and second clamp members  35 , 45 , to cut both the tissue  90  and the first and second portions of material  36 , 46  clamped therebetween. For this example, the second portion of material  46  may be an open cell sponge structure filled with the fluid adhesive  48 , and sealed by a cuttable surface  49 . The cuttable surface  49  can create a fluid filled, deformable second portion of material  46  that can be cut or penetrated to release the adhesive  48  sealed therein. Cuttable surface  49 , for example, can be placed on the second portion of material  46  as a dip, a spray coating, a vacuum deposited coating, a skin formed by a molding process, an injection molded coating and the like. Suitable materials for the cuttable surface can be absorbable or non-absorbable, and can include materials such as but not limited to butyrate or polyethylene rubber, silicone or plastic material, such as, for example, polyvinyl chloride, polyethylene, polyurethane, natural or nitrile rubber, polylactic acid, polyglycolic acid, polyglactin, polydioxanone, polyglyconate, whey protein, cellulose gum, starch, gelatin or any combination thereof. Cuttable surface  49 , is not limited to these processes and materials and by way of example, can comprise an adhesive filled sponge structure sealed within a pouch  49   a  about the second portion of material  46  or any other means to seal the glue filled second portion of material  48 . As shown in  FIG. 2 , the sealed second portion of material  46  is clamped between the clamping members  35 , 45  and is bulging laterally out of each side of second clamping member  45  and into a knife slot  50 . The bulging or ballooning is from the clamping pressure on the incompressible fluid adhesive  48  sealed into the second portion of material  46 . The first portion of material  36  can contain an adhesive initiator  38  that is combined with the first portion of material  36 . The combination of an adhesive initiator  38  and a first portion of material  36  may not be limited to the molding process, and can include, by way of example, a coating on the first portion of material  38 . 
     FIG. 3  shows the tissue  90  after being clamped, stapled, and cut with the surgical device  25 . The stapling and cutting process can form six staggered rows of staples  57  in the compressed tissue  90 , and can cut both the tissue  90  and the compressed first and second portions of material  36 ,  46 . The cutting of the compressed second portion of material  46  with knife  58  may breach the sealed surface  49  of the second portion of material  46  and can release the pressurized fluid adhesive  48  sealed within. With the surface  49  breached, the glue  48  can migrate inward about the cut. The speed of the inward migration of the adhesive  48  can be controlled by the viscosity of the fluid adhesive  48  and, for this example, is timed to ooze out of the cut in the second portion of adhesive after the surgical device  25  has the first and second clamping members  35 , 45  opened to release the tissue  90  clamped therein. The formed staples  57  may continue to apply pressure on the first and second portions of material  36 ,  46  to continue migration of adhesive  48  from the second portion of material  46  after the surgical device  245  has been removed. In  FIG. 3  the adhesive  48  has oozed or migrated over the cut in the tissue  90  to contact the adhesive initiator  38  in the first portion of material to create polymerized or set adhesive  48   a  across the cut. The polymerization process, once initialized, is shown migrating from the initial initiator contact site to convert all of the adhesive  48  into set adhesive  48   a  and to prevent migration of the adhesive  48  from the cut area. The above example uses materials and processes which will now be described in greater detail. 
   Buttress and Mesh Materials 
   Buttress and mesh materials are sheet-like fabric or foam reinforcing structures and are well known in the art for backing up staple or suture lines, and as hernia mesh support structures and the like. Buttress and mesh materials can be biocompatible to be implanted in the body, can be penetrated with surgical fasteners, and can be absorbable or non-absorbable. In the above example, two different portions of buttress material can used. The first portion of material  36  may be a closed cell foam buttress material containing an adhesive initiator  38 , and the second portion of material  46  can be a sponge type open cell buttress material containing a fluid polymer adhesive  48  sealed within by sealed surface  49 . 
   Buttress materials can include VICRYL™, produced by Ethicon, Inc., Somerville N.J., “DEXON™”, produced by Sherwood-Davis and Geck, St. Louis, Mo., and TEFLON™, produced by E.I. DuPont de Nemours &amp; Co., Wilmington, Del. Additionally, other buttress materials include animal material such as tanned bovine pericardium, biocompatible elastomers such as .epsilon.-caprolactone glycolide produced by Ethicon Inc., Gargrave, England, or any one of a number of suitable buttress materials. Suitable .epsilon.-caprolactone glycolide materials or foams are described in U.S. Pat. No. 5,468,253 hereby incorporated by reference. 
   Alternately, the first or second portion of material  36 ,  46  could be a mesh structure or matrix  337  (not shown) having a plurality of openings  336 . Such a matrix  337  could be a foam material containing openings  336 , or a mesh, or a threadlike structure. The first or second portion of material  36 ,  46  could include porosities or at least one capillary action inducing feature or a wicking feature to draw adhesive  48  or initiator  38  to or into the material. These wicking features can include a pore, a void, a weave, a bubble, an open cell, a mesh, or any other feature that can induce capillary action or wicking action. Wicking properties of structure  26  (not shown) can ensure openings  27  (not shown) remain clear of adhesive to allow tissue growth therethrough 
   Thus, for example, the first portion of material  36  can be a mesh structure coated in an adhesive initiator  38 , and the second portion of material  46  could be a mesh structure surrounded by a viscous adhesive  48  and sealed within a pouch  49   a.    
   In addition to the materials above, suitable absorbable materials for a mesh or buttress structure can include but are not limited to bioabsorbable materials such as polylactic acid, polyglycolic acid, polyglactin, polydioxanone, polyglyconate, whey protein, cellulose gum, starch, and gelatin. Non-absorbable materials suitable for mesh or buttress can include but are not limited to materials such as silk, nylon, polypropylene, braided polyester, polybutester, polyethylene, and polyetheretherketones (PEEK). 
   Thus, the above first portion of material  36  and second portion of material  46  could be a fibrous pad, a foam, a matrix, a mesh or any other structure that can contain an adhesive initiator  38  or an adhesive  48 . The first portion of material  36  and second portion of material  46 , can, for example, have wicking properties such that when placed on tissue, can wick adhesive  48  thereto. 
   Attaching Buttress and Mesh Materials to a Stapling Device 
   Buttress materials can be releasably attached to the surgical device  25  in a variety of ways such as but not limited to a releasable adhesive such as that described in U.S. Pat. No. 6,592,597 by Grant et al. which is hereby incorporated by reference in its entirety. 
   Additionally, other methods of attachment such as anvil carriers could be used such as that described in U.S. Pat. No. 6,656,193 by Grant et al. which is also hereby incorporated by reference in its entirety. The above methods of releasably attaching buttress materials are not meant to be limiting in any way and any other devices and methods of attachment are within the scope of the invention. 
   Adhesives 
   Adhesive  48  could be, but is not limited to polymerizable and/or cross-linkable materials such as a cyanoacrylate adhesive. The adhesive  48 , for example, may be a monomeric (including prepolymeric) adhesive composition, a polymeric adhesive composition, or any other compound that can adhere to tissue. In embodiments, the monomer may be a 1,1-disubstituted ethylene monomer, e.g., an .alpha.-cyanoacrylate. When cross linked or polymerized, the cyanoacrylate can change from a liquid to a solid. Polymerized adhesives  48   a  for example, can be formulated to be flexible to rigid and could be spongy. If desired, adhesive  48  an be a single part or dual part adhesive, and/or can contain additives such as alternate compounds. Polymerization of the adhesive  48  can occur from, but is not limited to, exposure to moisture or adhesion initiators  104 . 
   Adhesive Initiators 
   Particular adhesive initiators  38  for particular monomers may be readily selected by one of skill in the art without undue experimentation. Control of the molecular weight distribution of the applied adhesive can be enhanced by selection of the concentration and functionality of the initiator or accelerator vis-a-vis the selected monomer. Suitable polymerization initiators and accelerators for cyanoacrylate compositions include, but are not limited to, base compositions, detergent compositions; surfactants, including nonionic surfactants such as polysorbate 20 (e.g., Tween 20™; ICI Americas), polysorbate 80 (e.g., Tween 80™; ICI Americas), and poloxamers; cationic surfactants such as tetrabutylammonium bromide; anionic surfactants, including quaternary ammonium halides such as benzalkonium chloride or its pure components, and benzethonium chloride; stannous octoate (tin (II) 2-ethylhexanoate), and sodium tetradecyl sulfate; and amphoteric or zwitterionic surfactants such as dodecyldimethyl(3-sulfopropyl) ammonium hydroxide, inner salt; amines, imines, and amides, such as imidazole, tryptamine, urea, arginine and povidine; phosphines, phosphites and phosphonium salts, such as triphenylphosphine and triethyl phosphite; alcohols such as ethylene glycol; methyl gallate; inorganic bases and salts, such as sodium bisulfite, magnesium hydroxide, calcium sulfate and sodium silicate; sulfur compounds such as thiourea and polysulfides; polymeric cyclic ethers such as monensin, nonactin, crown ethers, calixarenes and polymeric epoxides; cyclic and acyclic carbonates, such as diethyl carbonate; phase transfer catalysts such as Aliquat™ 336 (General Mills, Inc., Minneapolis, Minn.); organometallics; manganese acetylacetonate; radical initiators and radicals, such as di-t-butyl peroxide and azobisisobutyronitrile; and bioactive compounds or agents. Other examples of adhesives  48  and adhesive initiators  38  may be found in United States Application 20040190975 by Goodman et al. which is herein incorporated by reference in its entirety. 
   First Alternate Embodiment 
     FIG. 4  shows an alternate embodiment of a surgical device  125  that is the above described endocutter that was combined with two releasable portions of an initiator material  136  that contain an adhesive initiator  38 . In  FIG. 4 , the two releasable portions of initiator material  136  are shown stapled on lung tissue after the tissue is clamped, stapled, and cut between the first and second clamping members  35 , 45  of the surgical device  125 . The clamping and stapling and cutting process has stapled, cut, and released the two releasable portions of material  136  containing an adhesive initiator  38  onto the tissue  90 . The releasable portions of initiator material  136  are buttress material and may prevent staple tear out in the thin frangible lung tissue. 
   Lung tissue comprises thin air sacs or bladders in combination with vascular structures to ensure the oxygenation of blood. As a consequence, severing or cutting lung tissue can include small bleeders and/or air leaks. In  FIG. 4 , an adhesive applicator  120  is shown applying adhesive  48  along the cut tissue  90  to ensure pneumostasis and hemostasis along the cut tissue. As the adhesive  48  contacts the adhesive initiator  38  in the releasable portions of initiator material  136 , the adhesive  48  begins to convert to the polymerized or set adhesive  48   a , and bonds to the cut tissue to create a seal. The set adhesive  48   a  can seal leaks and may be absorbable or non-absorbable. 
   Second Alternate Embodiment 
     FIG. 5  shows an alternate method of securing tissue with a stapling device, a single portion of initiator material  136 , and the adhesive  48 . As shown, a portion of initiator material  136  is placed between to tissue portions  177  and the tissue and initiator material  136  is clamped, stapled, and cut. A pair of cut edges  176  of the tissue  177  can then be coated with adhesive  48  from the adhesive applicator  120  (see  FIG. 4 ), and the contact of the adhesive  48  with the adhesive initiator  38  in the initiator material  136  has polymerized or set the adhesive  48  into the set adhesive  48   a  shown. The single portion of material  136  can be a matrix, a mesh, or a foam buttress. A foam buttress material that can be compressed by clamping and stapling between irregular tissue materials and can expand to fill gaps between irregular tissue surfaces. This method of securing tissue can be used with the endocutter described above or with a circular stapler described below. 
   Circular Stapler with Dual Rings of Buttress or Matrix 
     FIG. 6  shows a circular stapler  225  that is commonly used to create an end-to-end resection of a first portion of intestinal tissue  210  (not shown) with a second portion of intestinal tissue  211  (not shown) in an end-to-end anastomosis. The circular stapler  225  has a handle  205 , a shaft  206  extending distally therefrom, and a circular end effector  230  at a distal end of the shaft  206 . Circular end effector  230  includes a fixed first clamp member  235  and a movable second clamp member  245  for clamping and stapling and cutting tissue therebetween. A first initiator ring  236  of foam buttress is releasably attached to the first clamp member  235  and a second adhesive ring  246  foam buttress is releasably attached to the movable second clamp member  245  respectively. The first initiator ring  236  contains an adhesive initiator  38 , and the second adhesive ring  246  is a hollow cell foam containing the adhesive  48  sealed inside of a sealing surface  249  (See  FIG. 7 ). 
   Turning now to  FIGS. 7-10 , the fixed clamp member  235  can include a plurality of deployable fasteners or staples  57  in a circular array of one or more concentric rings of staples  57  below the first initiator ring  236 . A cylindrical knife  209  may be movably located within the fixed clamp member  235  inside of the array of staples  57 . The movable second clamp member  245  could includes a plurality of staple forming pockets  247  behind the second adhesive ring  246 . 
   When the movable second clamp member  245  moves from the open position of  FIGS. 6 ,  7  and  8 , to a closed position of  FIGS. 9 and 10 , the staple forming pockets  247  to opposably align with the staples  57  in the fixed clamp member  235 . Movable second clamp member  245  may be moved to the closed position of  FIGS. 9 and 10  and back to the open position of  FIGS. 6 ,  7  and  8  by rotating a knob  207  ( FIG. 6 ) on the handle  205 . Rotation of knob  207  in the opposite direction of knob  207  moves the movable second clamp member  245  to the open position. An actuatable firing trigger  208  ( FIG. 6 ) may be provided to fire the circular stapler  225 . When firing trigger  208  is fired, the staples  57  are driven into the tissue and formed in the staple pockets  247 , and the tissue is cut with the knife  209 . 
   A method of performing an anastomosis with circular stapler  225  and first initiator ring  236  and second adhesive ring  246  is shown in  FIGS. 7-10 . In  FIG. 7 , the circular end effector  230  has been inserted into a longitudinal slit (not shown) within the first portion of intestinal tissue  210 , and moved into the position shown adjacent to an open end of the tissue  210 . The movable second clamp member  245  may be moved to the open position and the second portion of intestinal tissue  211  can be inserted over the open movable second clamp member  245  as shown. 
   In  FIG. 8 , the intestinal tissue  210 ,  211  has been positioned as shown, and each portion of tissue  210 ,  211  has been fitted with a purse string of suture  212  placed about the open ends of the intestinal tissue. Each piece of suture  212  can be drawn tight to close the open ends of intestinal tissue  210 ,  211  and tied for security. 
   In  FIG. 9 , the movable second clamp member  245  has been closed to a position adjacent to the fixed clamp member  235  by rotating knob  207  to clamp the first and second portions of intestinal tissue  210 ,  211  therebetween. The clamping action is compressing the adhesive filled second adhesive ring  246 , and expanded the second adhesive ring  246  inwardly. 
   In  FIG. 10 , the circular stapling device  225  can be shown fired by actuating the firing trigger  208 . This action may moved the staples  57  out of the fixed clamp member  235  push them through the first initiator ring  236 , through the first and second portions of intestinal tissue  210 ,  211 , through the second adhesive ring  246  and form them in the staple pockets  247 . The cylindrical knife  209  can have advanced past the first initiator ring  236 , through the first and second portions of intestinal tissue  210 ,  211 , and through the adhesive filled second adhesive ring  246 . The knife  209  has released the adhesive  48  from the adhesive filled second adhesive ring  246  and the adhesive  48  is in contact with the outer surface of the knife. 
   In  FIG. 11 , the firing trigger  208  may have been released to draw the knife back across the adhesive  48 , to move the adhesive  48  across the severed ends of the intestinal tissue  210 ,  211 , and move adhesive  48  into contact with the first initiator ring  236  containing the adhesive initiator  38 . The adhesive initiator  38  can initiate the polymerization of the adhesive  48  smeared from the second adhesive ring  246 , across the cut edges of the intestinal tissue  210 ,  211 , and across the first initiator ring  236  to create a seal. The seal can prevent the migration of intestinal contents out of the intestine. 
   Alternately, the first initiator ring can be a matrix ring  236   a  impregnated with or coated with the adhesive initiator  38  (not shown). When the adhesive  48  contacts the adhesive initiator  38  on the matrix ring  236   a , polymerization of the adhesive is initiated. 
   Alternate Embodiment of a Circular Stapler with a Single Portion of Buttress or Matrix 
     FIGS. 12-14  can show an alternate embodiment of a method of using a single portion of material  339  containing an adhesive initiator  38  with the circular stapling device  225  and the adhesive  38  to create an end to end anastomosis of the first and second portions of intestinal tissue  210 ,  211 . In  FIG. 11 , the single portion of material  336  can be a matrix or a buttress containing an adhesive initiator  38 . Or, as shown in  FIG. 12 , the single portion of material  336  can be shown as a matrix  337  coated with or containing the adhesive initiator  38 . In  FIG. 13 , the single portion of material  336  can be shown as a buttress disk  338  coated with or containing the adhesive initiator  38 . Both the matrix  337  and the buttress disk  338  can be clamped between the portions of tissue  210 ,  211 , and the circular stapler  225  fired to form staples through the first portion of tissue  210 , the single portion of material  336 , and through the second portion of material  211 . 
   As shown in  FIG. 14 , the buttress disk  338  is impregnated with adhesive initiator  38  and can be clamped, stapled and cut between the first portion of intestinal tissue  210  and the second portion of intestinal tissue  211 . An adhesive applicator  120  may be used to drip or apply adhesive to an exposed edge  337  of the buttress disk  338  where contact of the adhesive  48  with the initiator  38  can induce polymerization of the adhesive  48  to polymerized adhesive  48   a . The polymerized adhesive  48   a  can seal the juncture of the first portion of intestinal tissue  210  and the second portion of intestinal tissue  211 . Whereas  FIG. 14  shows the example of a buttress disk  338  clamped between the tissue  210 ,  211 , the matrix  337  with initiator  38  can also be used as an example for this procedure to initiate the polymerization of the adhesive from contact with the matrix  337  with initiator  38  to seal the tissue  210 ,  211  juncture 
   It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 
   While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. 
   For example, an adhesive filled sponge can have a coating to seal the adhesive therein and the coating can be coated with an adhesive initiator, or any other combination or embodiment of dispensable adhesive, adhesive initiator, and a buttress and/or matrix is within the scope of this invention to those skilled in the art.