title: Introducing the circular stapling device atraumatically with the use of a second anvil.
abstract: Inserting a second anvil to the blunt end of circular stapling devices, when open placement of the distal purse-string is employed, lessens the risk of injury to the anal canal and allows smooth introduction. Once inserted, the anvil is easily removed and the anastomosis is constructed in the usual fashion.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, FL, USA.
authors.lastname: Pikarsky
authors.lastname: Singh
authors.lastname: Wexner