The use of circular stapling devices to facilitate low colorectal anastomosis (CRA) was first described in the 1970s. This approach is now standard practice and has consistently demonstrated equivalence in terms of safety and efficacy compared with hand-sewn anastomosis, with the added advantages of shorter anastomotic time and greater reproducibility. Briefly, the key elements of circular stapled CRA comprise: (1) selecting a stapler gun of appropriate size; (2) securing the anvil in the distal end of the mobilised colonic conduit; (3) performing a rendezvous manoeuvre to securely dock the anvil onto the end of the stapler gun, which has been advanced from below; and (4) firing the stapler to complete the anastomosis.

While there have been subtle modifications to staple design and configuration, there has been relatively little progress made in circular stapler functionality over the past few decades. Further advances in stapling technology could enhance the precision of CRA with the potential to positively impact on the incidence of anastomotic leakage and on the need for diverting stoma. However, refining the existing design requires the four key steps outlined above to be carefully considered to determine how and/or where the technology can be fine-tuned; sizing and anvil application are obligatory steps, while the rendezvous technique represents an elegant design that lends itself readily to both open and intra-corporeal CRA. The final and arguably most critical step in the technique, namely, discharging the stapler, represents a component in the pathway, where refinement may be both feasible and advantageous, and in this regard, the powered surgical stapler is emerging as a potential solution.

Powered surgical stapler devices were first introduced in 2011 and have been applied to a wide variety of clinical applications. More recently, powered circular stapling devices have been developed specifically intended for use in colorectal surgery. We provide a technical description of our initial experience with the ECHELON CIRCULAR™ Powered Stapler (Ethicon, Somerville, NJ, USA), which was employed during laparoscopic anterior resection carried out at a tertiary colorectal referral centre (University College London Hospital (UCLH), London, UK).