The instrument, Premium Plus CEEA™ stapler holds the titanium staples, which are arranged in a double staggered circular row. The device can be activated easily by squeezing the handles rigidly to a maximum limit. As soon as the staple formation is done, the knif -blade cuts out the excess tissue, causing a circular anastomosis. Selection of 21 mm, 25 mm, 28 mm, 31 mm or 34 mm stapler determines the staple line diameter. The Tilt Top™ anvil that is available with 25 mm, 28 mm, 31 mm or 34 mm staplers is permanently attached with the device on the center rod and is incapable for the removal. But the 21 mm stapler lacks this Tilt Top™ anvil feature.