The Baker's side-to-end anastomosis as illustrated is a very safe approach when the surgeon must perform a hand-sewn anterior or low anterior resection. Most surgeons, however, have access to and proficiency with stapling instruments. In these circumstances, the proximal descending colon is transected with a cutting linear stapler (GIA) while the rectal stump is divided between a pair of suture lines created with a noncutting linear stapler (TA) stapling device (Figure 19). The rectum is divided between the staple lines and the specimen removed. The staple line of the proximal colon is partially resected along the antimesenteric border so as to create an opening that allows passage of a circular stapler (EEA) anvil, whose shaft will exit through the taenia, approximately 5 cm proximal to this opening. A purse string is then applied about the anvil shaft and tied in a snug manner (Figure 20). The open cut end of the proximal colon is closed with the noncutting linear stapler. The main circular stapler (EEA) instrument is passed, with its disposable trocar retracted within, until it reaches the staple line of the rectal stump. Under direct vision, the surgeon guides the circular stapler (EEA) trocar out through the posterior rectal bowel wall about ½ cm behind the suture line. A purse string is carefully placed about the penetrating trocar. The trocar is removed and the anvil inserted into the circular stapler (EEA) instrument within the rectum. The rectal purse string is tightened and both purse strings are inspected. The two segments of bowel are carefully brought together and the instrument is fired. The firing and release require adherence to the manufacturer's instructions to verify correct tightness or compression of the tissue before firing and the correct amount of loosening for the cap to tilt before careful removal. The surgeon verifies the presence of two intact tissue rings (donuts) containing the purse strings of both the proximal and distal colon walls. After inspection of the anastomosis, the air bubble test described above is most useful, as the surgeon cannot always see fully around the anastomosis. An advantage of bringing the circular stapler (EEA) stapler trocar out posterior to the rectal stump staple line is that it places the junction of the two staple lines (corners) somewhat anteriorly, where they may be most easily reinforced with interrupted 000 nonabsorbable mattress sutures.